The opinion
IN THE SUPREME COURT OF
CALIFORNIA
FRANCISCO GUTIERREZ,
Plaintiff and Appellant,
v.
URIEL TOSTADO et al.,
Defendants and Respondents.
S283128
Sixth Appellate District
H049983
Santa Clara County Superior Court
20CV361400
July 31, 2025
Chief Justice Guerrero authored the opinion of the Court, in
which Justices Corrigan, Liu, Kruger, Groban, Jenkins, and
Evans concurred.
GUTIERREZ v. TOSTADO
S283128
Opinion of the Court by Guerrero, C. J.
We granted review in this matter to decide whether the
statute of limitations for medical professional negligence claims
within the Medical Injury Compensation Reform Act (Code Civ.
Proc., § 340.5)1 applies to an action for negligence brought by the
injured driver of a vehicle rear-ended by an ambulance
transporting a patient. We hold that MICRA’s statute of
limitations does not apply under these circumstances.
Our holding follows from principles articulated in our
previous decisions concerning the scope of MICRA’s statute of
limitations, as well as the general rule that the applicable
limitations period depends on the nature of the right being sued
upon. Where, as here, a plaintiff sues a health care provider for
breach of a duty owed to the public generally, as opposed to a
violation of professional obligations owed to patients, the two-
year statute of limitations for general negligence claims
(§ 335.1) applies. This conclusion is supported by MICRA’s text,
purpose, and legislative history, as well as relevant public policy
considerations.
1
Further statutory references are to the Code of Civil
Procedure unless otherwise noted. Hereinafter, section 340.5 is
referred to as the MICRA statute of limitations, and the various
provisions of the Medical Injury Compensation Reform Act are
referred to more generally as MICRA.
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Opinion of the Court by Guerrero, C. J.
Because the Court of Appeal concluded that the MICRA
statute of limitations applies here, we reverse its judgment and
remand for proceedings consistent with this opinion.
I. FACTUAL AND PROCEDURAL BACKGROUND
On January 20, 2018, Francisco Gutierrez (plaintiff) was
driving his truck on a California highway when an ambulance
driven by Uriel Tostado and operated by Tostado’s employer,
ProTransport-1, LLC (collectively, defendants), struck plaintiff’s
vehicle from behind. At the time of the accident, Tostado, a
licensed emergency medical technician (EMT), was transporting
a patient between regional medical centers; another EMT was
attending to the patient in the back of the ambulance.
Plaintiff sued defendants on January 7, 2020, claiming the
collision caused him to suffer neck and back injuries. He styled
his complaint as a general negligence action involving a motor
vehicle, resulting in personal injury and property damage.
Defendants moved for summary judgment on the ground
that plaintiff’s action was time barred under MICRA’s one-year
statute of limitations (§ 340.5). Plaintiff opposed the motion,
maintaining his claim sounded in general negligence and was
therefore timely under the two-year statute of limitations for
general negligence claims (§ 335.1). The trial court granted
defendants’ motion for summary judgment, finding that the
MICRA statute of limitations applied because, at the time of the
accident, “Tostado was [a] health care provider employed by
ProTransport . . . and was rendering professional medical
services that were within the scope of services he was licensed
to carry out.”
Plaintiff appealed, and a divided Court of Appeal affirmed.
(Gutierrez v. Tostado (2023) 97 Cal.App.5th 786 (Gutierrez).)
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The majority reasoned that MICRA was “not limited to suits by
patients or to recipients of medical services as long as the
plaintiff is injured due to negligence in the rendering of
professional services and his injuries were foreseeable.”
(Gutierrez, at p. 794.) A dissenting justice disagreed, arguing
that the majority’s view “extend[ed] MICRA’s statute of
limitations unpredictably and unfairly.” (Id. at p. 795 (dis. opn.
of Bromberg, J.).) According to the dissent, MICRA was not
intended to reach “run-of-the-mill traffic accident[s]” such as
this one, which should instead be governed by the two-year
statute of limitations applicable to ordinary negligence claims.
(Gutierrez, at p. 796 (dis. opn. of Bromberg, J.).)
We granted plaintiff’s petition for review.
II. DISCUSSION
To determine the reach of MICRA’s statute of limitations
provision, we begin by discussing general principles relating to
statutes of limitations and statutory interpretation. Next, we
turn to the text of section 340.5 and how we have interpreted its
coverage of claims involving “professional negligence.” Because
the text of section 340.5 does not definitively resolve whether
the statute applies here, we also consult MICRA’s purpose and
legislative history. We conclude from these interpretive
resources that the MICRA statute of limitations extends only to
claims deriving from the violation of an obligation owed by a
health care provider in connection with the provision of
professional services, as opposed to the breach of a duty that is
more generally owed to the public at large. After applying our
interpretation of section 340.5 to the facts of this case, we
conclude that plaintiff’s claim is premised on the breach of a
duty owed to the general public. Therefore, the MICRA statute
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Opinion of the Court by Guerrero, C. J.
of limitations does not apply here, and instead this action is
subject to the two-year statute of limitations for general
negligence claims. (§ 335.1.)
A. General Principles
A “statute of limitations is a law that sets the maximum
amount of time within which legal proceedings may be
initiated.” (Shalabi v. City of Fontana (2021) 11 Cal.5th 842,
844.) The general purpose of a statute of limitations is to
“protect defendants from the stale claims of dilatory plaintiffs”
and “to stimulate plaintiffs to assert fresh claims against
defendants in a diligent fashion.” (Norgart v. Upjohn Co. (1999)
21 Cal.4th 383, 395.) “The statute of limitations operates in an
action as an affirmative defense.” (Id. at p. 396.)
