Nurse practitioner, nonprofit challenge Missouri’s collaborative practice law

A nurse practitioner (NP) in Missouri is challenging a state law that requires her to obtain de facto permission to operate her own practice. That permission comes in the form of a $50,000 annual payment to a "collaborating" doctor, contracted solely to fill in a legal checkbox. 

Marcy Markes, who owns Columbia Allergy and Asthma Specialists—and has over 30 years of experience as an NP—filed a lawsuit naming Missouri Attorney General Andrew Bailey, the Missouri Board of Registration for the Healing Arts and Missouri Board of Nursing as defendants. She argues that the collaborative practice agreement laws violate both the U.S. and Missouri Constitutions.

“By law, Ms. Markes must contract with a physician to see patients at her clinic and provide the care that she is specifically licensed to deliver,” the complaint reads. “Because of this mandate, Ms. Markes must pay a physician $52,800 per year—an artificial cost imposed by Missouri law—just to engage in the very work she is uniquely qualified to perform.”

Through her lawyers at the nonprofit Pacific Legal Foundation, Markes argues that the practice agreement mandate violates the guaranteed right in Missouri for people to enjoy the fruits of their labor. Further, the team believes federal and state due process rights are violated, as the law provides no public safety benefit.

Instead, Markes contends that the law exists to put an unfair burden on NPs in an effort to stifle competition—something that may threaten public health, as much of rural Missouri lacks access to primary and specialty care physicians. 

“Nurse practitioners are exceptionally trained, licensed healthcare providers who shouldn’t need to pay a doctor tens of thousands of dollars just for permission to treat patients,” Donna Matias, an attorney representing Markes, said. “This protectionist scheme strips away Marcy’s constitutional rights while worsening Missouri’s healthcare crisis.”