Nebraska legislative committee advances contentious nomination for chief medical officer

LINCOLN — A Nebraska legislative committee on Thursday advanced the contentious appointment of a new chief medical officer who would be charged with determining new rules and regulations surrounding gender-affirming care for minors.

Members of the Health and Human Services Committee advanced the appointment of Dr. Timothy Tesmer on a 4-2 vote. It was a moment in a months-long fight over gender-affirming care bubbling up in the committee with tense questioning and senators yelling at one another behind closed doors.

Tesmer is an ear, nose and throat doctor who most recently practiced in Lincoln. He graduated from Nebraska Wesleyan University and the University of Nebraska Medical Center and has practiced in Louisville, Kentucky; Springfield, Missouri; and Colorado Springs, Colorado.

He described to the committee how he set up his private practice in 2020, noting he had a “vision” and set out to fulfill it by bringing in legal, financial and marketing experts.

“I wrote policy, I set standards and I ensured that my team met those standards,” Tesmer said. “These are the skills that I bring to this role today: The ability to set a vision when necessary, make tough decisions and collaborate with experts to achieve my goals.”

‘Multidisciplinary’ team to be created

But much of Tesmer’s hearing hinged upon how he would approach the authority granted to him under Legislative Bill 574, which Gov. Jim Pillen signed into law on Monday.

Through LB 574, the chief medical officer has the sole responsibility of regulating puberty blockers and hormone therapies for minors in transition care.

Tesmer said that while the law states it would rest “on the shoulders of the chief medical officer,” final rules and regulations would be evidence-based and reasonable.

“In reality, that will be accomplished by a team of multidisciplinary health care providers,” Tesmer said, including input from local, regional and national experts who provide gender-affirming care.

State Sen. Lynne Walz of Fremont, along with State Sens. John Cavanaugh and John Fredrickson, both of Omaha, had proposed specific rules and regulations that were not adopted during debate on LB 574.

Walz, a committee member, asked Tesmer whether he had seen those protocols and whether he would take them into consideration.

“I would be willing to look at that,” Tesmer responded. “But I have to apply that to the boundaries of the context of the law.”

Two doctors — Dr. Helen Grace, a pediatrician, and Dr. Alex Dworak, a family physician — testified in a neutral capacity and said they could be a resource to Tesmer.

They said if Tesmer can put his personal opinions aside and consult with experts, that is more important than prior expertise in the field of gender-affirming care. 

No physician can know all of Nebraska, Grace said, so collaboration is critical.

The gender care side of LB 574 will become law on Oct. 1, banning transition surgeries but kicking potential restrictions on puberty blockers and hormone therapies down the road.

The other half of LB 574, an approximate 10-week abortion ban, is already law.

Pillen during LB 574’s signing ceremony said that gender-affirming care as a catch-all solution was the work of “Lucifer,” which also became a point of contention Thursday among testifiers.

“We believe in protecting our kids, making sure that they — parents and kids — don’t get duped into the silliness that ‘If you do this, you’re going to become happy,’” Pillen said Monday. “That is absolutely Lucifer at its finest.”

Abbi Swatsworth, executive director for OutNebraska, testified against Tesmer for his role in supporting an original form of LB 574. In a statement, she condemned Pillen’s comments as “appalling” and “inflammatory.”

One person testified in Tesmer’s support, five in opposition and two in a neutral capacity. State Sen. Ben Hansen of Blair, the committee chair who had a key role to play in LB 574’s passage, said four comments were submitted in support, 83 in opposition and 7 in a neutral stance.

Does ‘one issue’ define chief medical officer

One heated moment, among a handful in lines of questioning, was State Sen. Machaela Cavanaugh of Omaha asking Tesmer whether top surgeries, those related to breasts, would be appropriate for any minors.

She said the questions were designed to assess his legal and medical understanding, noting the surgeries will be banned for trans youths.

Tesmer said breast augmentation or enhancement surgeries would be appropriate for cisgender minors but not transgender youths because they are irreversible. 

Cavanaugh blasted that as discriminatory and said her fear is that LB 574 is in a line of actions toward the eradication of transgender people in Nebraska. She has made similar comments on the floor of the Legislature. 

She added she is concerned that Tesmer, based on his statements, could advance that mission.

