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Two nurse practitioners (NPs) in Texas and the state’s NP professional association have filed a lawsuit to challenge Texas laws that require NPs to maintain “delegation agreements” with physicians who must oversee their clinical work. According to the complaint, the key plaintiff, who owns her own practice, is paying $96,000 per year for physician oversight services, which the physician can terminate at any time for any reason without state review. The suit argues that the agreements impose “extensive burdens on the nurse practitioners based on a fiction that it will protect patient safety” and notes that the overseeing physicians are at the same time competitors of the NPs. Collectively, the plaintiffs are seeking injunctive relief because they believe that the agreements function solely as contractual checkboxes rather than meaningful clinical supervision. They also argue that Texas has improperly delegated governmental authority to private physicians because physicians can effectively determine whether or not a licensed, qualified NP may practice medicine.
Courts will decide: This is a potentially significant lawsuit because it is not just another effort to obtain full practice authority for NPs. Instead, it argues that the current collaborative-practice requirements are unconstitutional under the Texas Constitution. Last year, an NP in Missouri filed a similar lawsuit challenging that state’s collaborative-practice requirements, arguing that the law violates her constitutional right to earn a living by forcing her to pay a physician $50,000 annually simply to allow her to practice within her scope of training and licensure, even with her 30 years of experience. If successful, these suits could create a new legal pathway for upending collaborative-practice laws in the 21 states that require some type of physician supervision.