This section contains the nature of the case and procedural background.

P is a 35-year-old black woman who suffers from a permanent and irreversible loss of kidney function (chronic end-stage renal disease). To stay alive, she must subject herself two or three times a week to hemodialysis. Without such treatment, the volume of liquids in the patient's system will increase dangerously; the liquid will begin to fill the lungs, making breathing difficult and possibly leading to heart failure. The resulting toxic waste buildup and chemical imbalances can also threaten the function of the heart and other organs. Unable to care for her children, P 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 emotional problems as well. In her lucid moments, she is very nice. At times, however, her behavior is such as to make extremely difficult the provision of medical care which she so desperately requires. D is a physician specializing in kidney problems who conducts his practice through Biomedical Application of Oakland, Inc. (BMA (D)), which operates an outpatient dialysis treatment unit on the premises of Providence Hospital (D). D has been treating P since 1975. On December 12, 1978, Dr sent P a letter stating he would no longer permit her to be treated at BMA (D) 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 (D).' P was refused service at Alta Bates and Herrick Hospitals. D continued to provide her with necessary dialysis on an emergency basis. On April 23, 1979, he again notified her by letter that he would no longer treat her on an outpatient basis. P filed a petition for a mandate to compel Ds to continue to provide her with outpatient dialysis services. That litigation was settled by a stipulated order which called for continued treatment provided P met certain conditions: that she keep all appointments at their scheduled time; that she refrain from the 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.' P was also required to participate in good faith in a program of regular psychotherapy and/or counseling. On March 3, 1980, D, contending that P had failed to fulfill any part of the bargain, again notified her that treatment would be terminated. P again filed a petition for writ of mandate claiming a violation in part of Health and Safety Code section 1317 to provide 'emergency' treatment. The trial court found these allegations to be unsupported. The court found that P had violated each and every condition that she had accepted as part of the stipulated order providing for continued treatment. P's behavior was found to affect not only D but also the other patients and the treating staff. P used profane and vulgar language and 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. 'P's 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 found that the rights and privileges of other patients endangered by P's conduct were superior to the rights or equities that P claimed. The court ruled that P 'has no legal right to compel medical service from any D for chronic or regular care of her kidney problems through dialysis,' and so denied her petition for writ of mandate. P appealed.

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