Nurse Practitioner Sues Missouri Over Collaborative Practice Laws: Could It Change the Game Nationally?

On August 21, 2025, Missouri nurse practitioner Marcy Markes filed a landmark lawsuit against the state, challenging the requirement that nurse practitioners (NPs) enter into Collaborative Practice Agreements (CPAs) with physicians. Markes argues that these laws violate her constitutional right to earn a living by forcing her to pay a physician over $50,000 annually simply to practice within her scope of training and licensure.

Markes, who has over 30 years of experience and operates Columbia Allergy and Asthma Specialists, is represented by the Pacific Legal Foundation. Her lawsuit names Missouri Attorney General Andrew Bailey as the defendant.

👉 Facebook nursing association announcement👉 Texas Nurse Practitioners summary

What Missouri Collaborative Practice Law Requires

Missouri is one of just 11 states that still restrict nurse practitioner practice by requiring physician oversight. Under current law, an NP must sign a written collaborative practice arrangement with a physician, which includes:

• Proximity requirements: Physicians must be within 75 miles (with limited exceptions for telehealth and rural clinics)

• Mandatory chart reviews: 10% of all charts reviewed every 14 days; 20% if controlled substances are prescribed

• On-site presence: Physician must be on site at least the first month, then periodically afterward

• Physician caps: Limits on the number of NPs one physician may supervise

👉 Policy overview – Missouri Nurses Association👉 Peer-review study of CPA restrictions

Markes argues these requirements are unnecessary, burdensome, and costly, particularly in a state where nearly 80% of counties are considered “medical deserts.”

The Constitutional Claims

The lawsuit asserts violations of both the Missouri Constitution and the U.S. Constitution:

• Missouri Constitution (Article I, § 2 – “gains of their own industry” clause): Markes argues the CPA requirement unlawfully restricts her ability to earn a living.

• Federal Due Process Clause: She claims the law infringes on her professional autonomy and economic liberty.

👉 Discussion thread – Reddit Noctor forum

Have There Been Other Lawsuits Like This?

Yes—Markes’ case is part of a new wave of NP litigation across the country:

• California (2025) – Two psychiatric NPs sued the Board of Nursing in Helgason & Sorenson v. Melby, claiming the Board is undermining AB 890, the state law granting NPs independent practice authority.👉 Sacramento County filing coverage

• Nebraska (2024/2025) – In Swanson v. Hilgers, a certified nurse midwife challenged supervision and home birth restrictions as unconstitutional under due process and equal protection.👉 Case writeup

• Abortion care cases – Courts in Alaska (Alaska case coverage) and Montana (Montana case summary) have struck down physician-only restrictions for advanced practice clinicians, showing that such limits are vulnerable when they reduce access to care.

• Title use lawsuits – In California, Palmer v. Bonta challenges the state’s prohibition on DNP-prepared NPs using the title “doctor,” raising First Amendment and professional identity concerns.👉 Background article

What Does Precedent Say?

There isn’t yet binding national precedent that invalidates NP collaboration laws. Courts have gone both ways when asked to strike down licensing rules:

• Cases striking down protectionist licensing:

  • Craigmiles v. Giles (6th Cir. 2002) – invalidated Tennessee’s casket-sales law

  • St. Joseph Abbey v. Castille (5th Cir. 2013) – struck Louisiana’s funeral casket restrictions👉 Opinion summary – St. Joseph Abbey

• Cases upholding licensing restrictions:

  • Powers v. Harris (10th Cir. 2004) – upheld Oklahoma funeral casket restrictions, accepting protectionism as a valid state interest

  • Sensational Smiles v. Mullen (2d Cir. 2015) – upheld dentist-only teeth-whitening law👉 Opinion summary – Sensational Smiles

• Missouri context: In Niang v. Carroll (2018), the Eighth Circuit upheld Missouri’s hair-braiding license law—but the U.S. Supreme Court later vacated the ruling as moot, meaning it no longer blocks future economic-liberty claims.

👉 Case background

Why This Matters

If successful, the Missouri lawsuit could:

• Eliminate collaboration requirements in Missouri, making it a full practice authority state.

• Establish precedent for other restrictive states, especially in the Midwest and South.

• Reinforce the national movement toward granting NPs the autonomy to practice at the top of their license—helping to address provider shortages in underserved areas.

Final Thoughts

This case is one to watch. For decades, the fight for NP full practice authority has largely been a legislative battle. But now, courts are being asked to step in and decide whether forcing NPs to pay physicians for permission to practice is an unconstitutional “competitor’s veto.”

If Missouri joins the list of states with full practice authority through the courts, it could set a new precedent for NP independence nationwide.

📌 We’ll continue to track updates in this case, as well as the related lawsuits in California and Nebraska.