The interpretation of a statute of limitations to ascertain
its reach presents a question of law that we review de novo. (See
Lopez v. Sony Electronics, Inc. (2018) 5 Cal.5th 627, 633–634.)
“ ‘ “ ‘When we interpret a statute, “[o]ur fundamental task . . . is
to determine the Legislature’s intent so as to effectuate the law’s
purpose. We first examine the statutory language, giving it a
plain and commonsense meaning. . . . If the language is clear,
courts must generally follow its plain meaning unless a literal
interpretation would result in absurd consequences the
Legislature did not intend.” ’ ” ’ ” (Smith v. LoanMe, Inc.
(2021) 11 Cal.5th 183, 190 (Smith).) However, “ ‘ “ ‘ “[i]f the
statutory language permits more than one reasonable
interpretation, courts may consider other aids, such as the
statute’s purpose, legislative history, and public policy.” ’ ” ’ ”
(Ibid.)
“To determine the statute of limitations which applies to
a cause of action it is necessary to identify the nature of the
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Opinion of the Court by Guerrero, C. J.
cause of action, i.e., the ‘gravamen’ of the cause of action.
[Citations.] ‘[T]he nature of the right sued upon and not the
form of action nor the relief demanded determines the
applicability of the statute of limitations under our code.’ ”
(Hensler v. City of Glendale (1994) 8 Cal.4th 1, 22–23.)
B. MICRA’s Text
“MICRA . . . refers to several statutes that restrict or place
conditions upon causes of action and remedies directed at
‘health care providers’ for ‘professional negligence.’ ” (Delaney
v. Baker (1999) 20 Cal.4th 23, 28, fn. 2.) The MICRA statute of
limitations applies “[i]n an action for injury or death against a
health care provider[2] based upon such person’s alleged
professional negligence.” (§ 340.5.) The statute defines
“ ‘[p]rofessional negligence’ ” as “a negligent act or omission to
act by a health care provider in the rendering of professional
services, which act or omission is the proximate cause of a
personal injury or wrongful death, provided that such services
are within the scope of services for which the provider is licensed
and which are not within any restriction imposed by the
licensing agency or licensed hospital.” (Id., subd. (2).) If MICRA
applies, “the time for commencement of the action shall be three
years after the date of injury or one year after the plaintiff
2
Neither party disputes that Tostado, as an EMT, met the
statutory definition of a “health care provider” under MICRA.
(See § 340.5, subd. (1) [defining “health care provider” for
purposes of the MICRA statute of limitations]; see also Aldana
v. Stillwagon (2016) 2 Cal.App.5th 1, 7 (Aldana) [explaining
that, under MICRA, “A ‘health care provider’ is ‘any person
licensed or certified pursuant to’ various statutory schemes
including, as relevant here, the Emergency Medical Services
System and the Prehospital Emergency Medical Care Personnel
Act”]; see Health & Saf. Code, § 1797 et seq., id., § 1797.4.)
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Opinion of the Court by Guerrero, C. J.
discovers, or through the use of reasonable diligence should
have discovered, the injury, whichever occurs first.” (§ 340.5.)3
We examined MICRA’s definition of “professional
negligence” in Flores v. Presbyterian Intercommunity Hospital
(2016) 63 Cal.4th 75 (Flores). In Flores, we considered whether
MICRA’s statute of limitations applied when the plaintiff, a
hospital patient, sustained injuries upon falling out of her bed
due to a malfunctioning guardrail. (Flores, at p. 79.) After
reviewing MICRA’s text, purpose, and legislative history, we
concluded that MICRA’s statute of limitations applied. (Flores,
at p. 89.) Starting with the text, we observed that the statute’s
definition of “ ‘professional negligence’ ” contains four elements:
“(1) ‘a negligent act or omission to act by a health care provider
in the rendering of professional services,’ (2) ‘which act or
omission is the proximate cause of a personal injury or wrongful
death,’ (3) ‘provided that such services are within the scope of
services for which the provider is licensed,’ and (4) ‘which are
not within any restriction imposed by the licensing agency or
licensed hospital.’ ” (Id. at p. 84, quoting § 340.5, subd. (2).)
Focusing on the first element, we rejected as overly
narrow the plaintiff’s argument that “ ‘professional services’ ”
only included services requiring a particularized degree of
medical skill. (Flores, supra, 63 Cal.4th at pp. 84–85.) We
noted, in this respect, that hospital staff might commit an act of
negligence in the rendering of medical care, even where no
special medical skill was implicated — for example, if a janitor’s
3
Plaintiff appears to concede that, assuming MICRA
applies at all, MICRA’s delayed discovery rule, extending the
limitations period up to three years (§ 340.5), did not expand his
time to sue.
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Opinion of the Court by Guerrero, C. J.
broom accidentally disconnected a patient’s oxygen ventilator.
