For Jionni Conforti, St. Joseph’s wasn’t just any hospital. The Catholic health system, which operates two hospital sites near where he lives in Totowa, New Jersey, came to feel like a “second home.”

“This is my neighborhood hospital,” Conforti, 33, told Rewire in a phone interview. “This is where I’ve gone my whole entire life. This is where I feel comfortable.”

Conforti’s mother died of cancer in a St. Joseph’s hospital, and his father was treated there following a serious accident. This made it all the more devastating for Conforti, who is transgender, when St. Joseph’s, citing its Catholic identity, refused to let him undergo a hysterectomy that he and his doctor said was medically necessary.

In a lawsuit filed last Thursday, Conforti’s attorneys say the hospital violated anti-discrimination provisions in the Affordable Care Act and New Jersey state law by denying Conforti a hysterectomy “because of his sex, non-conformity with sex stereotypes, and gender identity.”

The lawsuit came just days after a federal judge in Texas halted enforcement of the Obama administration’s protections for transgender patients enshrined in the Affordable Care Act, after a number of states and religiously affiliated health-care providers sued. Just days before that ruling, an association of Catholic employers and the Diocese of Fargo also filed suit in North Dakota, saying the protections “require Catholic hospitals and healthcare providers to perform gender transition procedures and abortions contrary to their own medical judgment and Catholic values.”

The protections, outlined in Section 1557 of the ACA, bar discrimination on the basis of sex in all health-care programs by entities that receive federal funds.

One in six hospital beds nationwide is in a facility that abides by directives issued by the U.S. Conference of Catholic Bishops, which restrict access to a range of care, from abortion and contraception to gender-confirming surgery.

In a written statement to Rewire, St. Joseph’s Regional Medical Center called itself “a leading Catholic healthcare institution serving one of the most diverse and underserved populations in New Jersey.”

“The Medical Center follows the Ethical and Religious Directives for Catholic Health Care Services in making decisions about care and treatment,” the statement read.

Conforti sought his hysterectomy in 2015 as part of his gender confirmation, and to reduce the risk of certain cancers associated with his hormone therapy. He secured letters from his primary care doctor and his therapist saying the surgery was medically necessary. At the recommendation of his surgeon, who has admitting privileges at St. Joseph’s, he sought confirmation that the health system would allow the hysterectomy. Conforti submitted an online inquiry and went to a St. Joseph’s hospital in Wayne, New Jersey, where, according to the complaint, the head nurse in charge of surgery assured him “there would be no issues with Jionni undergoing the hysterectomy procedure at either of SJRMC’s locations based on the reason for surgery—treatment of Jionni’s gender dysphoria.”

But about a week later, Conforti’s doctor told him St. Joseph’s refused to allow the surgery. That same day, Father Martin D. Rooney, director of Mission Services at St. Joseph’s Healthcare System, sent Conforti an email. “This is to follow up to your e-mail inquiring about scheduling a total hysterectomy here at St. Joseph’s to remove all female parts based on the medical necessity for Gender Reassignment,” Rooney wrote, according to the complaint. “This is to inform you that as a Catholic Hospital we would not be able to allow your surgeon to schedule this surgery here at St. Joseph’s.”

“For them to say, in writing, we’re not going to do this service, or provide the ability to have these facilities available for this service, because it has to do with your gender identity, and it has to do with the medical treatment for your gender dysphoria, really is discrimination at its core,” Omar Gonzalez-Pagan, staff attorney at Lambda Legal and a lawyer for Conforti, told Rewire in a phone interview. “And for them to use religion as an excuse for this discrimination, I think, is something that cannot be accepted.”

Conforti’s attorneys note in the complaint that hysterectomies are routinely performed at St. Joseph’s Regional Medical Center, which earned a “Hysterectomy Five-Star Rating” in 2016 from the health information company Healthgrades.

“Healthgrades also determined that SJRMC performed approximately 160 more hysterectomies than the average hospital,” Conforti’s attorneys wrote.

The complaint also notes that a substantial percentage of the health system’s revenue comes from taxpayer funding through Medicare and Medicaid, as well as from New Jersey’s charity care program.

“It should not be that we as a society are subsidizing discrimination,” Gonzalez-Pagan told Rewire.

Gonzalez-Pagan said he does not expect the recent Texas ruling on the Obama administration’s protections for transgender patients to affect his client’s lawsuit, even though Conforti’s case cites the same Affordable Care Act provision at issue in that Texas case, Section 1557. The judge’s order prevents the federal government from enforcing the protections, but does not stop private individuals from using them to sue. That ability remains in place, unless the Republican-led Congress and incoming Donald Trump administration deliver on their promise to repeal the Affordable Care Act.

“Ultimately our claim is based on the text of the statute and the multiple courts across the United States, both appellate and district, that have held that the provision on discrimination on the basis of sex encompasses discrimination on the basis of gender identity, transgender status or sex stereotyping,” Gonzalez-Pagan said. “These provisions are here to stay unless they can actually muster the sufficient votes, which I doubt, to actually do a substantive repeal.”

Conforti was ultimately able to get his hysterectomy at another hospital. But he says he still lives in fear of further discrimination. In that sense, he is far from alone, as new data from the National Center for Transgender Equality make clear. As Jack Qu’emi Gutiérrez noted in a December Rewire article,“23 percent of trans people avoided going to the doctor because they feared discrimination; one-third of respondents had at least one negative experience with their provider, including having to educate the provider on trans people in order to receive appropriate care.”

Conforti says he is afraid of what could happen if he ends up back at the medical center that denied his surgery. 

“My main concern right now is that I still live in Totowa and I’ve lived here my entire life, so in the event of an emergency, the only place that an ambulance would take me is to St. Joseph’s,” Conforti told Rewire. “And, you know, I worry that, God forbid something happened, what would I do, how would I be treated? So it’s a constant fear.”

In October 2016, that fear partly came true. Conforti was in a car accident in Wayne, New Jersey, and suffered minor injuries. The emergency service technicians recommended he get emergency care, but said they could only take him to the two St. Joseph’s locations nearby. If he wanted to go elsewhere, he would have to hire a private ambulance. Afraid to seek care from St. Joseph’s, Conforti instead asked his wife to drive him about 25 minutes away, to another hospital in Montclair, New Jersey.

Conforti’s lawsuit seeks damages and changes to policies at St. Joseph’s. Ultimately, Conforti says he thinks such changes are needed at Catholic-affiliated hospitals nationwide.

“If there is a procedure that is medically necessary, there should be no question whether or not they will do it,” Conforti told Rewire. “No one should be rejected or denied care, especially just for being who you are.”