North Carolina Supreme Court Urged to Review Certificate of Need Dispute

State Treasurer and State Employees Association Back Eye Surgeon's Challenge to CON Law

Apr. 2, 2026 at 2:36pm

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State Treasurer Brad Briner and the State Employees Association of North Carolina are urging the North Carolina Supreme Court to take another look at a six-year-old certificate-of-need dispute involving an eye surgeon who argues the law violates his constitutional rights.

Why it matters

The certificate of need law has been a contentious issue in North Carolina, with critics arguing it raises healthcare costs and limits competition, while supporters say it helps ensure affordable access to necessary medical services. The Supreme Court's decision on whether to hear the case could have significant implications for the future of the CON law in the state.

The details

Dr. Jay Singleton, a New Bern eye surgeon, has been challenging North Carolina's CON law in court since 2020, arguing it prevents him from performing most eye surgeries at his own practice and forces patients to go to a hospital that holds the region's only applicable CON. Briner, the state treasurer, and SEANC have now filed a brief urging the Supreme Court to take up the case, which was previously rejected by a three-judge trial court panel. The judges ruled the CON law is facially constitutional, but Singleton's lawyers say they plan to take the fight back to the state's highest court.

  • The case has been ongoing for six years since Singleton first filed the lawsuit in 2020.
  • In October 2024, the state Supreme Court unanimously ruled that Singleton could move forward with his lawsuit.
  • In December 2022, a three-judge trial court panel rejected Singleton's CON law challenge.
  • Singleton filed a notice of appeal in January 2023 and is now asking the state Supreme Court to hear the case before it proceeds through the Court of Appeals.

The players

Brad Briner

The State Treasurer of North Carolina who has filed a brief supporting Dr. Singleton's challenge to the CON law.

State Employees Association of North Carolina (SEANC)

A labor union representing state employees that has joined Briner in filing a brief urging the state Supreme Court to review the CON law dispute.

Dr. Jay Singleton

A New Bern eye surgeon who has been challenging North Carolina's CON law in court since 2020, arguing it violates his constitutional rights.

Institute for Justice

The law firm representing Dr. Singleton in his legal battle against the CON law.

North Carolina Department of Health and Human Services (DHHS)

The state agency defending the CON law in court.

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What they’re saying

“In theory, some argued, Certificate of Need laws would increase the accessibility, quality, and affordability of healthcare services. However, rather than lowering healthcare costs and improving access to healthcare, the Certificate of Need law has had the opposite effect — it raises costs and diminishes access while effectively prohibiting new providers from entering the market.”

— Lawyers representing the State Treasurer and SEANC

“Determining whether the Certificate of Need law runs afoul of the protections in North Carolina's Constitution, as alleged by Plaintiffs, is an issue of significant public interest justifying this Court's review.”

— Lawyers representing the State Treasurer and SEANC

“We have now complied with that instruction. The three-judge panel appears to have largely adopted the government's legal theories, which remain as wrong today as they have always been. We look forward to taking this fight back to the North Carolina Supreme Court, which we expect will treat the CON law with the genuine skepticism it deserves under the North Carolina Constitution.”

— Joshua Windham, Lawyer, Institute for Justice

“How do less services lead to lower costs? That's contrary to basic rules of economics.”

— Judge Jeffery Foster, Superior Court Judge

“Doesn't that in effect give the hospital a monopoly?”

— Judge Jacqueline Grant, Superior Court Judge

What’s next

The judge in the case will decide on Tuesday whether or not to allow the North Carolina Supreme Court to hear the case before it proceeds through the Court of Appeals.

The takeaway

This case highlights the ongoing debate over North Carolina's certificate of need law, with critics arguing it stifles competition and raises healthcare costs, while supporters say it helps ensure access to necessary medical services. The state Supreme Court's decision on whether to take up the case could have significant implications for the future of the CON law in North Carolina.