(Id. at p. 85.) We then rejected as overly broad the defendant’s
argument that “ ‘professional services’ ” encompassed any
services performed by a health care provider within the scope of
licensure, observing that this interpretation would collapse the
first and third elements of section 340.5’s definition of
professional negligence. (Id. at pp. 85–86.) We also pointed out
that because health care providers are licensed not only to
perform medical services but also to operate public-facing
facilities, the defendant’s interpretation would improperly
“sweep in not only negligence in performing the duties that
hospitals owe to their patients in the rendering of medical
diagnosis and treatment, but negligence in performing the
duties that hospitals owe to all users — including personnel and
visitors — simply by virtue of operating a facility that is open to
the public.” (Id. at p. 86; see also ibid. [rejecting the notion that
MICRA “would apply to a visitor’s action for injuries resulting
from a custodian’s negligence in leaving a broom on a hallway
floor, or a doctor’s action against the hospital for failure to place
a warning sign on a wet, recently mopped floor”].) We disavowed
such an “all-purpose rule covering essentially every form of
ordinary negligence that happens to occur on hospital property.”
(Ibid.)
Upon rejecting the parties’ starkly different positions, our
decision in Flores concluded that “the special statute of
limitations for professional negligence actions against health
care providers applies only to actions alleging injury suffered as
a result of negligence in rendering the professional services that
hospitals and others provide by virtue of being health care
professionals: that is, the provision of medical care to patients.”
(Flores, supra, 63 Cal.4th at p. 88, italics added.) We further
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Opinion of the Court by Guerrero, C. J.
explained, “[W]hether negligence in maintaining hospital
equipment or premises qualifies as professional negligence
depends on the nature of the relationship between the
equipment or premises in question and the provision of medical
care to the plaintiff. A hospital’s negligent failure to maintain
equipment that is necessary or otherwise integrally related to
the medical treatment and diagnosis of the patient implicates a
duty that the hospital owes to a patient by virtue of being a health
care provider. Thus, if the act or omission that led to the
plaintiff’s injuries was negligence in the maintenance of
equipment that, under the prevailing standard of care, was
reasonably required to treat or accommodate a physical or
mental condition of the patient, the plaintiff’s claim is one of
professional negligence under section 340.5. But section 340.5
does not extend to negligence in the maintenance of equipment
and premises that are merely convenient for, or incidental to,
the provision of medical care to a patient.” (Ibid., italics added.)4
4
The analysis in Flores noted parallels between the MICRA
statute of limitations and section 340.6, subdivision (a)
(section 340.6(a)), an analogous statute governing actions
against legal professionals. We found “instructive” (Flores,
supra, 63 Cal.4th at p. 88) our prior decision in Lee v. Hanley
(2015) 61 Cal.4th 1225, which addressed the scope of section
340.6(a). Similar to MICRA, section 340.6(a) imposes a one-year
statute of limitations for “[a]n action against an attorney for a
wrongful act or omission, other than for actual fraud, arising in
the performance of professional services,” subject to a delayed
discovery rule. In Lee, a client sued her attorney for improperly
withholding the client’s funds. (Lee, at p. 1229.) We recognized
that while the attorney’s withholding of the funds may have
violated certain professional obligations, the plaintiff’s action
could also be interpreted as a claim for simple conversion. (Id.
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Opinion of the Court by Guerrero, C. J.
Elaborating on this distinction, we observed in Flores that
hospitals are open to the public and include “numerous items of
furniture and equipment . . . that are provided primarily for the
comfort and convenience of patients and visitors, but generally
play no part in the patient’s medical diagnosis or treatment.”
(Flores, supra, 63 Cal.4th at p. 89.) We concluded that a defect
in such equipment implicates a general duty of care owed to all
Californians5 and would not give rise to a claim for professional
negligence. (Flores, at p. 89.) For instance, we explained, if “a
chair in a waiting room collapses, injuring the person sitting in
it, the hospital’s duty with respect to that chair is no different
at p. 1230.) We also observed that “[t]he obligations that an
attorney has by virtue of being an attorney are varied and often
overlap with obligations that all persons subject to California’s
laws have.” (Id. at p. 1238.) The test for determining whether
section 340.6(a) applies to an action arising from conduct that
violated overlapping duties, we concluded, was whether the
action, “in order to succeed, necessarily depends on proof that
an attorney violated a professional obligation as opposed to some
generally applicable nonprofessional obligation.” (Lee, at
p. 1238.)
5
A general negligence claim alleges a breach of the
ordinary duty of care that each person owes to others. “The
‘general rule’ governing duty is set forth in Civil Code
section 1714 . . . . [Citation.] First enacted in 1872, section
1714 provides: ‘Everyone is responsible . . . for an injury
occasioned to another by his or her want of ordinary care or skill
in the management of his or her property or person . . . .’ (Id.,
subd. (a).) This statute establishes the default rule that each
person has a duty ‘to exercise, in his or her activities, reasonable
care for the safety of others.’ ” (Brown v. USA Taekwondo (2021)
11 Cal.5th 204, 213–214; see also Lugtu v. California Highway
Patrol (2001) 26 Cal.4th 703, 716 [“Under general negligence
principles . . . a person ordinarily is obligated to exercise due
care in his or her own actions so as not to create an unreasonable
risk of injury to others”].)
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Opinion of the Court by Guerrero, C. J.
from that of any other home or business with chairs in which
visitors may sit”; as such, MICRA’s statute of limitations would
“not apply to a suit arising out of such an injury.” (Flores, at
p. 89.) In contrast, because the plaintiff’s malfunctioning bed
guardrail, which had been ordered to be set at a certain height
by the plaintiff’s physician, was “integrally related to [the
plaintiff’s] medical diagnosis and treatment,” we concluded the
plaintiff’s claim involved professional negligence, and therefore
MICRA’s one-year statute of limitations applied. (Flores, at
p. 89.)
