## Facts

- Magnolia Lyons, a blind person, went to Dr. Eugene R. Grether’s medical office with her four-year-old son and her guide dog for a scheduled appointment to treat a vaginal infection.
- Grether’s staff told Lyons she would not be treated unless the guide dog was removed from the waiting room.
- Lyons insisted the dog remain because she had not been assured the dog’s safety, care, and availability during treatment.
- Grether refused to treat Lyons, required her to leave the office with her son and dog, and did not assist her in obtaining alternate medical care.
- Lyons alleged she was humiliated in front of other patients and that her condition worsened over the next two days while she sought other treatment, causing pain and suffering.
- Lyons alleged the waiting room was a place open to invited members of the public and that Virginia’s White Cane Act gave her a right to be accompanied by her guide dog there.

## Issues

1. Whether the pleadings alleged facts sufficient to establish a physician–patient relationship, creating a duty to treat.
2. Whether the alleged refusal to treat and eviction constituted an unjustified withdrawal from that relationship, including in light of the patient’s asserted statutory right to keep a guide dog in the office under the White Cane Act.
3. Whether a physician’s waiting room can fall within the White Cane Act’s protection for blind persons accompanied by guide dogs, such that dismissal on demurrer is improper.

## Decision

- The Supreme Court of Virginia reversed the order sustaining the demurrer and remanded for further proceedings.
- The allegations permitted a reasonable inference of an implied contract for medical services based on a specific treatment appointment and the patient’s timely appearance, which could establish a physician–patient relationship and a duty to treat.
- Whether the physician’s unilateral termination was justified, including whether the patient had a reasonable opportunity to obtain substitute care, presented factual questions not resolvable on demurrer.
- The court rejected a categorical rule that a physician’s waiting room is outside the White Cane Act and held the statute’s application depended on facts, including the nature of public invitation by appointment.

## Legal Principles

- Absent statute, a physician generally has no legal obligation to accept every person seeking care; a duty to treat arises only upon formation of a physician–patient relationship.
- The physician–patient relationship is contractual in nature and may be implied from circumstances such as a mutually arranged appointment for a specific medical purpose and the patient’s appearance at the agreed time and place.
- Once a physician–patient relationship exists, a physician may not withdraw without regard to the patient’s welfare; withdrawal may require providing a reasonable opportunity to obtain needed services from another physician.
- On demurrer, well-pleaded facts and reasonable inferences are treated as true; disputed factual questions (relationship formation, statutory coverage, justification for withdrawal) are not decided as matters of law.
- Disability-access statutes such as the White Cane Act may bear on whether excluding a patient’s guide dog from a place open to invited members of the public is lawful and whether refusal of treatment is justified.

## Conclusion

The court held that the pleadings stated a viable claim because they plausibly alleged an implied physician–patient relationship and a potentially unjustified refusal to treat tied to the patient’s asserted statutory right to keep her guide dog in the office, requiring factual development rather than dismissal at the demurrer stage.


Lyons v. Grether, 218 Va. 630, 239 S.E.2d 103 (Va. 1977)