Doctor Advocates for Elimination of Certificate of Need Requirements in North Carolina

In the United States, securing a medical appointment can often involve lengthy waits, due in part to the dominance of large hospitals in local markets. This situation has prompted independent practitioners like Dr. Jay Singleton, an eye doctor in North Carolina, to challenge the status quo. Singleton’s plight highlights a different kind of waiting list—one for access to courts as he battles against restrictive government regulations. Recently, he received encouraging news from the North Carolina Supreme Court, which revived his legal efforts against state regulators who serve as gatekeepers for medical services. These regulators enforce Certificate of Need (CON) laws, which exist in various forms across 38 states, including North Carolina, with the aim of controlling healthcare costs and preventing excessive market entry.

CON laws empower state regulators to block new medical facilities or services in areas deemed sufficiently supplied. This means that opening or expanding certain medical establishments requires regulatory approval, which can significantly hinder independent doctors like Singleton. For instance, Singleton is unable to perform most surgeries at his own clinic in New Bern and must instead transport patients to a competitor’s location owned by a major healthcare organization. This bureaucratic hurdle contributes to rising costs and diminishes the availability of healthcare services for patients, ultimately reflecting inefficiencies in the healthcare system.

Singleton’s struggle began when he established his clinic in 2024, and his frustration with the regulatory barriers led him to file a lawsuit in 2020, supported by the Institute for Justice, a public interest law firm. Unfortunately, his legal journey has been long and arduous, with the Wake County Superior Court dismissing his case in 2021 without any evidence being presented, and the North Carolina Court of Appeals upholding that dismissal in 2022. The recent Supreme Court ruling allows Singleton a chance to retry his case, representing a glimmer of hope in the ongoing battle against restrictive healthcare regulations.

Singleton is not alone in facing this bureaucratic challenge, as other healthcare providers across the country have encountered similar obstacles. For instance, Iowa ophthalmologist Lee Birchansky fought for over two decades to obtain permission to perform surgeries at his own clinic. Other notable cases include Virginia’s successful defense against a CON lawsuit from a pulmonologist and a radiologist, and the barring of a home health care service in Kentucky by state regulators. These examples illustrate how CON laws predominantly benefit established healthcare providers, who enjoy reduced competition at the expense of emerging practitioners and, ultimately, patient choice.

The adverse impact of CON laws on healthcare accessibility is evident when considering states that have eliminated such regulations. Research, including studies conducted by Matthew Mitchell at George Mason University’s Mercatus Center, indicates that states without CON laws tend to have greater access to healthcare facilities, including hospitals, surgery centers, and specialized clinics. This suggests that deregulation might improve outcomes for patients, leading lawmakers in several states, including Arizona, Georgia, and Ohio, to scale back their CON laws in recent years. North Carolina has similarly made some adjustments to its CON regulations in 2023, but these changes have not alleviated Singleton’s predicament, leaving him still unable to operate his clinic fully.

Ultimately, the struggle against CON laws is a broader fight for greater access to healthcare and innovation within the industry. The persistence of independent medical professionals like Singleton underscores the need for more equitable regulations that facilitate competition rather than stifle it. As the landscape of healthcare continues to evolve, the advocacy for ending monopolistic practices and enhancing patient access remains crucial, revealing a pressing need for lawmakers and the judicial system to step up and support reform efforts. Singleton’s journey is emblematic of a larger movement pushing for a healthcare system that prioritizes patients over established providers’ interests.