CON Job: How a Little Known Law Prevents Access to Healthcare

Our story begins on a day in February
2012. Dr. John Harding was on call at LewisGale Medical Center in the
obstetrics unit in Salem, Virginia and a patient that he knew who came in she was
bleeding she was in pain she had a very dangerous medical condition that can be
fatal for both mother and child. Dr. Harding and his colleague took this
woman into one of the operating rooms and he said that he knew as soon as they
got in the room that the only chance this baby had at surviving was to get to
a neonatal intensive care facility as quickly as possible. Now there isn’t one
of those at LewisGale Hospital and the reason is that the state government had
told LewisGale that they weren’t allowed to build a neonatal intensive care unit
because the other hospital in the next town over opposed their application,
opposed the potential for more competition for their own neonatal
intensive care unit and unfortunately the baby at LewisGale didn’t make it. The application that LewisGale medical center filed was for a certificate of need. Certificates of need have no relation to health or safety
they simply dictate who can offer new medical services in a given area. The
medical provider has to prove to the government that there is a need for
those services. These laws were originally intended to control health
care costs, but over 30 years ago the federal government realized that
certificates of need do not reduce healthcare cost and it eliminated all
federal funding for them. Virginia isn’t the only state to require a certificate
of need. 34 states still have some kind of certificate of need requirement and
these requirements stifle medical entrepreneurs who want to offer
increased patient access to affordable medical care. One of these entrepreneurs
is Dr. Lee Birchansky an ophthalmologist from Cedar Rapids Iowa. When I came to Cedar Rapids back in 1991 I wanted to bring latest technologies
and services available for my patients. The thing that Cedar Rapids was lacking
was outpatient surgical facility adjacent to an ophthalmology practice
and in 1998 I would build a new building that would have my medical practice
on one side and an outpatient surgical facility on the other side and the only
way to get that up and running is to apply for a certificate of need so I
applied and I was denied through a hospital opposition.
Shortly thereafter I applied again and was denied about four or five
years later I applied for a certificate of need and was denied. I gave up after that
now hospitals are able to open an outpatient surgical facility without
going through this certificate of need process because there’s a loophole that
allows them to do so and what was more disappointing is that I’m denied and then
they go ahead and build additional operating rooms. Certificate need is
mainly in place to protect the existing facilities from competition.The
outpatient surgical facility has been vacant for many years now. It’s
ridiculous that I have a cataract surgery center that’s already built,
already equipped, all ready to go and I’ve applied for a certificate of need four
times. I’ve been denied every single time because the opposition does not want competition. Dr. Birchansky is teaming up with the Institute for Justice to file a federal lawsuit to protect his right to offer innovative, safer and less costly
medical procedures to Iowa patients. Absolutely I should have the right to do
cataract surgery in my own facility and my patients should not be denied a
more convenient more cost-effective setting


  1. This is insane. He's not using government money to set up the clinic, so why is there a process to prove whether or not something is "needed"? I understand if he wanted to pave a road using state funding, and had to prove that the road was needed in order to justify the cost to taxpayers. But this is a doctor's office. Competition is ALWAYS needed in any industry, especially the medical industry.

    If you have 17 Chinese restaurants on one street, then only the very best will stay in business and the rest will fail. There's no reason to prove that 17 Chinese restaurants aren't needed on a single street. The market itself will get rid of the excessive ones, and the necessary and desired restaurants will remain.

    If an extra doctor's office is not needed, then he will not make any money and the market demand itself will take care of the problem. No litigation or special process required.

  2. The injustice runs rampant now. As those in hospital harm us, harmed me, killed my cousin, rubbed their hands together to get a friends daughters organs. Curing doesn't profit.

  3. this is against competition, which contradict the essence of free market, which is the soul of USA.

  4. Most laws used to protect something, the greedy will somehow figure out how to use for their own evil gain, and since the government couldn't give less of a shit, they allow it to remain since they get to line their pockets. For instance, the law that allows corporations to declare personhood stems from a law intended to allow persons to sue corporations as if they were a person. In England, where the government actually cares even 10% of the time. It is effective. Here, it's used for corporations to act like a citizen when convinent, and as an entity when it is not.

