Payton v. Weaver

• Decision Date: 26 April 1982
• Citation: 182 Cal.Rptr. 225,131 Cal.App.3d 38
• Court: California Court of Appeals Court of Appeals
• Parties: Brenda Marie PAYTON, Appellant, v. John C. WEAVER, Jr., M.D., Providence Hospital, Herrick Hospital, Alta Bates Hospital, BMA of Oakland, Inc., etc., Respondents. Civil 50094.

Page 225

182 Cal.Rptr. 225

131 Cal.App.3d 38

Brenda Marie PAYTON, Appellant, v. John C. WEAVER, Jr., M.D., Providence Hospital, Herrick Hospital, Alta Bates Hospital, BMA of Oakland, Inc., etc., Respondents.

Civil 50094.

Court of Appeal, First District, Division 1, California.

April 26, 1982.

Hearing Denied June 23, 1982.

As Modified on Denial of Rehearing May, 26, 1982.

Warren B. Wilson, Joanne F. Casey, Wilson & Casey, Oakland, for appellant.

Charles Bond, Professional Law Corp., San Francisco, Marrs A. Craddick, Craddick & Candland, Walnut Creek, for respondents John C. Weaver, Jr., M.D. and BMA of Oakland, Inc.

Phillip S. Berry, Berry & Berry, Oakland, for respondent Providence Hospital.

William J. Bush, Stephen B. Peck, Hanson, Bridgett, Marcus, Vlahos & Stromberg, San Francisco, for respondents Alta Bates Hospital and Herrick Hospital.

Jerome Berg, San Francisco, for amicus curiae Union of American Physicians and Dentists.

Kenneth L. Freeman, San Francisco, Robert J. Pristave, Drew P. Kaplan, Ross, Hardies, O'Keefe, Babcock & Parsons, Chicago, Ill., for amicus curiae Renal Physicians Ass'n.

GRODIN, Associate Justice. ^*

Occasionally a case will challenge the ability of the law, and society, to cope effectively and sensitively with fundamental problems of human existence. This is such a case. Appellant, Brenda Payton, is a 35-year-old black woman who suffers from a permanent and irreversible loss of kidney function, a condition known as chronic end stage renal disease. To stay alive, she must subject herself two or three times a week to hemodialysis (dialysis), a process in which the patient's circulatory system is connected to a machine through which the blood is passed. Using salts and osmotic membrances, artificial kidneys in the machine drain the blood of excess liquids and accumulated impurities. Without such treatment, the volume of liquids in the patient's system will increase dangerously; liquid will begin to fill the lungs, making breathing difficult and possibly leading to heart failure. The resulting toxic waste build-up and chemical imbalances can also threaten the function of the heart and other organs.

Brenda has other difficulties. Unable to care for her children, she lives alone in a low-income housing project in West Oakland, subsisting on a $356 per month Social Security check. She has no family support; one brother is in prison and another is a mental patient. She confesses that she is a drug addict, having been addicted to heroin and barbiturates for over 15 years. She has alcohol problems, weight problems and, not surprisingly, emotional problems as well.

Despite these difficulties Brenda appears from the record to be a marvelously sympathetic and articulate individual who in her lucid moments possesses a great sense of dignity and is intent upon preserving her independence and her integrity as a human being. At times, however, her behavior is such as to make extremely difficult the provision of medical care which she so desperately requires.

The other principal figure in this case is respondent John C. Weaver, Jr., a physician specializing in kidney problems. He conducts his practice through respondent Biomedical Application of Oakland, Inc. (BMA), which operates an outpatient dialysis treatment unit on the premises of respondent Providence Hospital.

Dr. Weaver began treating Brenda in 1975 when, after the birth of Brenda's twin daughters, her system rejected a transplanted kidney. He has been treating her ever since. To her, "Dr. Weaver is and was and still is the man between me and death ... other than God, I don't think of nobody higher than I do Dr. Weaver."

On December 12, 1978, Dr. Weaver sent Brenda a letter stating he would no longer permit her to be treated at BMA because of her "persistent uncooperative and antisocial behavior over ... more than ... three years ... her persistent refusal to adhere to reasonable constraints of hemodialysis, the dietary schedules and medical prescriptions ... the use of barbiturates and other illicit drugs and because all this resulted in disruption of our program at BMA."

In the latter part of 1978, Brenda applied for admission to the regular dialysis treatment programs operated by respondents Alta Bates and Herrick hospitals, and was refused.

