Payton v. Weaver

Citations: 131 Cal. App. 3d 38; 182 Cal. Rptr. 225; 1982 Cal. App. LEXIS 1535Docket: Civ. 50094

Court: California Court of Appeal; April 26, 1982; California; State Appellate Court

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Brenda Marie Payton, a 35-year-old black woman suffering from chronic end-stage renal disease, must undergo hemodialysis multiple times a week to survive. She faces significant personal challenges, including living alone in low-income housing with no family support, a history of drug and alcohol addiction, and emotional issues. Despite these obstacles, Brenda is portrayed as a sympathetic and articulate individual who values her dignity and independence. 

Dr. John C. Weaver, her nephrologist since 1975, has provided continuous care since her kidney transplant rejection following the birth of her twins. However, due to Brenda's consistent uncooperative behavior, refusal to follow medical guidelines, and drug use, Dr. Weaver formally ended her treatment at his facility, Biomedical Application of Oakland, Inc. (BMA), in a letter dated December 12, 1978. He cited her actions as disruptive to the treatment program. Despite attempts to seek dialysis at other hospitals, Brenda faced refusals, and Dr. Weaver continued to provide emergency treatment until he officially notified her on April 23, 1979, that he could no longer treat her on an outpatient basis.

Brenda filed a petition for mandate to compel Dr. Weaver, BMA, and Providence to continue her outpatient dialysis services, leading to a stipulated order that required her to meet specific conditions: attending all appointments on time, abstaining from drugs and alcohol, adhering to dietary guidelines, cooperating with care providers, and following her physician's medical regimen. A sixth stipulation mandated her participation in regular psychotherapy or counseling. Despite ongoing treatment, Dr. Weaver notified Brenda on March 3, 1980, that her treatment would be terminated due to her failure to comply with these conditions, providing her with alternatives for care.

Brenda subsequently initiated a second petition for writ of mandate against Herrick and Alta Bates Hospitals, claiming they wrongfully denied her regular dialysis and violated Health and Safety Code section 1317 by failing to provide emergency treatment. She also alleged discrimination based on race and indigency, which the trial court dismissed as unsupported. Following a lengthy evidentiary hearing, the trial court determined that Brenda violated all conditions of the stipulated order. Evidence showed she purchased barbiturates regularly, failed to follow her diet, was frequently late or absent for appointments, had numerous hospital emergencies, appeared intoxicated for treatment, and discontinued counseling. Her behavior was characterized as grossly non-cooperative, disruptive to other patients, and detrimental to the treatment environment. The court found her actions intentional and detrimental not only to herself but to fellow patients and staff.

The trial court determined that Brenda's behavior during treatment was disruptive and abusive, infringing on the rights of other patients and imposing on nursing staff. It ruled that the rights of other patients outweighed Brenda's claims. The court found that Dr. Weaver provided adequate notice of his decision to stop treating Brenda and was not responsible for her subsequent denial of dialysis by other providers. It concluded that Dr. Weaver had fulfilled his obligations as her physician. Regarding Alta Bates and Herrick Hospitals, the court ruled they did not violate Health and Safety Code section 1317 by refusing Brenda emergency treatment, as her chronic kidney disease did not qualify as an emergency under the statute. In late 1978, after Dr. Weaver ceased treatment, Brenda was denied admission to outpatient dialysis programs for reasons unrelated to her race or financial status. The court noted that Brenda had options to manage her health and concluded she lacked a legal right to compel medical treatment for her kidney issues through dialysis. Consequently, her petition for writ of mandate was denied, but the court temporarily ordered Dr. Weaver and BMA to continue providing hemodialysis during the appeal. The analysis highlighted that Brenda was estopped from claiming Dr. Weaver had a continuing obligation due to her prior violations of a stipulated order, and the court affirmed that he had given sufficient notice and assistance in finding alternative providers.

The trial court evaluated Dr. Weaver's professionalism, indicating he demonstrated exceptional sensitivity and commitment to Brenda's medical needs, adhering to the highest medical standards. The court found no legal or equitable basis to impose ongoing responsibility for Brenda's welfare on him or the BMA clinic. Brenda claimed that Herrick and Alta Bates Hospitals breached obligations under Health and Safety Code section 1317 by denying her admission to outpatient dialysis services in late 1978. The court determined that Brenda was not in an emergency condition at the time of her application, emphasizing that her chronic condition did not qualify as an emergency requiring immediate treatment under section 1317. The court clarified that a patient with end-stage renal disease does not pose a medical emergency if they follow medical advice and attend scheduled treatments. It stated that while serious, the need for regular dialysis does not equate to emergency care as defined by the law. The court noted that hospitals are not necessarily obligated to accept all patients but raised questions about the obligations of publicly funded hospitals under the Hill-Burton Act. Ultimately, the court found no liability for the hospitals regarding Brenda's application.

A hospital with unique or scarce medical resources necessary for preserving life is considered a public service enterprise, which should not arbitrarily deny services without reasonable cause. Disruptive behavior from a patient may justify a hospital's refusal of treatment, but there is a collective responsibility among healthcare providers to share the burden of challenging patients through a contingency plan. However, this collective responsibility does not absolve patients of their own accountability. In Brenda's case, her behavior legally supports the hospitals' refusal to provide dialysis treatment. 

The court acknowledges the need to address how to ensure Brenda receives treatment despite her uncooperative behavior. Several alternatives for treatment have been considered: 

1. **Involuntary Conservatorship under the LPS Act**: This option is unsuitable as the County of Alameda has determined Brenda does not meet the necessary criteria.
   
2. **Involuntary Conservatorship under Probate Code section 1801**: This allows for the appointment of a conservator to manage personal needs and consent to medical treatment in emergencies, which remains a viable option.

3. **Voluntary Conservatorship under Probate Code section 1802**: This appears to be the most promising route, as Brenda's attorneys are willing to persuade her to consent to such an arrangement, potentially leading to her placement in a private psychiatric facility. The court suggests remanding the matter for the initiation of appropriate proceedings.

Respondents favor establishing a voluntary conservatorship for Brenda, but the court lacks authority to remand for this purpose. The trial court's order mandating Dr. Weaver to provide dialysis to Brenda will remain effective until the court's decision is final. Should Brenda initiate voluntary conservatorship proceedings during this timeframe, the appointed conservator will be responsible for ensuring continued treatment within the statutory framework and any court-imposed conditions. The judgment is affirmed, with Racanelli, P.J., and Elkington, J. concurring. Rehearing petitions were denied on May 26, 1982, and June 23, 1982, respectively. 

Dr. Weaver's initial appeal led to a petition for writ of supersedeas, which was granted on February 20, 1981. However, the Supreme Court required the trial court's order to remain effective pending appeal. The court sees no need to review this order as it will lapse when the opinion becomes final. Health and Safety Code section 1317 mandates emergency services for individuals at risk of severe harm, applicable to any licensed health facility with the requisite capabilities. The County of Alameda was not part of this litigation, and Dr. Weaver's attempt to join the county as a necessary party was denied, leaving the county's responsibilities and actions unaddressed. Brenda's attorneys suggested an order for Dr. Weaver to provide dialysis until another physician can take over, but the court is not inclined to impose this requirement, noting Dr. Weaver has already met his obligations, while acknowledging potential alternative resources.