The John Locke Foundation, a Raleigh, N.C.-based, free-market think tank, is supporting a North Carolina ophthalmologists’ challenge to the state’s certificate-of-need laws, according to an amicus curiae brief filed April 1 in the state Supreme Court.
Jay Singleton, DO, owner of Singleton Vision Center in New Bern, N.C., originally filed a lawsuit in April 2020, alleging that under current law, he can only perform an “incidental” amount of surgeries, as state planners believed they had “no need” for his services around New Bern.
Dr. Singleton’s case was first dismissed June 11, 2021, in Wake County Superior Court. On Oct. 18, 2024, the state Supreme Court issued an unsigned, unanimous, four-page ruling that gave the case new life while leaving the question of CON laws’ constitutionality open. Dr. Singleton takes his case back to the high court this week.
In December 2025, a trial court upheld the CON laws, rejecting Dr. Singleton’s challenge.
In the new filings, the foundation asks the state Supreme Court to use Dr. Singleton’s case to address the issues of “tiers of scrutiny” in dealings with constitutional questions in the state’s courts.
Dr. Singleton, alongside lawyers from the Institute for Justice, filed paperwork in March asking the court to review his case, The Carolina Journal reported April 1. He previously filed a notice of appeal in January.
Jon Guze, the Locke Foundation’s senior fellow for legal studies, wrote in the brief that the “tiers of scrutiny” approach had been previously developed by federal courts to manage constitutional adjudication involving the due process clauses of the Fifth and Fourteenth Amendments to the U.S. Constitution.
“Under that approach, the highest level of scrutiny is applied to laws that interfere with fundamental rights. Such laws may only be upheld if the government can show they are necessary to serve a compelling governmental purpose,” he wrote. “The lowest level of scrutiny, on the other hand, is applied to laws that regulate ordinary economic activity. Such laws are presumed to be constitutional unless they are plainly irrational, and — because the governmental bodies that enact such laws are presumed to be in the best position to strike the right balance between individual liberty and the common good — courts are supposed to defer to those governmental bodies rather than make an independent determination about whether the ‘rational basis’ test is satisfied.”
He argues that Dr. Singleton’s CON challenge demonstrates the consequences of state courts “casually” applying federal tiers of scrutiny doctrine to state-specific issues without consideration for their constitutions.
“That practice, which is sometimes called ‘lockstepping,’ can lead to dangerous error, as it has in this case,” reads the brief, which argues that the law has reduced access to healthcare. Singleton’s claims are based on the “Right to Their Labor, Law of the Land, Exclusive Emoluments, and Anti-Monopoly” clauses of the North Carolina Constitution, according to the Journal.
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