Doctor Fighting to Break Certificate of Need Barrier in North Carolina
Getting a medical appointment can take weeks or months in the United States, where big hospitals dominate local markets. Independent eye doctor Jay Singleton is trying to break up such a cartel in North Carolina, where he operates.
Singleton’s case is urgent, but he has been stuck on a different type of waiting list for years. Instead of health care access, he’s been fighting for court access. He had good news this month when the North Carolina Supreme Court revived his lawsuit against the state regulators who function as gatekeepers for the entire industry.
Certificate of need (CON) laws exist in various forms in 38 states and Washington, D.C. The stated goal of such laws is to keep costs down by preventing overinvestment in any single market. If regulators decide an area already has enough of any type of service, they can block new construction.
As a result, nobody in North Carolina can open or expand certain medical facilities without these regulators’ permission. Even purchasing an MRI scanner without their approval can be illegal. These restrictions prohibit Singleton from using his own clinic in New Bern for most of the surgeries he performs. He must drive two miles up the road to a competitor’s office, as it is owned by a major health care player. This unnecessary red tape increases costs and decreases scheduling options, and patients suffer.
Singleton has battled this scheme since he set up his clinic in 2024. Frustrated by a wall of bureaucracy and lack of progress, he sued in 2020 with representation from our public interest law firm, the Institute for Justice.
Getting to trial has not been easy. Wake County Superior Court tossed out his case in 2021 without discovery or witness testimony, and the North Carolina Court of Appeals upheld that decision in 2022. The state Supreme Court ruling simply allows Singleton to go back and try again.
Singleton is not alone in this struggle. The Iowa ophthalmologist Lee Bir
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