Opinion: Daily Journal

N.C. Certificate of Need laws cause real pain

Arbitrary limits on access to treatments lead to needless suffering and inconvenience, even for patients who aren't facing mortal illnesses

Kidney stones.

They’re not life-threatening, and I’ve never had one, but people who have tell me it’s awful. And to judge from the way my husband was writhing in pain, saying he wished someone would just kill him, I believe it’s bad. My husband has a condition that means he’s prone to kidney stones. This wasn’t the first one. It won’t be the last. That’s why he knew straightaway what this pain was. At the ER, they started pumping him full of drugs to get the pain under control.

Then they did a CT scan and, sure enough, there it was — a big, 8 x 7 x 10mm kidney stone. Sometimes, if you just wait it out, kidney stones will pass on their own, but not one as large as that. No, this was going to require some sort of intervention.

Next stop was the pharmacy, where we got two different pain medications, including one opioid, and a third drug for nausea. Then home to wait for an appointment with the urologist Monday afternoon. That was where it really started to get interesting.

There are options for treating kidney stones. Given one the size of his, there were really two choices. One was to go up into the kidney with a scope, clear it out, and insert a stent that would need to stay in for a few days. It’s effective, but it’s also invasive and just generally unpleasant. It also has a longer recovery time.

The other option is lithotripsy, or what I’ve been calling “shockwave therapy.” It’s totally non-invasive. The patient doesn’t even have to be knocked completely out, and they use high-energy shock waves from outside the body, focused on the stone, to break the stone up into tiny bits that can then be passed naturally.

Either one of these options is effective, but I don’t know anyone who wants a scope inserted if he can avoid it. So my husband opted for the lithotripsy. The problem? That procedure wasn’t available for eight days.

That’s right. Eight days.

You can definitely live eight days with a kidney stone. It’s not going to kill you. It would take about six weeks before it would start to damage your kidney. But it hurts. A lot. The pain has to be managed with drugs. In the middle of an opioid crisis, my husband is taking an opioid for more than a week, which would be avoidable if he could have the procedure more quickly. The drugs mean he can’t drive, so I’m shuttling him back and forth.  Because he has an office job and accommodating employers, he can continue to work, but that wouldn’t be possible if he had a job involving physical labor. He’s having to limit his activities outside of work. It’s just generally painful and inconvenient.

And why the delay? It’s not that the doctor wasn’t available. No, he could have done the more invasive procedure this week. The problem was that Duke, a large, major hospital in a major metropolitan area, doesn’t have its own lithotripter. They get a mobile unit one day every few weeks, a unit they share with multiple other practices in cities all over central and eastern North Carolina.  And they can’t just buy another machine. No, North Carolina’s Certificate of Need law requires that companies get a permission slip from the state to buy lithotripters and a number of other types of equipment. The company that provides the mobile lithotripter to Duke applied last year to the state for another machine. So did a company serving western North Carolina. The state only approved one, so the company that serves Wake county lost out.

Had North Carolina not had a Certificate of Need law, my husband might have had his lithotripsy earlier and been well on his way to full recovery. We’d not be refilling opioid prescriptions and limiting physical activity. That would be better for everyone. The delay is artificial, created by an antiquated system that lets bureaucrats, rather than doctors and hospitals, make decisions about how much equipment is needed.

We’re lucky. The delay that my husband experienced has been mostly inconvenient and painful, but not dangerous. But that’s not always the case. It’s time to get rid of CON laws that get in the way of doctors and hospitals offering the best care to their patients.

Julie Tisdale is city and county policy analyst at the John Locke Foundation.