On Wednesday morning, Ari Robbins was worried that his upcoming flight back to Washington state might be cancelled by the winter storm bearing down on the East Coast.

It was a more mundane concern than Robbins used to face while traveling, when his breasts, and the binder he used to conceal them, would set off airport scanners, leading to public humiliation and nerve-wracking conversations with confused security agents.

Robbins, who is transgender, had surgery to remove his breasts and can now pass through the body scanners—which force agents to push a button based on their assumptions about whether a passenger is male or female. Robbins is free from the chronic pain caused by his binder, which he had to wear to be seen as a man and feel safe in public. But his path to getting that surgery was far from easy, according to a lawsuit filed last month by the ACLU of Washington.

After his doctor at Swedish Plastics and Aesthetics told Robbins his chest reconstruction would be a “simple procedure,” Robbins, a law student at the University of Washington, structured his schedule around the surgery and arranged for after-care with family and friends. But last February, three weeks before the surgery, the practice called Robbins to cancel it. The patient care coordinator said his doctor could not handle the surgery because it was a “transgender surgery,” adding that she had called several other transgender patients to cancel their surgeries too, according to the lawsuit.

“I was shocked,” Robbins told Rewire in an interview. “It was getting to a very uncomfortable and unmanageable point and I felt like I didn’t know how much longer I had for my physical breaking point, how much longer I could deal with having breasts and not living the life that I wanted to live.”

In her notes, the doctor alternated between referring to Robbins with male and female pronouns, according to the lawsuit, which accuses Swedish Health Services and its affiliated Catholic health system, Providence Health & Services, of violating Washington’s anti-discrimination and consumer protection laws. It’s unclear if Providence’s Catholic identity contributed to the denial. Swedish, which operates several hospitals and more than 100 clinics, maintains that it is not Catholic, but after announcing the affiliation with Providence in 2011, it stopped performing “elective” abortions.

Swedish said in an emailed statement it could not comment on the lawsuit.

“At Swedish, we care for all of our patients regardless of race, color, religion, creed, sex, gender identity, sexual orientation or any other protected status,” the statement read. “We take great pride providing compassionate care and we do provide care and many treatment options for transgender patients. In light of that, we take this claim very seriously.”

The ACLU of Washington filed a similar suit in October against the Catholic health system PeaceHealth for refusing to cover chest reconstruction surgery for a transgender teenager who had insurance through his mother, a PeaceHealth worker. PeaceHealth cited a blanket policy of excluding “transgender services,” the ACLU said.

Washington is one of five states where more than 40 percent of acute-care hospital beds operate under Catholic restrictions.

Catholic hospitals have been sued repeatedly for denying gender-affirming surgery on religious grounds. Last month, the U.S. Conference of Catholic Bishops, which issues directives followed by Catholic hospitals, published a letter negating the existence of transgender people and urging the denial of affirming care to trans children.

Transgender patients face discrimination from non-religious providers too. A third of transgender people who had recently seen a health-care provider reported at least one negative experience related to their gender identity, according to a survey by the National Center for Transgender Equality. Yet the Trump administration has moved to gut protections in the Affordable Care Act  for transgender patients and give religious hospitals new leeway to discriminate against patients and workers.

Meanwhile, Catholic hospitals have expanded their reach through mergers and affiliations. Under a possible merger with Ascension, Providence, already the largest health-care provider in Washington, could soon become part of the largest hospital operator in the United States.

When his surgery was denied, Robbins had to drive across Washington to Idaho to find a surgeon who accepted his Washington Medicaid insurance. He spent four days in an Idaho hotel recovering after the surgery. Robbins, who plans to pursue a career in administrative and civil rights law, said he felt a responsibility to take a stand.

“I just hope that people can start to learn to expect trans people,” he told Rewire. “I don’t think anybody fits exactly into the definitions of men and women that we all hold in our heads …. I just hope that people can learn to expect trans people to exist.”