J. Justin Wilson
J. Justin Wilson · September 5, 2023

RALEIGH, N.C.—Late last Friday, the Supreme Court of North Carolina agreed to take up a lawsuit challenging the state’s medical monopoly law—known as a Certificate of Need (CON) law—that prevents medical providers from offering services without first obtaining government permission.

“We are eager to bring this case to the Supreme Court,” said Josh Windham, an attorney at the Institute for Justice (IJ), which represents Dr. Singleton. “For too long, medical innovators have been hamstrung by North Carolina’s medical monopoly law. And unfortunately, the courts have so far turned a blind eye to a law that harms patients while padding the pockets of established players. That’s a total abdication of the court’s duty to ensure that laws serve the public. We’re optimistic the Supreme Court will see that for what it is, and strike down this law once and for all.”

The case started at the height of the COVID-19 pandemic, in April 2020, when medical services were in short supply. With IJ’s help, Dr. Singleton filed a lawsuit challenging North Carolina’s CON law as an irrational monopoly. 

For years, Dr. Singleton has wanted to provide low-cost eye surgeries in his own vision center. But North Carolina’s CON law banned him from doing so unless he obtained a certificate proving his services are “needed” in his community. There has not been a new CON available for over a decade. That’s because “need” is not based on what will save patients time or money, but on how many nearby providers already exist—providers who, under the law, get to weigh in on whether they want more competition. As a result, Dr. Singleton is forced to perform most of his surgeries at the far more expensive hospital down the street—the sole entity in his area with a certificate.

During COVID-19, North Carolina briefly suspended its CON laws so that doctors could enter the market and save lives. Now, with the pandemic over, the state’s CON law is back in full force, which means that unless the state declares a “need,” doctors are banned from providing new services that could help real patients.

“For years, the legislature has tinkered around the margins of the CON law without ever fixing the anti-competitive problems with the law itself,” said Dr. Singleton. “So I’m excited the North Carolina Supreme Court is finally going to take my case. The fact that it took so long to get here is just another knock against the CON law. It shouldn’t be this hard to vindicate my basic right to help my patients.”

This case is part of IJ’s effort to ensure that state courts provide meaningful protections for economic liberty, and that they reject laws that merely shield incumbent businesses from competition. IJ currently has similar cases challenging protectionist restrictions on doctor dispensing in Texas and telehealth in South Carolina. IJ successfully challenged an attempt by Georgia to restrict lactation care in the state.