Flores thus perceived a fundamental distinction between
claims involving “professional negligence” (§ 340.5) that are
subject to the MICRA statute of limitations and claims involving
only general negligence that are beyond the statute’s scope.
While the former “implicates a duty that the [defendant] owes
to a patient by virtue of being a health care provider” (Flores,
supra, 63 Cal.4th at p. 88), the latter implicates the general
duty to exercise ordinary care that each person owes to all other
members of the public (Civ. Code, § 1714, subd. (a)).
Flores did not have occasion to apply these principles in
the context of a claim by a plaintiff who was not the patient of
the defendant health care provider, but rather, a third party
having no professional relationship with the defendant.6 Our
6
We recently addressed a third-party claim brought against
a legal professional in Escamilla v. Vannucci (2025) 17 Cal.5th
571 (Escamilla). There, we held that section 340.6(a)’s one-year
statute of limitations for claims against attorneys arising out of
professional services did not apply to a malicious prosecution
action brought against an attorney by a nonclient. (Escamilla,
at pp. 576, 590.) However, Escamilla does not fully answer the
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Opinion of the Court by Guerrero, C. J.
previous observations regarding the text of section 340.5,
however, strongly suggest that there must be a nexus between
the provision of medical care and the resulting injury. Although
section 340.5 refers to claims by a “plaintiff” rather than a
“patient,” it applies only to actions “for injury or death . . . based
upon . . . professional negligence,” rather than a broader
category of actions against health care providers. (Italics
added.) In addition, section 340.5 specifically defines
“ ‘[p]rofessional negligence’ ” as “a negligent act or omission to
act by a health care provider in the rendering of professional
services, which act or omission is the proximate cause of a
personal injury or wrongful death.” (Id., subd. (2).) This
circumscribed definition suggests the statute is only concerned
with injuries resulting directly from the negligent rendering of
medical care, as opposed to all injuries that might occur during
or that arise out of the provision of medical care. (See Flores,
supra, 63 Cal.4th at p. 85 [“the relevant professional service is
medical care: that is, the medical diagnosis and treatment of
patients”].)
Nonetheless, because section 340.5 may not be free from
ambiguity, we consider MICRA’s purpose and legislative intent
to better inform our analysis. (Smith, supra, 11 Cal.5th at
p. 190.)
question in this case. While we have previously regarded
sections 340.5 and 340.6(a) as sister statutes, their text is not
identical, and the nature of the claim raised in Escamilla
involved different considerations than those presented in the
instant case.
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Opinion of the Court by Guerrero, C. J.
C. MICRA’s Purpose and Legislative History
Flores included a comprehensive discussion of the purpose
and legislative history of MICRA. There, we explained that, for
“most of the 20th century,” medical malpractice claims were
subject to a one-year statute of limitations, which was the same
as the previously existing one-year statute of limitations for
general negligence claims. (Flores, supra, 63 Cal.4th at p. 80,
citing former § 340, subd. (3), as amended by Stats. 1905,
ch. 258, § 2, pp. 231–232.) Subsequently, the courts began to
adopt a “delayed discovery rule” for medical malpractice cases;
that is, the limitations period did not begin to run until the
plaintiff discovered, or through the use of reasonable diligence
should have discovered, the plaintiff’s injuries. (Flores, at p. 81.)
In 1970, the Legislature enacted a statute of limitations specific
to medical negligence claims to guard against “ ‘ “open-ended”
operation’ ” of the delayed discovery rule. (Ibid.) The 1970
statute provided that claims against specified medical
professionals “ ‘based upon such person’s alleged professional
negligence . . . or for error or omission in such person’s
practice’ ” must be brought within one year of the plaintiff’s
discovery of the injury, “subject to an outer limit of four years
after the date of injury.” (Ibid., quoting former § 340.5, added
by Stats. 1970, ch. 360, § 1, pp. 771–772.)
Five years later, the Legislature enacted MICRA, a
comprehensive package of legislative reforms intended to
remedy the spiraling costs of medical malpractice insurance.
(Flores, supra, 63 Cal.4th at p. 81.) The Legislature adopted
several measures intended to have such an effect. These
measures included amending the statute of limitations for
medical negligence claims to: (1) shorten the outer limit for
filing medical negligence claims from four years to three years;
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(2) expand covered medical professionals to include additional
categories of health care providers; (3) rephrase the description
of covered actions to include any “action for injury or death
against a health care provider based upon such person’s alleged
professional negligence”; and (4) add the definition of
“professional negligence” that appears today. (§ 340.5.)
While MICRA’s text refers to “professional negligence”
rather than “malpractice,” the manifest purpose of the
legislation was to reduce costs associated with medical
malpractice insurance. (See Western Steamship Lines, Inc. v.
San Pedro Peninsula Hospital (1994) 8 Cal.4th 100, 111.) In
convening an extraordinary legislative session to enact MICRA,
then-Governor Edmund G. Brown proclaimed that the “cost of
medical malpractice insurance has risen to levels which many
physicians find intolerable.” (Governor’s Proclamation to Leg.
