On Monday, the Supreme Court refused to hear a challenge regarding a Catholic hospital’s refusal to perform transgender surgery. The decision left in place a lower court’s ruling that sided with Evan Minton, a transgender man. Minton sued Dignity Health after the hospital refused to perform his hysterectomy.

The Washington Times reports:

He received the surgery three days later at a non-religious hospital but filed a lawsuit in California claiming he was discriminated against.

The lower courts ruled in his favor and against the hospital, which asked the justices to review the case.

Specifically, Dignity Health argued that religious health care institutions should be protected by the First Amendment and not forced to perform surgeries that conflict with its ethics.

Justices Neil M. Gorsuch, Clarence Thomas and Samuel A. Alito Jr. would have taken up the case for review.

However, a majority of justices refused to review the case. It takes four justices to agree to appeal the case.