“I am hoping beyond all hope that I am so off base and incorrect,” Cavanaugh said. “I am asking you to show me, in your words today and your actions moving forward, how wrong I am. But so far, everything you have said has reaffirmed my opinion. And I am concerned and deeply, deeply concerned about the discrimination that you are openly sharing with us today.”

Tesmer said he has personal opinions and biases, as all people do, but he would rely on his team in following the law.

“I can assure you right here, right now, I can assure you that personal opinions will be put aside,” he responded. “This issue, this one issue, I hope doesn’t define the whole chief medical officer role.”

State Sens. Merv Riepe of Ralston, Beau Ballard of Lincoln and Jen Day of Omaha pointed to other duties the chief medical officer will have to face and asked his advice, including expanding access to care, dealing with STDs in Douglas County and providing guidance to doctors related to the termination of pregnancies.

Rules and regulation process

Julia Keown, a registered nurse, testified in support of Tesmer’s nomination.

“I have the utmost faith in Dr. Tesmer’s ability to uphold his medical oath and follow national norms in the United States on what is the best medical practice,” Keown said.

These practices have already been put forth by multiple medical associations and societies, including a specific guide from the Endocrine Society.

The Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline is “interestingly, super similar” to the LB 574 amendments drafted by Walz and John Cavanaugh, Keown added.

Keown said that based on norms and her professional experience, it would be natural for Tesmer or any other chief medical officer to adopt these already formulated policies. Some opponents fear Tesmer may use his authority to implement a full ban on blockers and hormones.

‘You are at the epicenter of all of this’

During multiple lines of questioning, Cavanaugh and Tesmer interrupted one another. 

Cavanaugh told Tesmer that LB 574 defined the 2023 session. She was among the leading voices against the measure, including a three-month-long filibuster on nearly all legislation.

Cavanaugh and Day also criticized Tesmer for having a hand in LB 574’s passage when he was chair of the State Board of Health from early 2022 to a week before he assumed the acting CMO position on March 27.

That board, on March 20, released a statement in support of LB 574 in its original form, outlawing puberty blockers and hormone therapies in addition to puberty blockers. 

Tesmer asserted he had no knowledge of the statement prior to it being unveiled and voted on at an afternoon March 20 meeting. He said the statement advanced from a subcommittee that morning.

A public records request showed that State Sen. Kathleen Kauth of Omaha, who introduced LB 574, did coordinate with some board members to have the statement ready prior to the bill being debated on the floor. The request did not reveal any written communication to or from Tesmer, either in his email or text messages, prior to the board’s final vote.

Hansen said it’s not unusual for the State Board of Health to issue statements related to legislation. 

However, Day said Tesmer’s unawareness of the statement, as the board’s chair, casts doubt on his ability to lead.

“You have utilized that position of power to make this a defining issue, and now you are in a different position of power that has been tasked with this,” Cavanaugh told Tesmer. “So you are at the epicenter of all of this.”

“OK, if that’s the way you characterize it, then I’m happy to be at the epicenter of this role,” Tesmer responded. “If that’s what this CMO role is defined by, I’m happy to do that.”

Tesmer said he supported the statement because he is against the transition surgeries for minors and signed on because of the “irreversible” language in the bill. However, there is one mention against both “irreversible surgical and hormonal manipulation of minors for the purposes of gender reassignment.”

The March 20 meeting minutes state that Tesmer attempted to remove that sentence from the final draft that he ultimately supported.

‘The author of your own destruction’

Just before the 4-2 vote on advancing Tesmer’s appointment, in a closed-door meeting, Day expressed concern about Tesmer bringing biases into future work. 

Riepe said he looks at character first and that he’s heard from Lincoln-based physicians that Tesmer has good character.

A glance from Walz prompted Cavanaugh to comment: “What is left to say? … These four gentlemen do not care,” she said, noting her four male colleagues who would vote to support Tesmer and LB 574.

Hansen said that characterization was not fair.  He said there is a difference between caring and having a difference in opinion.

State Sen. Brian Hardin of Gering, the committee’s vice chair, leaned forward as Hansen and Cavanaugh argued.

“You have been the author of your own destruction,” he told Cavanaugh.

Hansen, Hardin, Ballard and Riepe supported Tesmer while Cavanaugh and Day voted against him. Walz was present, not voting.

The full Legislature will consider Tesmer’s appointment sometime next week, Hansen said.