Is One Doctor Finally Going To Defeat North Carolina’s Anti-Competition Laws?

For almost 50 years, North Carolina’s Certificate of Need (CON) laws have restricted patients from receiving care and providers from supplying it. These laws, which enable current healthcare providers to legally prevent any new medical practices from opening, kill competition before it can begin. Consequently, states that enforce them have fewer practicing providers, higher healthcare costs, and longer medical travel and waiting room times.

One North Carolina ophthalmologist, Dr. Jay Singleton, is battling particularly hard to challenge these laws in his state. The North Carolina Supreme Court recently handed him a victory when it agreed to resurrect the ongoing lawsuit he previously waged against state regulators, in which he said the state’s application of the law was unconstitutional. With this renewal, local patients and doctors have another chance to increase healthcare access.

Singleton initially applied for a CON to perform routine eye surgery in his new surgical suite, which was constructed according to all safety regulations. Without the suite, he and his patients were forced to travel to the closest hospital and pay its steep overhead fees, so constructing his own surgery facility and jumping through all necessary legal hoops seemed a worthwhile alternative. After it was finished to code, the only hurdle he faced was proving to the state CON board that the area needed his services. 

Unfortunately, existing providers were allowed to testify at a North Carolina CON hearing, and they convinced the board a new ophthalmology surgical suite was not needed. Despite being a highly qualified and popular doctor with numerous willing patients, his surgery building was deemed unnecessary. In CON states, incumbent healthcare organizations regularly prevent qualified practitioners from operating businesses that meet every safety guideline and are in high demand.

After paying for the suite, CON attorneys, and required paperwork fees, Singleton realized he could spend the rest of his life and all his money without ever getting a certificate. The basic process, even without excessive pushback from competitors, takes approximately 90 days and between $5,000 and $50,000 in North Carolina. With the common legal fights, those figures have no upper limit. 

Singleton had a few options. He could keep waging what would likely amount to a hopeless fight, he could give up and keep performing surgeries at the hospital, or he could challenge the law itself. In 2020, he did just that, but his case has been in legal limbo ever since. Fighting a law that benefits numerous large hospitals is difficult.

Although the trend in the states has been CON reversal, progress is slow. After the 1986 repeal of federal funding laws that made state CON almost mandatory, the relative obscurity of the laws and the power of hospital lobbyists have kept voters from reversing them in 35 states. 

However, Singleton and his patients have renewed hope with the recent revival of his court case. And with the increased attention to the issue, other patients and other providers in North Carolina also have an opportunity to make their voices heard anew. Dr. Singleton has been fighting this battle since 2009, and voters need to seize this chance to pressure their legislators to overturn these laws entirely. 

Fifteen other states have managed to repeal their CON laws. North Carolina could finally join them.