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While disruptive conduct on the part of a patient may constitute good cause for an individual hospital to refuse continued treatment, since it would be unfair to impose serious inconvenience upon a hospital simply because such a patient selected it, it may be that there exists a collective responsibility on the part of the providers of scarce health resources in a community, enforceable through equity, to share the burden of difficult patients over time, through an appropriately devised contingency plan.
Appellant Brenda Payton, who suffered from chronic end stage renal disease, petitioned the trial court for a writ of mandate, alleging that her physician had improperly attempted to terminate treatment and that the denial by two hospitals of her applications for admission to their out-patient dialysis programs constituted a refusal of emergency treatment, in violation of Health & Saf. Code, § 1317. The basis for the physician's action was the appellant’s disruptive and uncooperative behavior, which affected other patients and staff, and her violation of an order resulting from previous litigation by which she had agreed to refrain from the use of drugs and alcohol and to abide by her prescribed medical regimen. The trial court denied the requested relief, concluding that the physician had discharged all obligations imposed by the patient-physician relationship and that chronic kidney disease did not itself constitute an emergency within the meaning of § 1317. Appellant challenged the trial court’s decision.
The court affirmed the judgment because appellant's behavior was of such nature as to justify respondents' refusal of dialysis treatment on either an individual or collective basis. Moreover, the court held that the physician had no legal obligation to continue providing dialysis treatment to appellant, noting that she had been given sufficient notice that treatment would be terminated and a list of other dialysis providers in the area. The court also held that the need for continuous treatment as such could not reasonably be said to fall within the emergency treatment provisions of Health & Saf. Code, § 1317. However, the court also held that hospitals were not without obligation to patients in need of continuing medical services for their survival and that there may exist a collective responsibility on the part of providers of scarce health resources in a community, enforceable through equity, to share the burden of difficult patients over time.