Nurse practitioner sues North Carolina over physician permission mandate

Raleigh, North Carolina; September 2, 2026: A North Carolina nurse practitioner filed a lawsuit today challenging a law that prevents her from practicing unless she pays a physician for permission to do so. Jamie Gallagher alleges that the law, which forces nurse practitioners into costly “collaborative practice agreements” (CPA) with physicians, violates her rights protected by the North Carolina Constitution by imposing arbitrary burdens that do nothing to protect patients.

“North Carolina’s law does not make patients safer—it makes care harder to provide,” said Donna Matias, a senior attorney with Pacific Legal Foundation. “A license should reflect what a provider is trained and qualified to do. Jamie deserves the freedom to serve her patients and grow her practice without purchasing permission from a physician who isn’t even required to know anything about her specialty.”

Jamie is a Doctor of Nursing Practice and a board-certified Family Nurse Practitioner with nearly 32 years of nursing experience. After seeing a gap in care for midlife women, she opened Peri & Pause, a practice focused on perimenopause and menopause care. Demand grew quickly, and Jamie opened two locations within a year, with plans for a third.

But North Carolina requires Jamie to maintain a CPA even though the state has already licensed her to provide the care she offers at her clinic. She currently pays $16,500 per year for a physician to sign a contract with her, even though he is not required by law to see her patients, review charts, or provide direct supervision. A victory would end North Carolina’s redundant CPA requirement, allow qualified nurse practitioners to provide care to the full extent of their training, and open up more access to care for patients.

Pacific Legal Foundation represents Gallagher free of charge. The case is Jamie Gallagher v. Anuradha Rao-Patel.