The Montana House voted on Wednesday to censure the state's first openly transgender legislator Zooey Zephyr, who called for her colleagues to vote against a gender-affirming care ban for transgender youth.
The House voted 68-32 to censure Zephyr, who is barred from participating from the House floor.
Zephyr said that she would continue to stand behind her beliefs after the censure.
"As I left the House chambers, I pressed my light to speak—a reminder that this legislature is removing 11,000 Montanans from discussion on every bill going forward," Zephyr tweeted. "I will always stand on behalf of my constituents, my community, and democracy itself."
Zephyr told conservative lawmakers they would have "blood on their hands" during debate on SB99, which would ban gender-affirming care for transgender youth.
The bill passed and is now on the desk of Gov. Greg Gianforte, who has signaled his support for the legislation.
On Wednesday, in a hearing before the vote about disciplinary actions Zephyr could face, she defended her words.
"I rose up in defense of my community that day, speaking to harms that these bills bring that I have firsthand experience knowing about. I have had friends who have taken their lives because of these bills. I have fielded calls from families in Montana, including one family whose trans teenager attempted to take her life while watching a hearing on one of the anti trans bills," she said on the House floor.
Zephyr said, "When the speaker asks me to apologize ... on behalf of decorum, what he's really asking me to do is be silent when my community is facing bills that get us killed."
The "Youth Health Protection Act" would restrict the use of hormone therapy, puberty blockers and surgeries on people under age 18 for the purposes of gender transitioning.
Gender-affirming care has been found to be associated with improved mental health of transgender adolescents and teenagers, according to research in the New England Journal of Medicine and JAMA Pediatrics.
Gender dysphoria, the stress one may feel when they do not desire the gender identity typically associated with their assigned sex at birth, can lead to negative mental health outcomes for transgender people, according to studies.
"If you are denying gender-affirming care and forcing a trans child to go through puberty, that is tantamount to torture, and this body should be ashamed," said Zephyr in the April 18 debate.
She continued, "If you vote yes on this bill, I hope the next time you bow your heads in prayer, you see the blood on your hands."
Zephyr told ABC News that she believes she is being silenced by "those in power who don't want to be held accountable."
"When I stood up to speak on Senate Bill 99, I chose my words with precision, and I spoke with clarity because I see the real harm that these bills bring. I won't be apologizing for my remarks," she said on ABC News' Start Here podcast.
Zephyr told ABC News that she has been stonewalled from debate or comment on the Montana House floor for over a week by Republican leaders, who say her comments broke the rules of "decorum."
"All representatives are free to participate in House debate while following the House rules; the choice to not follow House rules is one that Representative Zephyr has made," said House Speaker Matt Regier in a statement to reporters. "The only person silencing Representative Zephyr is Representative Zephyr."
The Montana Freedom Caucus, which includes several of Zephyr's colleagues, misgendered Zephyr by using he/him pronouns and argued the legislation "protects minor children from forced life-altering and unnecessary surgical procedures." Physicians from across the country have previously told ABC News that some types of gender-affirming care are reversible or partially reversible and are only pursued after thorough discussions and evaluations with medical professionals.
On Monday, protesters took to the statehouse chanting, "let her speak!" as a debate about a separate bill that would allow students to misgender or deadname transgender people without disciplinary action went on. Several protesters were arrested. Deadnaming refers to the use of a transgender person's name from before they transitioned, such as their birth name.
Other legislators say Zephyr encouraged their disruptions.
"When the speaker disallowed me to speak, what he was doing is taking away the voices of the 11,000 Montanans who represent who elected me to speak on their behalf," Zephyr said Wednesday in defense of protestors.
Late Tuesday, legislators were told they would be voting Wednesday on whether Zephyr "violated the rules, collective rights, safety, dignity, integrity or decorum of the House of Representatives" and if her actions warrant discipline.
The House "may expel or punish a member for good cause shown with the concurrence of two-thirds of all its members," according to the Montana Constitution.
Her censure is reminiscent of the Republican-controlled Tennessee state House of Representatives expulsion of two Democratic lawmakers in what marked the first partisan expulsion in the state's modern history.
On April 6, state Reps. Justin Jones and Justin J. Pearson were expelled for allegedly violating the chamber's rules of decorum by protesting gun control on the House floor.
The protest was in response to the mass school shooting in Nashville that left three children and three adults dead.
Pearson was reinstated by the Shelby County Board of Commissioners and Jones was reinstated by the Nashville Metro Council.
Rep. Gloria Johnson evaded expulsion for her participation in the protest by one vote.
"We're also in a moment right now with those in power in the Republican Party don't want to be held accountable," Zephyr told ABC News. "So whether it is my transness here in Montana rising up in defense of my community, other cisgender women rising up in defense of the trans community in Nebraska or people in Tennessee, representatives in Tennessee rising up about gun violence. It's really about the marginalized being silenced by those in power who don't want to be held accountable."
States across the country are considering bans on transgender health care for minors that are similar to Montana's SB99.
At least 12 states -- Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Iowa, Kentucky, Mississippi, South Dakota, Tennessee and Utah -- have passed laws or policies that restrict gender-affirming care for people under the age of legal majority, which is the threshold for legal adulthood.