  5. Or instead of viewing health care as competition why not view it as cooperation, then this would not have happened. The middle ages never had problems like these because they had the guild system, but of course the technology back then was more primitive than today.

  6. I’m gonna go out on a limb here and say the “One Dislike 👎🏻” up above is the hospital that opposes the doctor opening his operating clinic.

  7. wow, whatever happened to capitalism, i thought the whole point of capitalism is that u can open up a business and be your own boss and provide services that people WANT. if people want something and u are able to provide it for money hence capitalism u should be able too especially if u have the liscence to do so and should not be denied a cerificate of need if u have patients in your area that need these services. this doctor seems to really want to help his patients but cant and its a shame.

  8. Introduce a single payer system already! That will remove the profit driven madness we see today, where hospitals and insurance companies are willing to go to any length to save a buck or make a buck.

  9. Wow, thank god I didn't die in Montana. That's scary to know that I was practically by luck that I was able to get to the hospital soon enough, or even I would of been dead from birth.

  10. wow, CA is actually one of the states that doesn't have these certificates. I'm impressed, they actually have something good 😛

  11. Someone says, "This is just COMMUNISM!"
    No. That's if the state of Iowa or the Feds owned the hospital.
    This is Crony Capitalism, which is the most common form of capitalism in the US, just about every industry. This is just a particularly overt example of it.

  12. You cant charge an institution for manslaughter, in fact doing so would raise scary precedents over indirect death. But that one lost life should be enough to say, "Our rules are not working for the welfare of the people and should be changed".

    Hospitals need some profit to stay afloat, but that profit should never be at the expense of the people. There needs to be far reaching changes in the healthcare industry, a single payer system sounds like a catch all but its not the only solution.

  13. I'm less more amused and more dismayed when I realized most of those states are in the south and are traditionally conservative leaning.
    All hail the all mighty dallah, eh?

  14. I got a question, how did the competing hospitals no at this guy applied for a permit. So I guess the first thing that happens after you file for the permit is that the city employees contact any possible competition and let them know you're attempting to start your business. So the existing business gets to decide. I'm telling you things just get more screwed up every single day

  15. God bless that mother and I know your holding that child in heaven, but please rain down hell on those responsible for the death of that child and the suffering of the mother!!!!!
    Every hospital should have exactly what's needed for every case, and in a lot of circumstances, just like this one, the patient doesn't have the time it will take to get to another county or city hospital, this has nothing to do with compassion, and everything to do with greed!!!!!!!!

  16. Bear in mind, the hospital will also add a "facilities fee" to any billing, which an independent ophthalmologist will not be able to do.

    So the service performed in the hospital…….or any hospital-associated clinic…….will be significantly more expensive than the service performed in an independent clinic. For a general medical medical service, office visit, that sort of thing, the "facilities fee" about doubles the price. I've seen that mentioned in news articles about that, in news and radio stories on the subject, coast-to-coast, national papers, regional papers, national radio, etc., and it reflects my own experience as well, when my own doctor went from independent practice to hospital employment. Same service, the fee doubled.

    So the CON allows the hospital to FORCE you to pay more for their service.

  17. We had the same thing happen to our town. The world's sick and our wealthcare system is one of the major symptoms. Until we tell the money junkies that we no longer honor their fiat fake currency as even trade for our labor and refuse to accept it and demand REAL MONEY printed by our GOVT and not private banks then it will only get worse and worse until we won't have any MONEY available to us, only digital credits that are totally controlled by the whims of those who have the access to the networks that pass the credit points around. THINK people!! This is not just today but look at all the children and THINK of their lives too!

  18. This is proof that all bureaucracy must be forced squarely under the boot of our elected officials. We also need to carefully watch and retract laws such as the piece of stupidity revealed in this video. No bureaucracy ever has the right to make and enforce its own laws and regulations without being approved one at a time by our duly elected representatives. No legislature has the right to pass laws which run counter to the public good or in favor of economically interested minorities over other groups. Equal justice under the law means exactly that. No exceptions.

  19. If you dig deep enough you will find that the state is the one preventing you from advancing. People are waking up from state government corruption.

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