The Richmond Observer – CON diet strikes again, rejecting proposed surgery center
SANFORD – There are plenty of places to eat in your town. There’s no waiting to talk about it either. But the local restaurants just aren’t that appetizing. The food is really not good; the service, less than ideal. So when you crave a good meal out, you and many of your neighbors usually choose to drive across the county border to where the offerings are more to your liking. Updated menus, modern cuisines, excellent service, experience and recipes that hit the nail on the head.
A restaurateur in this neighboring county notices the number of customers who come from out of town. A commitment to service and an eye for opportunity gives the restaurateur an idea: to open another location to serve the market of hitherto itinerant customers where they live. You and your community are excited. Finally, a restaurant worthy of a date in your hometown. Soon you will no longer have to cross the county border.
Or so you thought.
A state government bureaucracy stepped in, denying the restaurant’s building permit and crushing your local umami dreams. As it turns out, all new restaurants must get approval from a government council that determines your community’s true dining needs, and they rejected approval for the potential new restaurant in your city, citing ” a surplus of dining options already available to consumers “. On the board are the owners of those same “dining options” that you carefully avoid whenever looking for a good meal. It looks like you’ll have to keep making this trip for a date.
Of course, that wouldn’t happen in the competitive retail restaurant market. Because, each Bojangles wins a competing Biscuitville; each Chic-Fil-A, a Popeyes. For you, that means plenty of high quality, competitively priced savory options to choose from in your local market. No long distance travel necessary.
This sort of thing regularly happens in the North Carolina health care market under current certificate of need laws. The CON law regulating health care resources in this state has, for decades, placed full authority over new or expanded health care resources – additional beds, new operating rooms, ambulatory care facilities, medical technology. imaging, state-of-the-art medical equipment – in the hands of designated people. bureaucrats, many of whom represent existing suppliers with whom new offerings would compete.
Currently, such a CON storyline is unfolding in Lee County, and it’s already a familiar story. Because it’s basically the same story from above, except that we replace “places to eat” with “places to have your bad knee surgery. “
The Surgical Clinic in Pinehurst, in neighboring Moore County, regularly serves Lee County residents who don’t find their local options for elective surgeries, like knee replacement, as appetizing as Moore’s. Pinehurst Surgical has applied for a Certificate of Necessity to build a new surgery center in Lee, offering all kinds of elective surgeries with the option of night time surveillance.
The North Carolina Department of Health and Human Services denied the request. In issuing the denial, the DHHS cited an existing surplus of operating rooms in Lee County. Yet locals, patients, often avoid these same operating rooms, like those at Central Carolina Hospital, instead of alternatives, such as Pinehurst Surgical, in neighboring communities.
The negative effect reverberates far beyond healthcare, says Jim Womack, who served as Lee County Commissioner from 2010 to 2014.
“[Central Carolina Hospital’s] the reputation is horrible, and it is hurting economic growth and development in Lee County, ”Womack told the Carolina Journal. “There are a lot of people here who would like to see a new hospital or new options.
After a successful career in business with info-tech health systems, Womack says suboptimal health care is often a compromise for businesses looking for a location, families looking to relocate or retirees looking for recreation (and local health resources to keep them recreated on them).
Pinehurst Surgical’s application, if approved, would have enabled the type of facility that enhances these healthcare offerings. Since it was rejected, however, residents of Lee County can continue to travel, and all of those businesses, families and retirees can continue to drive.
“This result is the absurd result of North Carolina’s certificate of need laws,” said Brian Balfour, senior vice president of research for the John Locke Foundation. “At a time when lack of access to care is a growing concern, the CON Act allows state government officials to refuse the construction of medical care facilities that would allow access to patients in need. This is further proof of why North Carolina should abolish all of its CON laws. “
True to form, the bureaucracy that controls who should and should not be allowed to erect or expand health care facilities and resources in North Carolina does not necessarily do so consistently. One hundred miles east, Carteret Health Care requested a certificate of necessity to install a second linear accelerator, a very expensive piece of equipment regulated by the CON for the treatment of cancer, in 2022. In the eyes of the bureaucracy, the combined populations counties of Carteret and Craven – grouped together because of the small population – did not justify such a second accelerator. In this case, Carteret Health Care obtained an exemption and approval, after successfully arguing that it is difficult for cancer patients to drive out of town on a daily basis to be irradiated.
While Lee County residents traveling to the next county for shoulder surgery haven’t quite reached the “need” threshold, enough to accommodate a new surgery center, Carteret Health Care did. In particular, Carteret Health Care is a county hospital, which may be treated differently from groups of private physicians wishing to compete with hospitals by providing communities with better care options.
And why not? While competition can be good for consumers, it is not good for business, prompting hospitals and their industry associations to keep CON and Pinehurst Surgical laws out of Sanford. Exactly, says Balfour, why North Carolina should abolish these laws.
“A free healthcare market would allow local medical providers to decide what medical facilities are needed and where,” Balfour explains. “CON laws serve primarily to limit the supply of medical care, reducing patient options while increasing costs.”
Legal battles continue, although court rulings frustrate CON opponents.
On Tuesday, October 5, the North Carolina Court of Appeals dismissed an attempt to overturn a certificate of necessity decision in Wake County. The appeal judges refused to go beyond their authority to try to close a “loophole” in the CON.
The unanimous decision in Wake Radiology Diagnostic Imaging v. NC Department of Health and Human Services means loss for Wake Radiology. A competitor, the Bone and Joint Surgery Clinic, may retain a state government certificate allowing it to operate a magnetic resonance imaging, or MRI, scan. Wake Radiology has taken legal action to block Bone and Joint’s CON. Wake Radiology had argued that Bone and Joint obtained its certificate without having to go through the standard CON process.