Teladoc, Inc. v. Texas Medical Board

Teladoc, Inc. (plaintiff) was a telehealth-services company that operated by employing board-certified physicians (plaintiffs) to provide virtual consultations and prescribe certain medications for treatment. In 2003, the Texas Medical Board (TMB) (defendant), the state agency responsible for regulating the practice of medicine, established Rule 190.8, which prohibited physicians from prescribing any controlled substance without first establishing a physician-patient relationship. The rule clarified that a professional relationship included establishing a diagnosis by using acceptable medical practices, such as a physical examination. In 2010, TMB established Rule 174, which clarified that for telemedicine providers to establish a physician-patient relationship, the provider must first conduct a physical examination. TMB then sent Teladoc a letter stating that Rule 190.8 required a face-to-face examination. In response, Teladoc sought an injunction to prevent TMB from interpreting Rule 190.8 to require a face-to-face examination. The trial court ruled for Teladoc, explaining that TMB’s interpretation in the letter was essentially an amendment to Rule 190.8 because the old rule was written in such a way that a physical examination was given as an example of an acceptable medical practice rather than a requirement. Following the ruling, TMB issued an emergency rule to amend Rule 190.8 to require a face-to-face examination and then finalized the rule through the formal rulemaking process. Teladoc then filed suit, asserting that Rules 190.8 and 174 violate antitrust law and the Commerce Clause. TMB motioned to dismiss the case on the grounds that the antitrust claim is barred by the state-action-immunity doctrine and that Teladoc failed to state a claim under the Commerce Clause.