A group of plaintiffs on Friday filed an amended complaint in Florida seeking to block enforcement of the state’s restrictions on gender-affirming care for trans adults. The complaint alleges that the restrictions “put multiple substantial, harmful, and medically unnecessary obstacles in the path of transgender patients seeking treatment.”

Florida’s restrictions on gender-affirming care for trans individuals took effect in May. SB 254 prohibits gender-affirming care for minors and allows for emergency custody of a minor “subjected to or threatened with being subjected to” gender-affirming care. Additionally, the law includes provisions that limit a trans adult’s access to care. SB 254 requires an adult to see a physician in-person, complete state-certified consent documents and have a third party present to witness the consent. Furthermore, only a physician may “prescribe, administer, or perform” gender-affirming care.

Plaintiffs allege the physician requirement is a “substantial” obstacle to receiving necessary care. The complaint states competent care may be provided by medical professionals other than a physician. Most common are certified Nurse Practitioners (NPs) who are able to provide diagnoses and prescribe medication. NPs are considered to be more accessible than physicians. This is highlighted by a cited report showing a projected shortfall of 18,000 “practicing physicians” in Florida by 2035.

The plaintiffs allege the in-person meeting requirement also provides a “substantial” and possible “harmful” barrier to gender-affirming care. According to the complaint, this could bar some trans patients who are currently using telehealth and do not live in close proximity to a doctor from receiving gender-affirming care.

The amended complaint builds on a previous injunction issued in June. The injunction, issued by the United States District Court for the Northern District of Florida, blocked SB 254’s provisions relating to gender-affirming care for minors. The judge ruled that the legislation ran counter to “widely accepted standard of care,” and is likely unconstitutional. Legislation banning or restricting healthcare for trans individuals have been blocked, struck down or challenged in Arkansas, Georgia and Indiana.

In April, Equality Florida issued a travel advisory for the state, saying “Florida may not be a safe place” for the LGBTQ+ community.