In 2022, Katie Chubb tried to open a birth center in Augusta, Ga., that would offer women the choice of midwifery-led maternity care outside of a hospital setting. She followed the rules, built a business plan, found investors, and sought to meet a growing need for safe maternity care in her community, where the rate of pregnancy-related deaths ranks higher than in some third world countries. But before she could open her doors, she ran into Georgia’s certificate of need (CON) laws, which require government permission before a health care provider can open or expand a facility.
One requirement of Georgia’s CON laws is a hospital transfer agreement. However, such emergency transfers are rare, and federal law requires hospitals with emergency departments to accept any patient who seeks care. All three Augusta hospitals refused to enter into an agreement with Chubb, who, after all, would be their direct competition. With the help of the Pacific Legal Foundation, Chubb sued, challenging a warped system that allows entrenched hospitals to veto new providers and limit patient access to health care services.
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