(May 16, 1975) Stats. 1975, 2d Ex. Sess. 1975–1976, p. 3947; see
also Stats. 1975, ch. 2, § 12.5, p. 4007 [preamble to MICRA;
purpose of MICRA was to remedy “a major health care crisis in
the State of California attributable to skyrocketing malpractice
premiums”].) Consistent with this goal, MICRA’s legislative
materials reflect concerns regarding malpractice claims, not
garden-variety negligence claims against health care providers.
(See, e.g., Assem. Com. on Judiciary, Rep. on Assem. Bill No. 1
(2d Ex. Sess. 1975–1976) as amended June 6, 1975, pp. 1–3
[describing MICRA as effecting “malpractice” reforms, including
amending the statute of limitations for “medical malpractice”];
Assem. Com. on Ways and Means, Analysis of Assem. Bill No. 1
(2d Ex. Sess. 1975–1976) as amended June 13, 1975, pp. 1–2
[describing MICRA as amending the “malpractice” statute of
limitations]; Sen. Com. on Ins. and Fin. Institutions, Analysis of
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Opinion of the Court by Guerrero, C. J.
Assem. Bill No. 1 (2d Ex. Sess. 1975–1976) as amended Aug. 11,
1975, p. 3 [same].)
In sum, although we have recognized that MICRA’s
reference to “ ‘professional negligence’ ” may not be “strictly
limited to classic sponge-in-the-patient medical malpractice
actions” (Waters v. Bourhis (1985) 40 Cal.3d 424, 432–433; see
also Flores, supra, 63 Cal.4th at p. 85), containing the costs
associated with traditional malpractice cases, including the
insurance premiums associated with medical malpractice, was
MICRA’s core motivating principle.
Our understanding of MICRA’s specific aims and
accordingly limited reach informed our decision in Flores. As we
explained in Flores, extending MICRA to claims for any injury
sustained on a hospital premises would overshoot the
Legislature’s goal of reducing the cost of medical malpractice
insurance. (Flores, supra, 63 Cal.4th at pp. 86–87.) We
concluded that “[t]he text and purposes underlying section
340.5 . . . require us to draw a distinction between the
professional obligations of hospitals in the rendering of medical
care to their patients and the obligations hospitals have, simply
by virtue of operating facilities open to the public, to maintain
their premises in a manner that preserves the well-being and
safety of all users.” (Id. at p. 87.) We further observed that
extending MICRA to claims arising from the breach of an
ordinary duty of care may have actually been
“counterproductive” to MICRA’s purpose when it was enacted
because the statute of limitations for general negligence claims
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was also only one year at that time. (Flores, at p. 87, fn. 4.)7
With the MICRA statute of limitations being “one year when the
injury was or should have been immediately discovered, three
years when discovery of the injury was delayed, and in some
circumstances subject to tolling,” “[t]o the extent that MICRA
reflected legislative concerns about . . . skyrocketing
malpractice rates, those concerns would have counseled against
treating a garden-variety negligence claim as a claim for
professional negligence.” (Flores, at p. 87, fn. 4.)
This review of MICRA’s purpose and history corroborates
that in determining whether the MICRA statute of limitations
applies, we look to whether the plaintiff’s claim derives from
professional obligations that are distinct from the duty to
exercise ordinary care that is owed to the public generally.
Where the plaintiff’s claim is premised on the violation of a
professional obligation owed in the rendering of a patient’s
medical care, treatment, or diagnoses, the claim sounds in
professional negligence and the MICRA statute of limitations
will apply. (See, e.g., Nava v. Saddleback Memorial Medical
Center (2016) 4 Cal.App.5th 285, 292 (Nava) [MICRA applied
when a patient was injured falling off a gurney, as “the alleged
negligence in the use or maintenance of the gurney from which
[the plaintiff] fell was integrally related to his medical diagnosis
or treatment”]; see also Mitchell v. Los Robles Regional Medical
7
In 2002, for reasons not relevant here, the Legislature
lengthened the statute of limitations for general negligence
claims from one to two years. (§ 335.1, added by Stats. 2002,
ch. 448, § 2, p. 2522.) This legislative change had the “perhaps
unintentional effect” of creating a longer statute of limitations
for general negligence claims than for medical negligence
claims. (Flores, supra, 63 Cal.4th at p. 82, fn. 2.)
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Center (2021) 71 Cal.App.5th 291, 298–299 (Mitchell) [MICRA
applied when a patient was injured walking to the restroom
without a nurse escort, as the nurse’s judgment that plaintiff did
not need assistance implicated the nurse’s professional duty to
protect and ensure the comfort of the patient].) Where, in
contrast, the alleged negligence does not implicate a specific
professional obligation along the foregoing lines and violates
only the duty of ordinary care owed to the general public, the
claim does not involve professional negligence and the MICRA
statute of limitations is inapplicable. (See, e.g., Johnson v. Open
Door Community Health Centers (2017) 15 Cal.App.5th 153, 160
(Johnson) [MICRA did not apply when a patient tripped on a
scale placed in an unsafe location in her doctor’s office after her
medical consultation concluded].)8
Under this rule, the absence of any professional duty owed
directly to a plaintiff may shed light on the nature of that
plaintiff’s claim; however, it is nonetheless possible that a claim
by a nonpatient plaintiff will sound in professional negligence,
bringing the MICRA statute of limitations into play. As both
parties note, several Court of Appeal decisions have applied
various provisions of MICRA to claims by nonpatients. Many of
these cases involved a plaintiff who was either the patient’s heir
(in cases involving claims of wrongful death) or the patient’s
spouse (in the case involving claims for loss of consortium), and
the plaintiffs’ claims flowed from the breach of a professional
obligation that the health care provider owed to the patient in
8
We make note of Nava, Mitchell, and Johnson to illustrate
the general principles set forth in this opinion but express no
view as to whether these principles were correctly applied to the
specific facts of those cases.
