EYES ON THE PRIZE.

• Author: Martin, Edward

An ophthalmologist fights the health-care establishment to get a bigger slice of the outpatient-surgery business.

In a tree-shaded medical park at the bottom of a sharp hill, Jonathan Christenbury focuses on his patient's eyes through the microscope of a laser. A few moments after the patient is rolled in, Christenbury fires the laser. The patient hears a series of ticks but feels no pain. Elapsed time -- 15 to 30 seconds per eye.

Since 1995, here in Charlotte and at clinics in Statesville, Monroe and the Lincoln County town of Denver, Christenbury and his associates, using lasers precise enough to slice an inch into 100,000 slivers, have performed more than 22,000 operations, most for nearsightedness and farsightedness. Even by a conservative estimate, that exceeds $21 million in eye operations. For years, Christenbury Eye Center Inc. of Charlotte grew and prospered, and all was well.

That is, until Jonathan Christenbury proposed to use his eye business as a springboard for an outpatient-surgery center where dozens of doctors would operate -- and not just on eyes. That, his opponents say, is when he got too big for his stitches. The result was a three-year court fight. Christenbury won, but only time will tell if he and doctors like him might still lose the war. The struggle has morphed into an effort to change Tar Heel law that pits doctors against hospitals. At issue is where outpatient surgery, a rapidly growing part of the state's $40 billion in annual health-care spending, will be performed. The business is burgeoning, driven by managed-care pressure to shorten hospital stays, which have fallen by 25% in the 1990s. Technological advances such as the excimer laser that Christenbury uses and ultrasound machines that crush kidney stones from outside the body reduce procedures that once necessitated days in bed to a few hours at an outpatient clinic.

Hospitals have most of the outpatient-surgery business and want to keep it. They argue that centers like the one Christenbury proposes would pick off paying patients, duplicate their buildings and equipment and drive up costs. The state has a certificate-of-need law to prevent that and wielded it to block Christenbury when he wanted to build a Charlotte multispecialty center, anchored by his booming eye business.

At the center of the debate is a square-jawed Charlotte eye doctor whose personal success, health-care insiders say, partly explains why he's a lightning rod. He accuses hospitals of...