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In May, a Powell County paramedic saved snake expert Jim Harrison’s life after a bite from a Jameson's mamba. Harrison called for emergency transport, but before the helicopter arrived, local paramedic Eddie Barnes acted swiftly to assist.
Harrison, who keeps his own antivenom on hand because time is critical following a snake bite, begged Barnes to administer the antidote, saying he would die without it. Out of caution, Barnes called Clark Regional Medical Center, where an emergency room doctor granted him permission to administer the antivenom.
Instead of celebrating Barnes, the Kentucky Board of Emergency Medical Services notified him that his emergency medical services (EMS) license was at risk of revocation. Following a rule change two years ago, only wilderness paramedics are permitted to administer antivenom in Kentucky.
Thankfully, the board dismissed Barnes’ case. But the fact that an EMS responder could be hauled before regulators for doing the right thing underscores how rigid rules can clash with patient care. Using occupational licensing regulations to prevent providers like Barnes from performing tasks for which they are trained is illogical, even dangerous.
Certificate of need laws reduce patient access to care
Similarly, certificate of need (CON) laws make it difficult or impossible for providers to offer new health care services in Kentucky. These laws, which restrict providers from opening facilities or expanding services, reduce patient access to care and can endanger lives.
In 2017, entrepreneur Philip Truesdell and his family founded a non-emergency medical transport company just over the border in Ohio to assist patients in traveling to appointments or between facilities. It was easier for Truesdell to start his company in Ohio because the Buckeye State doesn’t have CON laws for medical transport.
Truesdell began receiving calls from Kentucky patients unable to access care only to learn he couldn’t help them without a CON from the Kentucky Cabinet of Health and Family Services.
Applying for a CON in Kentucky is a costly drawn-out process, with competitors often using the process to protest applications and block new entrants. This is devastating for the hundreds of Kentucky residents requesting Truesdell’s medical transport services every year.
The federal government agrees CON laws do more harm than good
Proponents of CON laws claim health care providers need monopoly power to remain financially viable. However, nearly 40% of the U.S. population lives in a state with no — or limited — CON laws, allowing economists to compare outcomes. As expected, restricting health care supply increases costs, reduces access and lowers quality.
The federal government agrees: Every presidential administration since Reagan’s has urged states to curtail CON laws, which are particularly harmful in rural and underserved areas desperate for more care. Patients and providers — not government officials — should decide when care is needed.
Regulation should empower, not restrain, frontline providers
While in the end, no licenses were lost or careers ruined in Powell County, Barnes’s case highlights a broader issue: regulation should empower, not restrain, frontline providers. Rigid laws like CON mandates share the common flaw of prioritizing bureaucracy over patient outcomes.
States are taking notice. Since 2023, Georgia, North Carolina, South Carolina, Tennessee and West Virginia have reformed their CON laws. Earlier this year, Kentucky lawmakers took a step forward by repealing a CON law for birthing centers. More work remains.
Legislators must continue to evaluate whether these laws serve constituents or merely protect the status quo. When laws threaten those who save lives, they must be reformed.
Jaimie Cavanaugh is state policy counsel at Pacific Legal Foundation. Caleb O. Brown is CEO of the Bluegrass Institute.
This article first appeared at the Louisville Courier-Journal.