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the first instance. (Yates v. Pollock (1987) 194 Cal.App.3d 195,
197, 199 [MICRA’s damages cap9 applied to wrongful death
action by patient’s spouse and children]; Bell v. Sharp Cabrillo
Hospital (1989) 212 Cal.App.3d 1034, 1037, 1048–1052
[MICRA’s damages cap applied to wrongful death action by
mother whose minor son was the patient]; Atkins v. Strayhorn
(1990) 223 Cal.App.3d 1380, 1394–1396 [MICRA’s damages cap
applied to loss of consortium claim by spouse of patient].)
This court also applied MICRA’s statute of limitations to
nonpatient claims in Hedlund v. Superior Court (1983)
34 Cal.3d 695, 703 (Hedlund), a case involving unusual facts. In
Hedlund, a mother and son sued two psychiatrists whose
patient shot the mother while the son was present. (Id. at
p. 700.) We held the mother’s claim sounded in professional
negligence, because “the duty imposed on a therapist . . . to
diagnose or recognize the danger posed by the patient” was
“inextricably interwoven” with a duty to warn where the patient
made threats to a “known victim.” (Id. at p. 703.) We held the
son had also stated a cause of action for professional negligence
because “it was foreseeable that [the patient’s] threats, if carried
out, posed a risk of harm to bystanders and particularly to those
in close relationship to [the mother],” and therefore the
psychiatrists’ duty to warn “extended” to the son. (Id. at p. 705.)
However, we declined to decide “whether a duty exists as to all
bystanders who might be injured” because “the foreseeability of
such injury [wa]s not before us.” (Ibid.)10
9
See Civil Code section 3333.2.
10
The underlying duty that Hedlund invoked has since been
superseded in part by statute. (See Civ. Code, § 43.92, subds. (a)
& (b).)
17
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
Thus, as explained above, the plaintiff’s status as a patient
or nonpatient is not necessarily determinative. Rather, the
fundamental question is whether the plaintiff’s claim for
negligence involves a violation of professional obligations, as
opposed to the breach of a duty owed to the public generally.
D. MICRA Does Not Reach Plaintiff’s Claim
Applying the foregoing principles, we conclude that the
MICRA statute of limitations does not apply here, as plaintiff’s
claim stems from the breach of a general duty of care owed to
the public.
Plaintiff does not allege that defendants were negligent in
performing “medical diagnosis or treatment” of the patient
whom they were transporting. (Flores, supra, 63 Cal.4th at
p. 89.) Rather, plaintiff alleges that defendants were negligent
in their failure to obey traffic laws applicable to all drivers on
the road. Plaintiff’s claim is akin to the example of the
collapsing waiting room chair in Flores. (Ibid.) Like the
hospital’s duty to maintain the chair in good working order,
defendants owed a duty to the general public to drive their
ambulance with ordinary care under the circumstances. (See
Cabral v. Ralphs Grocery Co. (2011) 51 Cal.4th 764, 774 [“the
general duty to take ordinary care in the conduct of one’s
activities (Civ. Code, § 1714, subd. (a)) indisputably applies to
the operation of a motor vehicle”].) In other words, defendants’
duty to drive with ordinary care was not a duty owed “by virtue
of being a health care provider” (Flores, at p. 88), but rather, a
18
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
duty owed simply by virtue of being a driver.11 As such,
plaintiff’s claim sounds in general negligence and falls outside
of MICRA’s scope.
In reaching a contrary conclusion, the majority opinion
below relied on two cases applying MICRA to claims by
nonpatients based on fact patterns somewhat similar to the one
here: Canister v. Emergency Ambulance Service, Inc. (2008)
160 Cal.App.4th 388 (Canister) and Lopez v. American Medical
Response West (2023) 89 Cal.App.5th 336 (Lopez). Canister held
that MICRA applied to an action by a police officer who was
injured while riding with a patient in an ambulance when it
collided with another vehicle. (Canister, at pp. 406–408.)12
Canister, which predated Flores, reasoned that the EMTs
operating the ambulance were rendering professional services
to the patient when the collision occurred and that “courts have
broadly construed ‘professional negligence’ to mean negligence
occurring during the rendering of services for which the health
care provider is licensed.” (Canister, at p. 406.) Following
Canister, Lopez held that MICRA’s statute of limitations applied
to claims by a passenger patient and his son who had
11
The dissenting opinion below considered it significant that
the ambulance here was not responding to an emergency
situation. (Gutierrez, supra, 97 Cal.App.5th at p. 796 (dis. opn.
of Bromberg, J.).) To be clear, while the existence of an
emergency may affect what will constitute ordinary care, it does
not fundamentally alter the fact that the ambulance driver’s
duty to other drivers is one of ordinary care.
12
Canister addressed the applicability of MICRA, not with
respect to its statute of limitations, but in the context of another
MICRA provision that allows defendants to introduce evidence
of collateral payments made to the plaintiff. (Canister, supra,
160 Cal.App.4th at p. 392; see Civ. Code, § 3333.1, subd. (a).)
19
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
accompanied the patient during transport. (Lopez, at p. 347 &
fn. 6; see also id. at p. 345 [noting, “This case falls squarely
withing the holding of Canister”].)
