Locke Backs Doctor's Challenge to NC Certificate-of-Need Law

The John Locke Foundation files brief supporting eye surgeon's fight against state's healthcare regulations.

Apr. 1, 2026 at 8:10pm

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The John Locke Foundation is supporting a New Bern eye surgeon's challenge of North Carolina's certificate-of-need law with a new filing at the state's highest court. Dr. Jay Singleton argues the CON law violates his constitutional rights by preventing him from performing most eye surgeries at his own practice, forcing patients to use a hospital that holds the region's only CON and resulting in much higher bills.

Why it matters

North Carolina's CON law acts as a government permission slip, requiring healthcare providers to obtain a certificate before building facilities, adding beds, or purchasing expensive equipment. Critics argue these regulations drive up costs and limit patient choice, while supporters say they help control healthcare spending. Singleton's case could lead the state Supreme Court to reconsider how it evaluates the constitutionality of economic regulations.

The details

Singleton, working with the Institute for Justice, filed paperwork in March asking the North Carolina Supreme Court to take a second look at his case after a three-judge trial court panel rejected his CON law challenge last December. The John Locke Foundation and constitutional scholar John Orth filed a brief supporting Singleton, arguing the lower courts erred in applying a 'tiers of scrutiny' approach that presumes economic regulations are constitutional unless 'plainly irrational.' Instead, Locke says Singleton's claims are based on fundamental rights protected by the state constitution, which should trigger heightened judicial scrutiny.

  • Singleton first filed his lawsuit against state regulators in 2020.
  • In October 2024, the state Supreme Court unanimously ruled Singleton could move forward with his case.
  • In December 2025, a three-judge trial court panel rejected Singleton's CON law challenge.
  • Singleton filed a notice of appeal in January 2026.

The players

Dr. Jay Singleton

A New Bern eye surgeon challenging North Carolina's certificate-of-need law, which he argues violates his constitutional rights by preventing him from performing most eye surgeries at his own practice.

John Locke Foundation

A North Carolina think tank that has long opposed the state's CON law and is supporting Singleton's legal challenge with a new filing at the state Supreme Court.

Institute for Justice

A national law firm representing Singleton in his case against North Carolina's CON regulations.

John Orth

A retired University of North Carolina law professor and constitutional scholar who filed a joint brief with the John Locke Foundation supporting Singleton's challenge.

North Carolina Department of Health and Human Services

The state agency regulating healthcare facilities and equipment through the certificate-of-need program that Singleton is challenging.

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What they’re saying

“Locke has opposed North Carolina's Certificate of Need (CON) Law for many years, not only because it is unconstitutional and violates the rights of North Carolinians, but also because it directly harms patients, employers, insurers, and taxpayers by making health care more expensive and less accessible.”

— Jon Guze, Senior Fellow for Legal Studies, John Locke Foundation

What’s next

The North Carolina Supreme Court will decide whether to take up Singleton's case and reconsider the lower courts' application of the 'tiers of scrutiny' approach to evaluating the constitutionality of the state's CON law.

The takeaway

This case highlights the ongoing debate over the proper role of the courts in reviewing economic regulations like North Carolina's certificate-of-need law. The outcome could set an important precedent for how the state's highest court evaluates challenges to laws that restrict individual rights and economic freedoms.