CON Laws Have Real Consequences for Real People

When drafting legislation, logical people focus on moral objectivity and statistics to guide their decisions. Anecdotal evidence rightfully takes a backseat. But anecdotes show the result of legislation on real people, and they need to take their proper place in the discussion at some point in the decision-making process.

By their nature, certificate of need (CON) laws stifle competition and restrict options for both medical practitioners and patients. And statistics show that they consistently increase costs, wait times, and commuting distance for both.

Although the logic and numbers speak for themselves, stories of people harmed by CON laws need to be told. They paint the picture for legislators and voters who see numbers as just… numbers. Below are just two notable cases. Both happen to be from Virginia, which as of 2020, had some of the most restrictive CON laws in the country.

Want a non-invasive colonoscopy? We’ll get back to you on that… in four years.

In Virginia, more than a thousand people die of colorectal cancer annually, as reported by Reason. The high rate is attributable to the fact that only half of people who need a colonoscopy screening receive one. They wait until they have unusual symptoms to see a doctor.

By that point, the cancer is often terminal.

The traditional colonoscopy finds abnormalities by using a long physical probe, and this experience is as unpleasant as it sounds. It is painful, time-consuming, expensive, and somewhat risky. 

So when gastroenterologist Dr. Mark Baumel proved he could do an effective and less-invasive virtual colonoscopy with a CT machine, he asked Virginia officials if he could buy the equipment and open the facilities to do so. His request was denied, largely because his competitors complained it would cut into their business.

In 2013, after four years of expensive legal wrangling, Dr. Baumel saw that decision overturned. But in that time, thousands of people suffered and died of colorectal cancer in Virginia.

Ironically, the very government that initially mandated CON laws also touts story after story of people who avoided colonoscopies because of their unpleasant nature, with tragic results. The CDC has interviewed grieving family members who made heartbreaking comments such as, “My mom never got a colonoscopy done until it was too late.”

It also interviewed doctors who pointed out that the cancer can be stopped before it even starts, requiring just the removal of precancerous polyps that can be found by non-invasive methods.

Of course, nobody can determine exactly how many colorectal cancer deaths could have been prevented if Virginia’s CON laws did not exist. But an easy colonoscopy option would certainly have saved time, money, and probably lives. And it could have been available for years.

Virginia CON laws have tragic consequences for a baby.

In 2012, a woman entered LewisGale Medical Center in Virginia at 24 weeks pregnant, suffering from placental abruption. The condition is life-threatening for both mother and child, and it requires immediate intervention in a high-tech neonatal unit.

LewisGale did not have that unit, but not for lack of trying, resources, or qualifications. When it attempted to open such a center two years earlier, the state of Virginia deemed it “unneeded,” per Reason.

LewisGale’s competitors told Virginia they could handle any neonatal emergencies, and they protested the proposed competition from LewisGale. The state of Virginia sided with them, telling LewisGale their neonatal services would not be necessary, and therefore not allowed. 

The baby in this scenario tragically died. 

The high-tech NICU, at Carilion Medical Center, was six miles away from LewisGale, and its special ambulance required to transfer dire neonatal cases was on another call at the time of this incident. By the time Carilion’s ambulance became available, the baby had passed away.

Again, nobody can rightfully claim the baby had any guarantee of survival if treated immediately, but it would be ludicrous to deny that early intervention saves lives. 

Spreading the word could make all the difference. 

People languishing in waiting rooms and on lists often do not even realize their situation results from CON laws. This fact makes collecting anecdotal evidence difficult. But with even minimal digging, it is apparent that many tragic stories of medical failures could be attributed to some degree to laws that intentionally shrink the number of available medical services. 

Hopefully, increased education on this issue will help victims to recognize the nature of the problem. Perhaps they will then be empowered to speak out more often and more effectively in the future.