## Facts

- Brenda Marie Payton had chronic end-stage renal disease and required hemodialysis multiple times per week to survive.
- Dr. John C. Weaver, Jr., a nephrologist, treated Payton through an outpatient dialysis unit operated by Biomedical Application of Oakland, Inc. (BMA) on hospital premises.
- Over time, Payton engaged in disruptive and noncompliant conduct at the dialysis unit, including repeated failure to follow treatment requirements and behavior that interfered with staff and other patients.
- In December 1978, Dr. Weaver notified Payton that he would terminate treatment due to persistent uncooperative behavior and related concerns; despite this, he continued dialysis on an emergency basis for a period because she lacked an alternative provider.
- Payton sought admission to outpatient dialysis programs at Alta Bates and Herrick Hospitals but was refused.
- During litigation, an order allowed Payton to resume dialysis subject to conditions (including behavioral and counseling requirements); the trial court later found she failed to comply.
- In March 1980, Dr. Weaver again gave notice of termination, provided alternative provider information, and offered assistance in locating other care.

## Issues

1. Whether a physician and affiliated outpatient dialysis provider have a continuing legal obligation to provide regular, life-sustaining dialysis indefinitely to an existing patient, despite serious noncompliance, after notice of termination and opportunity to obtain substitute care.
2. Whether hospitals violated California Health & Safety Code § 1317 by refusing to admit a chronic renal-failure patient into their outpatient dialysis programs on the theory that the patient’s condition constituted an ongoing “emergency.”

## Decision

- The Court of Appeal affirmed denial of Payton’s petition for writ of mandate.
- Dr. Weaver and BMA had no legal obligation to continue providing regular dialysis after adequate notice and reasonable steps to avoid foreseeable harm by facilitating transfer to other providers.
- Alta Bates and Herrick Hospitals did not violate Health & Safety Code § 1317 because the statute’s emergency-services duty did not require acceptance of a patient for ongoing outpatient dialysis for a chronic condition.

## Legal Principles

- A physician–patient relationship does not, by itself, impose a perpetual duty to provide specialized, ongoing treatment; termination may be permissible when supported by legitimate grounds (including serious noncompliance) and accompanied by reasonable notice and opportunity to secure alternative care.
- A provider’s obligations upon termination focus on avoiding foreseeable, immediate harm through appropriate notice and transitional steps, not on guaranteeing lifetime treatment.
- Health & Safety Code § 1317’s emergency-services obligation applies to conditions requiring immediate intervention to avoid imminent danger; it does not convert chronic maintenance therapy needs into a continuous statutory “emergency” requiring a facility to provide long-term preventive or scheduled care.

## Conclusion

The court refused to impose an open-ended, judicially enforceable duty on a particular physician or private facility to provide indefinite life-sustaining dialysis to a persistently noncompliant patient after proper termination procedures, and it construed § 1317 to require emergency intervention for imminent peril rather than mandating acceptance for ongoing outpatient dialysis.


Payton v. Weaver, 131 Cal. App. 3d 38 (Cal. Ct. App. 1982)