Four judges on the federal appeals court overseeing Alabama cases issued sharp rebukes of their colleagues who decided against considering a preliminary injunction for the state’s ban on gender-affirming care for minors.

Last year, a three-judge panel of the U.S. Court of Appeals for the 11th Circuit reversed a Montgomery federal judge’s preliminary injunction in the challenge to the Alabama law by transgender minors and their parents.

The plaintiffs requested the full 11th Circuit rehear the decision, which was denied in a 7-to-4 decision. U.S. Circuit Judge Nancy Abudu, the 12th judge on the court, recused herself.

The four judges who disagreed with the majority called the panel’s reversal of U.S. District Court Judge Liles Burke’s preliminary injunction “wrong and dangerous.”

U.S. Circuit Judge Robin Rosenbaum claimed the decision means parents only have the right to get medical treatments for their children that were “in existence as of 1868,” the year that the 14th Amendment was ratified.

“If ever a case warranted en banc [full court] review, this is it,” she wrote. “The panel opinion’s reasoning strips every parent in this Circuit of their fundamental right to direct that their children receive any medical treatment (no matter how well-established and medically endorsed)—except for those medical treatments in existence as of 1868. Yes, 1868—before modern medicine.

“So in the states of Alabama, Florida, and Georgia, blistering, blood-letting, and leeches are in, but antibiotics, antivirals, and organ transplants are out,” she continued.

Rosenbaum argued there is nothing in the law “that handcuffs us to nineteenth-century medicine.

“To the contrary, Supreme Court precedent recognizes parents’ fundamental right to direct that their child receive well-established, evidence-based, non-experimental medical treatment, subject to medically accepted standards and a physician’s independent examination and medical judgment,” she wrote.

“In short, the panel opinion is wrong and dangerous,” Rosenbaum continued.

“Make no mistake: while the panel opinion continues in force, no modern medical treatment is safe from a state’s misguided decision to outlaw it, almost regardless of the state’s reason. Worse still, if a state bans a post-1868 treatment, no parent has legal recourse to provide their child with that necessary, life-saving medical care in this Circuit. And if an individual can’t access a medical treatment because of their sex or transgender status, they are similarly without legal recourse.”

U.S. Circuit Judge Charles Wilson claimed the decision “will only lead to future confusion and contradictory results in the interpretation of similar state statues across the circuit.”

“The Act as it stands now shapes the way parents of transgender children may care for their children, while parents of cisgender children remain unaffected. Should a parent of a child be prevented from seeking medical care because of the sex of their child?” he wrote.

“For these reasons,” Wilson continued, “it is difficult to envision issues of greater importance than those presented here. We should have reheard this case en banc. Accordingly, I respectfully dissent from our refusal to do so.”

U.S. Circuit Judge Adalberto Jordan said the panel that reversed Burke’s injunction misapplied the law.

“In this case, the panel characterized the liberty interest [of the due process doctrine] in part by asking whether there is a history of recorded uses of transitioning medications for transgender individuals (e.g., puberty blockers and cross-sex hormone treatments) as of 1868, when the Fourteenth Amendment was ratified. Finding no such history, the panel concluded that there is no fundamental right for parents to treat their children with such medications,” Jordan wrote.

“The panel’s decision necessarily means that the fundamental right of parents to obtain medical treatment for their children extends only to procedures and medications that existed in 1868, and not to modern advances like the polio vaccine (developed in the 1950s), cardiac surgery (first performed in 1893), organ transplants (first successfully completed in 1954), and treatments for cancer like radiation (first used in 1899) and chemotherapy (which started in the 1940s).”

U.S. Circuit Judge Jill Pryor did not write on opinion but concurred with her colleagues.