Public hospitals must provide abortions on site if they also offer maternity services, a Washington state judge said Tuesday.

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Public hospitals must provide abortions on site if they also offer maternity services, a Washington state judge said Tuesday.

The ruling from Skagit County Superior Court Judge Raquel Montoya-Lewis concerns the state’s third-largest public hospital district, Skagit Regional Health, and Skagit Valley Hospital in Mount Vernon, which routinely refers patients to Planned Parenthood when they seek abortions.

The American Civil Liberties Union of Washington sued the district in 2015 as part of a campaign to make sure public health-care facilities follow the state’s abortion rights law, the Reproductive Privacy Act, passed by voter initiative in 1991.

The law prevents the state from interfering with a woman’s right to have an abortion, requires the state to pay for voluntary abortions for low-income women, and says that if a public hospital provides maternity services it must also provide “substantially equivalent” abortion services.

The hospital argued that it’s OK with having abortions performed on-site, but that it doesn’t have staff members who are willing to provide the services. The law allows health-care providers to opt out of providing abortions, but the judge said that doesn’t give the entire hospital a right not to offer abortions.

“The key distinction here is that individual providers may choose either to provide or not provide these services, but the state, acting here through the Hospital District, cannot exercise such an opt out clause,” Montoya-Lewis wrote. “The Hospital District must comply with its responsibility under the (Reproductive Privacy Act), and the Court sees no tenable reason why it cannot.”

The hospital district did not immediately return a message seeking comment.

The executive director of the state ACLU chapter, Kathleen Taylor, called the decision an important affirmation of women’s right to have an abortion.

“We brought the lawsuit to ensure that all women in our state can access the full range of reproductive health care at public health facilities in their communities,” Taylor said in an emailed statement. “This ruling makes the promise of the state’s Reproductive Privacy Act a reality for women across Washington state.”

The organization sued on behalf of Kevan Coffey, a Mount Vernon nurse practitioner who formerly worked at Skagit Valley Hospital. When she would call the hospital’s women’s health department for a patient who wanted or needed to terminate a pregnancy, the department would tell her to refer the patient to Planned Parenthood.

She also described it as a personal issue, saying she takes medication that can cause severe birth defects and would need an abortion if she became pregnant.

As part of its campaign, the ACLU also sent letters to hospital districts in Jefferson County, Mason County and on Whidbey Island, warning them they could be sued for not providing abortions. Jefferson County’s formed a task force and decided to offer abortions, but the others did not respond, said Doug Honig, a spokesman for the state ACLU chapter.

“We’ll make sure hospital districts around the state are aware of the ruling and of the need for all of them to comply with the law,” he said.