Texas nurse practitioners file lawsuit to practice without paying physician gatekeepers
July 22, 2026
Austin, Texas; July 22, 2026: Today, Texas nurse practitioners as well as a state association representing them filed a lawsuit challenging a Texas law that forces them to pay physicians for permission to practice the skills Texas already licenses them to perform. Lead plaintiff Sandy McCoy and nonprofit Texas Nurse Practitioners allege the law violates their rights by oppressively burdening their right to earn a living and by delegating away government power — in this case, to private physicians with a financial stake in limiting competition.
“Texas’ law does not protect patients — it restricts access to care for patients and blocks qualified nurse practitioners from serving communities that need care,” said Donna Matias, a senior attorney with Pacific Legal Foundation. “The government cannot require professionals to meet a licensing standard, then force those who satisfy it to buy permission from a competitor before they can practice. Nurse practitioners deserve the freedom to care for their patients without such unconstitutional burdens.”
McCoy opened her Plano practice to provide thorough, patient-centered care built on more than 30 years of experience as a nurse practitioner. She has treated trauma patients, led nursing teams, taught nursing classes, and served as president of Texas Nurse Practitioners. But Texas law requires her to maintain a costly physician “collaboration” agreement — even when that supervision exists only on paper.
The lawsuit challenges Texas’ collaborative practice agreement under the Texas Constitution’s Due Course of Law Clause and private nondelegation doctrine. A victory would allow licensed nurse practitioners across Texas to care for patients without paying for a physician’s permission and would expand healthcare access where it is needed most.
Pacific Legal Foundation represents the plaintiff nurse practitioners free of charge. The case is Sandy McCoy, et al. v. Stephen Brint Carlton, et al.
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About Pacific Legal Foundation
Pacific Legal Foundation is a national nonprofit law firm that defends Americans threatened by government overreach and abuse. Since our founding in 1973, we challenge the government when it violates individual liberty and constitutional rights. With active cases in 34 states plus Washington, D.C., PLF represents clients in state and federal courts, with 18 wins of 21 cases litigated at the U.S. Supreme Court.