Hines v. Quillivan, 688 F.Supp.3d 522

Ronald Hines, a Texas-licensed veterinarian, provided individualized veterinary advice via his website and email without performing physical exams; Texas law requires a physical exam or on-site visit to establish a veterinarian–client–patient relationship.
The Texas Board disciplined Hines in 2013 for practicing veterinary medicine without a physical exam; Hines brought suit challenging the Examination Requirement as a First Amendment violation.
The Fifth Circuit (Hines I) initially relied on the professional-speech doctrine to uphold regulation, but the Supreme Court’s NIFLA decision rejected that doctrine, prompting renewed litigation (Hines II) and remand to determine whether the law regulates speech or conduct.
On remand, the district court held that, as applied to Hines’s email-based practice, the Examination Requirement regulates speech but is content neutral, and thus subject to intermediate scrutiny.
The court concluded the Board produced evidence of real harms from telemedicine without exams and that the Examination Requirement is narrowly tailored to materially alleviate those harms; summary judgment was granted for the Board and Hines’s First Amendment claims were dismissed with prejudice.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standing to bring pre-enforcement First Amendment claim	Hines: prior discipline + ongoing activity = injury; law chills speech or poses a credible threat	Board: no chilling shown because Hines continued to communicate; no standing	Court: Hines has standing—past enforcement, continued risk, and redressability satisfied
Does the Examination Requirement regulate speech or conduct (as-applied)?	Hines: his activity is purely communicative (emails) so the statute regulates speech	Board: statute targets non‑expressive conduct (physical exam) and discipline can attach regardless of communication	Court: As-applied to Hines, the statute regulates speech because enforcement is triggered by his communications
Is the regulation content-based or content-neutral?	Hines: application requires reading content, so strict scrutiny should apply	Board: law is topic-agnostic and applies to all veterinary advice, so content-neutral	Court: content-neutral — Board reviews emails only to identify whether veterinary advice occurred; intermediate scrutiny applies
What level of scrutiny and does the law survive?	Hines: even under intermediate scrutiny, the Requirement is not narrowly tailored and lacks evidence of real harm	Board: intermediate scrutiny applies and the law substantially advances important interests	Court: intermediate scrutiny applies; Board showed real harms and material alleviation; law survives

Nat’l Inst. of Family & Life Advocates v. Becerra, 138 S. Ct. 2361 (2018) (rejected a distinct professional‑speech doctrine and clarified content‑based/content‑neutral inquiry)
Holder v. Humanitarian Law Project, 561 U.S. 1 (2010) (as‑applied analysis where statute regulating services was found to restrict communicative conduct)
Reed v. Town of Gilbert, 576 U.S. 155 (2015) (content‑based restrictions require strict scrutiny)
United States v. O’Brien, 391 U.S. 367 (1968) (intermediate scrutiny test for regulations of expressive conduct)
Cent. Hudson Gas & Elec. Corp. v. Pub. Serv. Comm’n of N.Y., 447 U.S. 557 (1980) (commercial‑speech intermediate scrutiny framework)
Hines v. Quillivan (Hines II), 982 F.3d 266 (5th Cir. 2020) (remanded for district court to determine whether regulation targets speech or conduct after NIFLA)
Vizaline, L.L.C. v. Tracy, 949 F.3d 927 (5th Cir. 2020) (recognized that NIFLA abrogated professional‑speech reliance)
Lujan v. Defenders of Wildlife, 504 U.S. 555 (1992) (standing requirements)
Susan B. Anthony List v. Driehaus, 573 U.S. 149 (2014) (pre‑enforcement standing and credible threat of enforcement)
NetChoice, L.L.C. v. Paxton, 49 F.4th 439 (5th Cir. 2022) (content‑neutral time, place, or manner analysis)