NASHVILLE, Tenn. (AP) — Vanderbilt University Medical Center is being sued by its transgender clinic patients, who accuse the hospital of violating their privacy by turning their records over to Tennessee’s attorney general.

Two patients sued Monday in Nashville Chancery Court, saying they were among more than 100 people whose records were sent by Vanderbilt to Attorney General Jonathan Skrmetti. His office has said it is examining medical billing in a “run of the mill” fraud investigation that isn’t directed at patients or their families. Vanderbilt has said it was required by law to comply.

The patients say Vanderbilt was aware that Tennessee authorities are hostile toward the rights of transgender people, and should have removed their personally identifying information before turning over the records.

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Tennessee has stood out among conservative-led states pushing myriad laws targeting transgender people, enacting some of the nation’s most anti-LGBTQ restrictions, even as families and advocates have voiced objections that such policies are harmful. The lawsuit seeks class-action status on behalf of everyone at the clinic whose private medical records were released to Skrmetti.

“Against that backdrop, its failure to safeguard the privacy of its patients is particularly egregious,” the lawsuit says.

The attorney general’s office has said the hospital has been providing records of its gender-related treatment billing since December 2022, and that the records have been kept confidential. Elizabeth Lane Johnson, an attorney general’s office spokesperson, noted Tuesday that the office isn’t a party to the lawsuit, and directed questions to Vanderbilt.

VUMC spokesperson John Howser said Tuesday that it’s common for health systems to get such requests in billing probes and audits, and “the decision to release patient records for any purpose is never taken lightly, even in situations such as this where VUMC was legally compelled to produce the patient records.”

Many of the patients involved are state workers, or their adult children or spouses; others are on TennCare, the state’s Medicaid plan; and some were not even patients at the transgender clinic, according to the lawsuit. It says that records for more than 100 current and former patients were sent without redacting their identities.

The lawsuit says that since the patients learned that their information was shared, they’ve been “terrified for their physical safety, have had significant anxiety and distress that has impacted their ability to work, has caused them to increase home security measures, and drop out of activities in which they normally would participate.”

The lawsuit accuses Vanderbilt of negligence that inflicted emotional damage and violated patient privacy protection and consumer protection laws. It seeks monetary damages, improved security procedures, an injunction blocking further release of their records without notice, an acknowledgement by Vanderbilt that it violated its own privacy policy, and an admission that the policy inadequately informs patients of their rights regarding disclosures.

The hospital waited months before telling patients their medical information was shared, acting only after the existence of the requests emerged as evidence in another court case. Howser said that at that point, hospital officials thought patients should hear it from them instead of media reports or other ways.

The attorney general also requested a slew of additional information, including the names of everyone referred to the transgender clinic who made at least one office visit, as well as people who volunteer for the hospital’s Trans Buddy initiative, which aims to increase access to care and improve outcomes by providing emotional support for the clinic’s patients.

Howser said Vanderbilt’s lawyers are in discussion with the attorney general’s office “about what information is relevant to their investigation and will be provided by VUMC.”

The attorney general’s office made the requests several months after conservative commentator Matt Walsh surfaced videos last September that include a medical center doctor saying gender-affirming procedures are “huge money makers” for hospitals. Vanderbilt paused all gender-affirming surgeries for minors the next month under pressure from Republican lawmakers and Gov. Bill Lee, who demanded an investigation.

Vanderbilt said it had provided about five gender-affirming surgeries to minors each year since its clinic opened in 2018, all to people over 16 who had parental consent. None received genital procedures.

Tennessee lawmakers then passed a ban on gender-affirming care for minors. A federal appeals court recently let it take effect after a lower court judge blocked it.

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Kimberlee Kruesi in Nashville contributed to this report.