Government Preferences Posted on June 30, 2015

Women’s Surgical Center v. Reese


Last Step

Oral argument before the Georgia Supreme Court.

Next Step

The Georgia Supreme Court will issue a decision.

Executive Summary

At a time of soaring medical costs, health care consumers need options more than ever. The market is responding with lower-cost, higher-quality, customized options. But many states thwart competition and choices through “Certificate of Need” (“CON”) laws designed not to protect the public but rather powerful medical interests.

Medical CON laws were designed to restrict health care spending in order to lower costs. The trouble is, they ended up restricting competition for medical services, driving up prices, stifling innovation and limiting access to care. That is why the federal government did away with its CON requirements in 1986, and why a dozen states quickly followed suit. Still, 36 states and the District of Columbia maintain these anti-competitive systems that jack up the prices of every medical procedure they regulate. Unfortunately, Georgia is one of the worst offenders.

Dr. Hugo D. Ribot Jr., M.D. and Dr. Malcolm Barfield, D.O. found out firsthand how counterproductive Georgia’s CON laws can be.

Dr. Ribot and Dr. Barfield are OB/GYNs who co-own an outpatient surgery center in Cartersville, Georgia. Between the two of them, they provide non-emergency surgical services to hundreds of Georgians and also deliver hundreds of babies each year. In October 2014, they decided to expand their surgery center to serve more patients by adding a second operating room and by allowing other surgeons to use their state-of-the-art facility. More doctors and more operating rooms mean flexibility to schedule more patients, increased efficiency, and better access to care. But first they had to get past Georgia’s CON laws.

Even though other doctors had asked to use the surgery center, before Dr. Ribot and Dr. Barfield could open their doors to more patients, they had to spend thousands of dollars and countless hours to prove that there is a “need” for more surgical services in the Cartersville area. They also had to overcome opposition from their competitors—existing hospitals in the surrounding area—that filed statements opposing the doctors’ CON application.

After six months of waiting, in March 2015, the Georgia Department of Community Health protected the existing hospitals from competition and denied the doctors’ CON application. The bureaucrats decided that because Dr. Ribot and Dr. Barfield were not using their operating room to capacity, they could not allow other surgeons to use the operating room, or add a second operating room to provide more scheduling flexibility.

This Goldwater Institute lawsuit seeks to end the CON program in order to enable patients to get the healthcare they need and to prevent medical practitioners from wasting thousands of dollars and countless hours trying to prove “need” to the State before they are allowed to offer their services to the public.


Case Logistics


  • Women’s Surgical Center, LLC d/b/a Georgia Advanced Surgery Center for Women
  • Dr. Hugo D. Ribot Jr., M.D.
  • Dr. Malcolm Barfield, D.O.


  • Clyde L. Reese III, Esq., Commissioner of the Georgia Department of Community Health
  • Rachel L. King, Esq., Health Planning Director, Georgia Department of Community Health


Superior Court of Fulton County, Atlanta



Relief sought

We are asking the Georgia courts to strike down Georgia’s medical CON laws so that licensed doctors are able to offer their services to the public without first complying with anti-competitive restraints.

Date filed

June 30, 2015


Case Documents

Complaint for Declaratory Judgement and Injuctive Relief (6/30/2015) (141.0 KB)

Response to Petition(2/4/2016) (484.8 KB)

Amcius brief of Pacific Legal Foundation.pdf (111.2 KB)

Amicus Brief of Georgia Alliance of Community Hospitals.pdf (170.1 KB)

Governments brief.pdf (5.1 MB)

Governments Cross-Appeal Brief.pdf (4.4 MB)

Plaintiffs Opening Brief.pdf (398.1 KB)

Plaintiffs Response Brief.pdf (78.9 KB)

Second Amicus brief of Georgia Alliance of Commuinty Hospitals.pdf (170.1 KB)


Local  Counsel

Glenn Delk graduated from Vanderbilt Law School in 1976.  Since then, Mr. Delk specialized in civil dispute resolution and litigation in state and federal courts, with an emphasis on corporate and securities litigation, representing brokerage firms, companies and individuals.  Mr. Delk has an “AV” rating from Martindale Hubbell, the highest rating possible and has received that rating for the last twenty years.



Jim Manley is a senior attorney at the Goldwater Institute’s Scharf-Norton Center for Constitutional Litigation. Jim litigates Goldwater Institute cases nationwide, in the areas of free speech, economic liberty, and ... Read

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