Under pressure from a disabilities rights group, Seattle Children's hospital administrators admitted Tuesday that they violated the law by failing to consult a judge before removing the uterus of a severely disabled 6-year-old girl known as "Ashley." But they said they stand by the procedure as appropriate for some children with special needs.

"We believe we acted in Ashley's best interests," said Dr. David Fisher, medical director of Children's Hospital and Regional Medical Center, at a press conference.

Doctors say Ashley, 9, has the mental capacity of a three-month-old. With the blessing of the girl's family, the hospital performed a hysterectomy, removed her breast buds and gave her hormone therapy – controversial procedures aimed at improving her quality of life by keeping her small and arresting her normal development into a sexually mature adult.

Washington state law forbids involuntary sterilization without court approval. A 38-page report first made public Tuesday by the Washington Protection and Advocacy System, a federally funded advocacy organization for people with disabilities, found that the hospital wrongly relied on the opinion of an attorney who advised Ashley's family that a judge's involvement was not necessary.

At a press conference, the hospital admitted that it did not follow the letter of the law. An "internal miscommunication" led to legal wrongdoing, Fisher acknowledged. "We didn’t understand the law. We didn't have it in front of us."

The legal consequences for the hospital are unclear. The local district attorney's office referred a call to the state attorney general's office, whose spokeswoman, Kristin Alexander, said she thought criminal charges are possible but unlikely.

Washington has one of the nation's strictest laws regarding forced sterilization, said Georgia State University law professor Paul Lombardo11, who studies the history of eugenics. The state allows involuntary sterilization, but only with a court order.

Advocates for disabled people vowed to fight such procedures anywhere in the country.

"We believe this is not acceptable treatment for a child with disabilities, despite the rationalization of the family," said Curt Decker, executive director of the National Disability Rights Network.

Ashley's hysterectomy alone was troublesome enough, he said, but the growth-stunting procedure and removal of breast buds "are heinous because they were so innovative and new, something that we in the disability community had not thought possible."

On Tuesday, the hospital said it plans to institute stricter safeguards to protect disabled children in the future. Nevertheless, Fisher defended the procedures as an appropriate treatment given the extreme condition of the child in this case. He added that parents of other disabled children have requested variations on the so-called Ashley treatment, and the hospital is not ruling the procedures out.

"Ashley was a unique child," he said. "There would have to be another unique child and set of circumstances, with a court order."

Ashley's parents also said they stand by their decision. In a statement issued Tuesday, they said they thought the law about sterilization would not apply because Ashley could not procreate voluntarily and because "sterilization is not the intent of the Ashley treatment but a byproduct of it."

The parents added that requiring court orders for all involuntary hysterectomies "puts an onerous burden on already overburdened families of children with medical conditions as serious as Ashley's."