Canister and Lopez are in some tension with Aldana,
supra, 2 Cal.App.5th 1. Aldana held that MICRA’s statute of
limitations did not apply when a paramedic drove a supervisor’s
truck to an emergency situation and got in a car accident with
the plaintiff en route. (Aldana, at pp. 7–8.) Aldana reasoned
that “[d]riving a nonambulance vehicle to the scene of an injured
victim is outside the scope of the duties for which a paramedic
is licensed,” and therefore MICRA did not apply. (Aldana, at
p. 8.) Furthermore, applying Flores, the Aldana court
determined that “[a] paramedic’s exercise of due care while
driving is not ‘necessary or otherwise integrally related to the
medical treatment and diagnosis of the patient’ [citation], at
least when the patient is not in the vehicle.” (Ibid.) Aldana
recognized that “Canister concluded that both the EMT driving
the ambulance and the EMT attending the patient [in that case]
were rendering professional services.” (Id. at p. 7.) On this
point, the Aldana court did not expressly disagree with Canister,
but observed, “[i]n light of Flores, it is questionable whether
[Canister’s] conclusion was correct.” (Ibid.) In dismissing
Aldana’s relevance to the instant case, the Gutierrez majority
suggested that Aldana’s holding was limited to its facts.
(Gutierrez, supra, 97 Cal.App.5th at pp. 793, 795.)
We conclude Canister and Lopez were incorrect to the
extent they suggest that a plaintiff’s claim sounds in
professional negligence merely because the plaintiff’s injuries
“occur[ed] during the rendering of services” to a patient.
(Canister, supra, 160 Cal.App.4th at p. 406, italics added.) For
MICRA’s statute of limitations to apply, it is not enough that
20
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
there is a temporal connection between the plaintiff’s alleged
injuries and a health care provider’s rendering of professional
services. Rather, the alleged injury must be “suffered as a result
of negligence in rendering the professional services that
hospitals and others provide by virtue of being health care
professionals.” (Flores, supra, 63 Cal.4th at p. 88.) That is, the
breach of the professional obligation must be the “proximate
cause of a personal injury or wrongful death.” (§ 340.5,
subd. (2).) Here, plaintiff’s injuries were allegedly caused by
Tostado’s negligent driving. As previously noted, this is not a
“duty that the [defendant] owes to a patient by virtue of being a
health care provider” (Flores, at p. 88); an ambulance driver
owes the general public a duty to drive with ordinary care simply
because they are operating a vehicle on a road.
Defendants would have us interpret MICRA more broadly.
In their view, the ambulance transport here was “integrally
related” to the provision of health care to the patient passenger
(Flores, supra, 63 Cal.4th at p. 88) and, because plaintiff’s
injuries resulted from the ambulance transport, his claims
should be covered by MICRA. Defendants misunderstand
Flores. As previously discussed, in the context of a claim
brought by a patient, Flores considered whether the
malfunctioning bed guardrail at issue was “integrally related”
to the patient’s medical care. (Flores, at p. 89.) Based on a
factual concession that her doctor had ordered the guardrail to
be set a certain height, we concluded that the patient’s
“injuries . . . resulted from [the defendant’s] alleged negligence
in the use or maintenance of equipment integrally related to [the
patient’s] medical diagnosis and treatment”; therefore, MICRA
applied. (Flores, at p. 89.) Here, no similar nexus exists
between professional negligence, i.e., the breach of “a duty that
21
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
the [defendant] owes to a patient by virtue of being a health care
provider” (id. at p. 88) and plaintiff’s injuries as alleged in the
complaint. Even if we assume the patient in this case was
receiving medical services during the ambulance transport,
there are no allegations suggesting that professional negligence
in rendering those services was the proximate cause of plaintiff’s
injuries.
In this sense, plaintiff’s claim is distinct from claims by a
patient’s relatives for wrongful death or loss of consortium based
on medical negligence, or the claims by the foreseeable victims
of the dangerous patient in Hedlund. In those cases, MICRA
applied because the plaintiff’s injuries were proximately caused
by the breach of a professional obligation owed to a patient. For
instance, in Hedlund, the plaintiffs’ cause of action for failure to
warn came within MICRA because the proper diagnosis of the
patient was an element of the plaintiffs’ cause of action.
(Hedlund, supra, 34 Cal.3d at pp. 703–704.) We explained:
“Tarasoff [v. Regents of University of California (1976) 17 Cal.3d
425 held] that diagnoses and predictions about the danger of
violence presented by a patient must be rendered under
accepted rules of professional responsibility, and that in so doing
therapists must exercise the ‘ “reasonable degree of skill,
knowledge and care ordinarily possessed and exercised by
members of [the profession].” ’ [Citation.] Diagnosis of
‘psychological problems and emotional and mental disorders’ is
a professional service for which a psychologist is licensed, and a
negligent failure in this regard is therefore ‘professional
negligence’ as that term is defined in section 340.5. This
diagnosis and prediction is an essential element of a cause of
action for failure to warn. It is the basis upon which the duty to
the third party victim is found.” (Id. at p. 703.) Here, by
22
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
contrast, there is no professional failure that plaintiff must
plead or prove to succeed on his personal injury claim.13
E. Policy Considerations
In justifying its holding below, the Gutierrez majority
reasoned, “Under [plaintiff’s] proposed approach, two people
involved in the same accident at the same time would be subject
to two different statutes of limitations, possibly resulting in two
separate lawsuits with inconsistent judgments and greatly
increased costs for all involved.” (Gutierrez, supra,
97 Cal.App.5th at p. 795.) The Gutierrez majority regarded this
as an “untenabl[e]” policy outcome. (Ibid.) The dissent, drawing
parallels between plaintiff’s position and our holding in Lee (see
fn. 4, ante), rejected this argument. The dissent explained: “The
majority objects that it is impracticable to interpret MICRA’s
statute of limitations to depend on whether a claim requires
proof that a professional obligation has been violated because
claims by two people involved in the same accident at the same
time might be subject to two different statutes of limitations.
