The Singleton Lawsuit: A Fight for "Economic Liberty"
Dr. Singleton’s case was built on a simple, frustrating premise: he owns a state-of-the-art surgical facility, but state law forbids him from using it for most surgeries. Because the North Carolina Department of Health and Human Services (DHHS) has not officially declared a "need" for more operating rooms in his area, Singleton is legally forced to perform his procedures at the local hospital.
The cost difference is staggering. Singleton testified that he could perform a cataract surgery at his office for about $1,800, but because of the CON law, the hospital charges patients and insurers nearly $6,000 for the same procedure—primarily due to high "facility fees."
The three-judge panel, however, was not moved by the economic argument. They ruled that the law is constitutional because it serves a "legitimate public purpose": keeping hospitals financially stable so they can provide 24/7 emergency care and charity services to the uninsured.
What is a Certificate of Need?
For those unfamiliar with the red tape, a Certificate of Need is essentially a government permission slip. Under current North Carolina law, healthcare providers cannot:
Build a new hospital or surgical center.
Add more beds to an existing facility.
Purchase major medical equipment (like MRI or CT scanners).
...unless they can prove to the state that the existing facilities in that area are insufficient.
Why It Matters for Western North Carolina
In the mountains, where healthcare access is a constant conversation, the ruling has immediate ripples:
Stalled Projects: Just this month, reports highlighted a "field of dirt" in WNC where a new AdventHealth hospital was slated to open in 2025. The project has been mired in CON-related litigation for years, as competing systems use the law to challenge and delay new entries into the market.
Consolidation Concerns: Critics in Asheville and Buncombe County argue that the law protects large systems like Mission Health (HCA) from smaller, more affordable competitors, contributing to North Carolina being recently ranked as the most expensive state for healthcare in the nation.
The "Monopoly" Debate: The judges noted that "competition" still exists because residents can drive to other facilities in the region, but for many WNC residents, a two-hour drive over a mountain gap is not a viable alternative for care.
The Next Steps: Appeals and the Legislature
This is far from the final word. Dr. Singleton’s legal team at the Institute for Justice has already confirmed they will appeal the decision, likely taking the case back to the North Carolina Supreme Court.
Meanwhile, the battle is moving from the courtroom to the capital. Senate Bill 370, which seeks to fully repeal CON laws by January 1, 2026, has already passed the State Senate and is currently awaiting action in the House. If passed, the legislature could do what the courts refused to: open the doors to a free-market healthcare system in North Carolina.
WNCTimes