Nurse Practitioner Vasectomy Bill Goes to the Governor

Oregon is poised to become the third state to expand the scope of practice of its nurse practitioners to allow them to perform the male sterilization procedure. Urologists opposed the bill, comparing nurse practitioners to gas station attendants.

The Oregon Senate cut the final strings keeping nurse practitioners from performing vasectomies on Tuesday, voting 25 to 5 to delete a statute that specifically bars them from doing this work, even if they have been specially trained.

“Vasectomies are an important form of birth control that allow men to take part in their family planning,” said Sen. Elizabeth Steiner Hayward, D-Portland, who brought the bill forward with the support of the Oregon Nurses Association. “They are safer and less expensive than tubal ligation for women.”

House Bill 2103, which was first introduced by Planned Parenthood two years ago, now heads to Gov. Brown. Oregon would then become the third state to allow nurse practitioners to do vasectomies, after Washington and Alaska, both of which enabled this practice in the 1990s.

Sen. Betsy Johnson, D-Scappoose, joined four Senate Republicans in opposing HB 2103, but the bill had a much narrower passage in the House, where Rep. Knute Buehler, R-Bend, who worked to defeat a similar bill in 2015, led his party in opposition. Just three House Republicans supported the bill, while Rep. Brian Clem, D-Salem, opposed it in a 37-21 vote.

Steiner Hayward had to suppress laughter in her speech supporting the use of nurse practitioners to perform male sterilization, as more than one male Republican senator declared a “conflict of interest” since HB 2103 could ultimately affect their reproductive health.

A public hearing in May was much less humorous, as a pair of urologists piped in and testified as if allowing a female-dominated profession like nurse practitioners to perform vasectomies were an assault on their manhood.

Dr. Gregory McCoy testified that he already has to patch up botched vasectomies performed by family physicians, and he had even less faith that nurse practitioners could do the work.

“The only way I could conceivably support this is if the Oregon legislators consented to have their vasectomies performed by suboptimally trained providers such as nurse practitioners,” McCoy said. “If that were the case, it would be a short-lived law, I can assure you.”

“Allowing someone with as much as formal surgical training as a gas station attendant to perform surgery on someone’s testicles is not putting patient safety first. These people do not and will not have privileges at our hospital to perform vasectomies -- and I sit on the board,” said Dr. Brian O’Halloran, who works at St. Charles Hospital in Bend. “I bet if I asked any nurse practitioner sitting there right now to describe the anatomy of the spermatic cord and the structures therein, she couldn’t do it.”

Steiner Hayward responded to these men with disgust, recounting an anecdote from her medical school training in which a surgeon expressed similarly arrogant remarks about her desire to perform Caesarean-sections during an obstetrics fellowship.

“He told me, ‘No family physician will ever perform C-sections in my hospital,’” she said, even as she later delivered 50 babies without complications through this procedure in her residency. “I can only begin to tell you how offended I am at your dismissive attitudes toward our nurse practitioner colleagues. They know their scope of practice. They are experienced. They will not do anything they do not feel comfortable with.”

Dr. Eugene Fuchs, a professor of urology at Oregon Health & Science University, tried to put a better tack on his profession’s opposition to HB 2103, arguing that nurse practitioners as well as family physicians should only do vasectomies if they’ve been adequately trained and are well-practiced -- which a nurse practitioner who focused on women’s health at Planned Parenthood might not be.

Fuchs said he had worked with urologic nurse practitioners and felt they would be qualified: “These individuals can certainly learn to do vasectomies, no question about it.”

Susan King, calmly persisted in what was her last turn testifying as the director of the Oregon Nurses Association, a post she retired from on May 31: “We’re asking to remove an outdated and unusual restriction from statute,” she said. “My organization has never asked for authority for any procedure that our members would take lightly. We have kept that faith.”

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No matter what procedures are "legally" allowed for NP's and PA's, it should be the choice of an informed patient as to whether it is done by them, or a doctor;  and then either a Generalist or a Specialist.

Nick Benton