New Bern ophthalmologist Dr. Jay Singleton has spent more than two decades performing eye surgeries at CarolinaEast Medical Center. After investing in equipment and renovations at his own vision center, he discovered that state law barred him from offering outpatient procedures without a certificate of need – a permit the Department of Health and Human Services has never granted for his area.
Legal battle highlights monopoly concerns
In April 2020, Dr. Singleton sued the state, claiming the certificate‑of‑need (C.O.N.) program violates North Carolina’s constitutional protections against monopolies and special privileges. His complaint argues that the law “protects established providers from competition” by reserving certificates for hospitals.
The case has bounced through the courts. A trial judge dismissed the suit in 2021, but the state Supreme Court reversed, noting that the challenge was facial – it questioned the law itself, not just Singleton’s situation. After a three‑judge panel sent the case back to a lower court, a Wake County panel upheld the law in December 2025. The appeal now rests with the North Carolina Court of Appeals.
Other physicians have faced the same barrier
Singleton is not alone. In 2018, Winston‑Salem surgeon Dr. Gajendra Singh sued over the same law after he could not purchase a fixed MRI scanner without a C.O.N. He resorted to renting mobile units, which raised costs for patients. Singh’s case faltered after he closed his imaging center for financial reasons.
Both lawsuits underscore a broader pattern: the C.O.N. program often forces doctors to rely on costly workarounds or to abandon services altogether, limiting patient choice and keeping prices high.
Legislative reform gains traction
State Senator Benton Sawrey, a Republican from Johnston County, has emerged as a leading advocate for reform. After serving as local counsel on Singleton’s case, Sawrey was elected to the Senate in 2022. In April 2025 he sponsored a bill that would repeal nearly every aspect of the C.O.N. law. The measure cleared the Senate with unanimous Republican support and two Democratic votes (Senators Julie Mayfield and Dan Blue). Although the bill stalled in the House, its passage in the Senate signals growing bipartisan appetite for change.
Democratic supporters argue that the current system has delayed needed hospital projects in fast‑growing regions. Sen. Mayfield, representing Buncombe County, said the C.O.N. process has prevented competition for Mission Hospital in her district, hindering access to care.
Regional context and future outlook
North Carolina’s C.O.N. program is among the most restrictive in the nation, requiring reviews for 23 types of medical services. Neighboring states such as Tennessee and South Carolina have already rolled back portions of their own programs, and New Hampshire fully repealed its law in 2016.
Legal scholar Renée Flaherty of the Institute for Justice, which has backed both Singleton’s and Singh’s cases, believes a successful challenge could set a precedent for other states. “We hope the Supreme Court will take up the case within a year,” she said, noting that past challenges at the federal level have largely failed.
For patients in Craven County and across North Carolina, the outcome could mean more doctors offering affordable outpatient procedures locally, reduced reliance on hospital monopolies, and greater competition that drives down costs.
What’s next?
The Court of Appeals will issue a ruling later this year. If the decision favors the plaintiffs, the case is likely to return to the state Supreme Court. Meanwhile, legislators are expected to introduce new reform bills in the 2027 session, building on the momentum from the 2025 Senate vote.
North Carolinians who value choice, lower healthcare costs, and competition should watch the upcoming court decisions and legislative proposals closely, as they will shape the state’s healthcare landscape for years to come.
Original reporting: Carolina Public Press — read the source article.
