A letter signed by at least 550 individuals, health care professionals, and advocacy groups is urging Seattle Children’s Hospital to restore access to gender-affirming surgical care to trans people under 19.

The community letter, organized by the Seattle trans advocacy group Gender Justice League (GJL) and addressed to Children’s Board of Directors, says the hospital’s decision sends a “troubling” message to trans communities and may violate state law. The Washington Law Against Discrimination explicitly protects the rights of transgender people in places of public accommodation, which include hospitals.

Signed by the ACLU of Washington’s health policy program director, reproductive rights advocates like ProChoice Washington, LGBTQ groups like the Lavender Rights Project and Gender Justice League, as well as various health clinics, doctors, and labor unions, the letter calls on the hospital’s board of directors to immediately resume surgical care, educate the public on the scientific consensus that supports transgender care, and engage with workers, families, and advocates to collectively rally public support for its gender-affirming care program.

Telling a crowd of at least 100 protestors outside the hospital about the letter on Sunday afternoon, GJL Executive Director Danni Askini said the hospital’s leadership “has the research, they know the facts, they know that this care is medically necessary, that it’s safe, that it’s effective, that it supports young people and that it’s lifesaving.”

Askini told the crowd, who earlier had been line dancing to Chappell Roan and making postcards to send to hospital leadership, that GJL was talking to lawyers and looking for young people who’d been denied care at Children’s.

“We’re considering and are going to pursue any and every legal avenue that we can to hold Children’s accountable,” she said. “They are violating the Washington Law Against Discrimination, they’re harming our community and we’re not going to take that shit.”

This letter follows news, which The Stranger broke on Thursday, that the hospital had again stopped providing gender-affirming surgery for their patients under 19. A patient and his mother, who spoke on the condition of anonymity, said a surgeon and his staff told the 17 year old that he couldn’t get top surgery at the hospital until he turned 19. Sources familiar with hospital policy confirmed other patients have been told the same thing.

The surgeon did not explain to our source why he had to wait, but the age cutoff seemed an obvious clue. Soon after taking office in January, President Donald Trump issued a sweeping executive order to withdraw all federal support for all trans care for patients 18 and younger. The order threatened major research institutions, like Children’s, that depend on millions in federal grants each year.

Trump’s order prompted the hospital to stop surgeries for the first time in early February, indefinitely postponing at least one 16-year-old patient’s top surgery just hours before he was expected in the OR. But that patient, who we called Ethan to protect his privacy, did end up having surgery in the end. His mother says the hospital rescheduled the procedure shortly after a federal judge in Seattle blocked Trump’s order in response to a lawsuit brought by Washington Attorney General Nick Brown with the Attorneys General of Oregon and Minnesota. Brown’s office confirmed the order is still blocked.

The hospital filed a declaration in support of that lawsuit. For that reason, the letter says, signatories held back from making public calls against Seattle Children’s.

“However, we are done holding back,” the letter continues. “Seattle Children’s has sown fear and panic within our communities. This action perpetuates the harmful narrative that medical care for transgender youth is not medically necessary, and it fuels harmful and misguided biases against transgender young people. It emboldens bigots and bullies who make these young people’s lives extremely difficult and endangers their mental health in our schools and communities.”

The letter references Maine, a state in an active standoff with the Trump administration over transgender athletes in school sports, as showing that standing up for trans youth is a “moral obligation.”

“We ask you, as a Board of Directors: Where will you draw the line in the years to come as these attacks persist and the targets ever evolve?” the letter reads. “Why did you sign up to serve young people in your community?  Which childrens’ health are you willing to sacrifice in the face of future moral panics and political pressure?”

It’s unclear why the hospital has drawn the line at surgery in the first place. Trump’s order does not distinguish between puberty blockers, hormones and surgery, it considers all three “mutilation,” so all three types of care would theoretically pose an equal threat to federal funding. But our source, who gets his hormones from Children’s, hasn’t lost his prescription, he says.

The hospital hasn’t said why it changed its mind. Six days after the first of our emails and phone calls, Children’s has not responded to The Stranger or made a public statement about this decision.