For several months Dr. Weaver continued to provide Brenda with necessary dialysis on an emergency basis, through Providence. On April 23, 1979, he again notified her by letter that he would no longer treat her on an outpatient basis. This letter led to Brenda's filing of a petition for mandate to compel Dr. Weaver, BMA, and Providence to continue to provide her with outpatient dialysis services. That litigation was settled by a stipulated order which called for continued treatment provided Brenda met certain conditions: that she keep all appointments at their scheduled time; that she refrain from use of alcohol and drugs; that she maintain prescribed dietary habits; and that she "in all respects cooperate with those providing her care and abide by her physician's prescribed medical regimen." Later, a sixth stipulation was added: that Brenda would "enter into and participate in good faith in a program of regular psychotherapy and/or counselling."

Dr. Weaver and BMA continued treatment of Brenda as an outpatient pursuant to the stipulation, but on March 3, 1980, Dr. Weaver, contending that Brenda had failed to fulfill any part of the bargain, again notified her that treatment would be terminated. He provided her with a list of dialysis providers in San Francisco and the East Bay, and volunteered to work with her counsel to find alternative care.

Brenda then instituted a second proceeding, again in the form of a petition for writ of mandate, this time naming Herrick and Alta Bates hospitals as respondents, along with Dr. Weaver, BMA and Providence. As pertinent here, the petition alleges that all respondents have "wrongfully failed and refused and continue to fail and refuse to provide Petitioner with regular hemodialysis treatment and medical supervision as required by her chronic end-stage kidney condition"; and, more specifically, that the refusal by Herrick and Alta Bates to admit her as an outpatient to their dialysis treatment programs violated their obligations under Health and Safety Code section 1317 to provide "emergency" treatment. The petition also contained allegations that Herrick and Alta Bates had discriminated against her on grounds of race and indigency, in violation of the Civil Rights Act of 1968 and the Hill-Burton Act (42 U.S.C. § 291), but the trial court found these allegations to be unsupported, and they are not at issue here.

The trial court, after a lengthy evidentiary hearing, found that Brenda had violated each and every condition which she had accepted as part of the stipulated order providing for continued treatment, and that finding is basically undisputed. There was evidence that Brenda continued, after the stipulated order, to buy barbiturates from pushers on the street at least twice a week; that she failed to restrict her diet, gaining as much as 15 kilograms between dialysis treatments; that she continued to be late and/or miss appointments; that due primarily to missed appointments she had 30 emergencies requiring hospitalization in the 11 months preceding trial; that she would appear for treatment in an intoxicated condition; that she discontinued her program of counseling after a brief period; and, as the trial court found, she displayed in general "gross non-cooperation with her treating physician, BMA of Oakland and Providence Hospital." The trial court found that her behavior in these respects was "knowing and intentional."

Brenda's behavior was found to affect not only Dr. Weaver but the other patients and the treating staff as well. Dialysis treatment is typically provided to several patients at a time, all of them connected to a single dialysis machine. There was evidence that Brenda would frequently appear for treatment late or at unscheduled times in a drugged or alcoholic condition, that she used profane and vulgar language, and that she had on occasion engaged in disruptive behavior, such as bothering other patients, cursing staff members with obscenities, screaming and demanding that the dialysis be turned off and that she be disconnected before her treatment was finished, pulling the dialysis needle from the connecting shunt in her leg causing blood to spew, and exposing her genitals in a lewd manner. The trial court found that during the times she has sought treatment "her conduct has been disruptive, abusive, and unreasonable such as to trespass upon the rights of other patients and to endanger their rights to full and adequate treatment," and that her conduct "has been an imposition on the nursing staff." The court determined that, on balance, the rights and privileges of other patients endangered by Brenda's conduct were superior to the rights or equities which Brenda claimed.

The court also found, contrary to Brenda's contentions, that Dr. Weaver had given sufficient notice to Brenda, and that Dr. Weaver was not responsible for Brenda being refused dialysis by any other respondent. It concluded that Dr. Weaver had "discharged all obligations imposed by the patient-physician relationship" with Brenda.

As to Alta Bates and Herrick hospitals the court found that they had not refused Brenda "emergency" treatment in violation of Health and Safety Code section 1317. In late 1978, after receiving notification from Dr. Weaver that he would no longer treat her, Brenda made application to the regular outpatient dialysis programs at these two hospitals and was refused--for reasons, as the trial court found, that did not include her race, her indigency, or any actions on the part of Dr. Weaver. It concluded, on the basis of reasoning which we shall discuss later in this opinion, that Brenda's chronic kidney disease did not...