Active: Federal lawsuit challenges titling restrictions against Nurse Practitioners

Like a growing number of nurse practitioners in California, Sarah Erny earned a Doctorate of Nursing Practice (DNP), the highest degree in advanced nursing. She’s dubbed affectionately—and accurately—“Dr. Sarah” by her patients and colleagues.

Today, however, although Sarah holds a doctorate, she is being criminally punished for exercising her right to publicly—and truthfully—use the title “Dr.” This has drawn the wrath of the Medical Board of California, the San Luis Obispo County District Attorney’s Office, and the Board of Registered Nursing. Sarah has been fined more than $20,000 and may lose her nursing license. As a result, she has moved to Washington state to continue her practice.

The consequences of Sarah’s truthful use of the “Dr.” title has struck fear into other DNPs, forcing them to choose between their livelihoods and their rights.

A directive baked into the state’s Medical Practice Act makes it a crime for any healthcare professional other than licensed physicians or surgeons to call themselves “doctor” or “Dr.” on signs, business cards, or letterhead, or in ads. Anyone caught violating this prohibition faces fines and loss of license.

Enforcing this law against nurse practioners is slipshod. Many medical professionals with similarly advanced degrees, such as veterinarians, dentists, naturopaths, and acupuncturists truthfully use the title “doctor.” The same is true of individuals with doctorates in other fields, like college professors.

The government hasn’t gone after everyone who truthfully uses the title “Dr.,” but Sarah’s case has chilled free speech within the DNP community. Three DNPs refuse to be silenced, however, and aim to combat this unjust restriction on their ability to earn a living:

  • Jacqueline Palmer, a family nurse practitioner since 2018 with a DNP earned in 2020, was referred to as “Dr.” by her patients at the family practice health clinic. However, upon learning about the actions against Sarah Erny, Jacqueline stopped using the title and removed the “Dr.” designation from her signature. She hung up her clinic coat embroidered with “Dr. J. Palmer, FNP-C.” Jacqueline now fears the state will come after her for having truthfully identifying “Dr.”
  • Heather Lewis is a family nurse practitioner who recently completed her DNP. She changed her internet and social media presence, business cards, and name tag to reflect that she is now “Dr. Heather Lewis, FNP, DNP.” She fully intends to use the title she worked hard to earn, all the while holding herself out as a nurse practitioner at the three clinics where she serves patients.
  • Rodolfo Jaravata-Hanson is a newly minted DNP who fully intends to use his earned title on his clinic scrubs and business cards and in his internet presence. While he will identify himself as a nurse practitioner, he believes his earned title will reassure his patients that he has pushed himself to achieve the highest level of educational qualifications for an advanced practice nurse.

California’s restriction of the word “doctor” isn’t a protection against fraud and injury. Instead, the state is appropriating the word “doctor” for certain protected professions: licensed physicians and surgeons. Never mind that neither “Dr.” nor “doctor” appears anywhere on physicians’ or surgeons’ certificates.

The government cannot hijack a commonly used word and reserve it for a narrow range of preferred jobs. Nor can the state police the use of truthful language to limit career opportunities.

Forced either to lie about their qualifications and experience, stay silent, or fight back, Jacqueline, Heather, and Rodolfo are choosing the latter. Represented at no charge by Pacific Legal Foundation, the trio filed a federal lawsuit challenging California’s unjust titling law to restore their right to accurately describe themselves and their credentials and to earn an honest living.

What’s At Stake?

  • The government cannot appropriate a commonly used title and reserve it for a narrow range of preferred, well-connected jobs. Nor can it make laws that restrict the truthful speech of its citizens.
  • People should be able to accurately describe themselves by their profession without government censorship.

Case Timeline

September 25, 2023
First Amended Complaint
United States District Court Central District California
September 09, 2023
Order Denying in Part and Granting in Part Defendants' Motion not to Dismiss
United States District Court Central District California
June 06, 2023
United States District Court Central District California