While it is true that claims by different people may be subject to
different statute[s] of limitations, that is no reason to reject the
Lee majority’s approach. Lee itself recognized that under this
13
Defendants acknowledged at oral argument that
section 340.5 only applies to actions for “injury or death against
a health care provider based upon such person’s alleged
professional negligence.” (§ 340.5, italics added.) As such, by its
own terms, section 340.5 would not apply to plaintiff’s claim to
the extent it involved property damage to his vehicle. The fact
that section 340.5 does not reach property damage, which is
commonly claimed in general negligence actions, further
underscores that claims arising from a routine car accident —
such as the one at issue in this case — sound in general rather
than professional negligence.
23
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
approach claims brought by the same person concerning the
same conduct may be subject to different statutes of limitations
[assuming the person brings separate causes of action based on
professional negligence and other theories]. [Citation.] As a
consequence, it is neither impermissible nor impractical to
interpret MICRA’s statute of limitations so that claims
involving the same conduct may be subject to different statutes
of limitations if they are based on different theories.” (Gutierrez,
supra, 97 Cal.App.5th at p. 798 (dis. opn. of Bromberg, J.).)
We agree with the dissent. The possibility of different
plaintiffs being subject to different statutes of limitation is
neither unworkable nor inherently unfair.14 A more obvious
unfairness would result from defendants’ proposed rule; that is,
health care provider defendants would be afforded greater
protection against an array of lawsuits than other types of
defendants merely due to their identity as health care providers.
In Escamilla, we “discern[ed] ‘no policy reason in the legislative
history [of section 340.6(a)] or elsewhere for providing a more
circumscribed limitations period for attorney defendants than
for client defendants of malicious prosecution actions.’ ”
(Escamilla, supra, 17 Cal. 5th at p. 588.) This reasoning applies
14
In making this observation, we do not opine on whether
claims brought by the patient who was riding in the ambulance
that struck plaintiff’s vehicle in this case would be subject to a
different statute of limitations than plaintiff’s claim. That
would depend on the specific facts alleged by the patient, and
the nature of the duties or obligations involved, which are not
issues before this court.
24
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
with equal force in the context of general negligence claims
against health care providers.15
Nor are we persuaded by the argument of amici curiae
California Medical Association, California Dental Association,
and California Hospital Association (collectively, medical
associations) that our holding would allow plaintiffs to avoid the
MICRA statute of limitations through artful pleading. The
medical associations express concern that plaintiffs could
control which statute of limitations applies to their lawsuits
simply by characterizing professional negligence claims as
general negligence claims. Thus, according to the medical
associations, it would be plaintiffs “who determine whether
MICRA applies, even when plaintiffs are patients, even when
defendants are health care providers, and even when defendants
were engaged ‘in the rendering of professional services’ when
plaintiffs were injured.”
However, as we have explained, the applicable statute of
limitations is not driven by a plaintiff’s strategic choice of words
but, rather, the substance of a plaintiff’s allegations. “Under
well established principles the applicable statute of limitations
15
Defendants do not advance the additional policy
argument, cited in the Gutierrez majority opinion, that a
decision in plaintiff’s favor could negatively impact medical
malpractice insurance rates. (See Gutierrez, supra,
97 Cal.App.5th at p. 795.) In any event, we have not been
provided any clear evidence of such potential impacts. The
Insurance Commissioner, in an amicus curiae letter, explained
that standard professional medical liability forms submitted by
the Insurance Services Office “would not categorically cover
traffic accident claims like the one in this case just because they
involve a collision with an ambulance,” but noted that individual
policies may vary.
25
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
is determined by the nature of the right sued upon.” (Hedlund,
supra, 34 Cal.3d at p. 704, italics added.) Here, we hold that a
plaintiff’s claim sounds in general negligence, and not
professional negligence, when it arises from a breach of a
general duty of care owed to all members of the public. Whether
such a breach is at issue will depend on the facts alleged in the
complaint — not the terminology the plaintiff chooses to employ.
A plaintiff’s claim may sound in general negligence, even when
the plaintiff is the patient (see, e.g., Johnson, supra,
15 Cal.App.5th at p. 160), even when the defendant is a health
care provider, and even when professional services are being
performed at the time the plaintiff is injured. But this is
consistent with the aim of MICRA, which was designed to
address the rising costs of litigation associated with professional
negligence claims against health care providers — not any
negligence claims against health care providers.
F. The Two-year Statute of Limitations Under
Section 335.1 Applies
Plaintiff’s claim is not based on the breach of a
professional obligation that defendants owed to the patient they
were transporting in the ambulance that collided with plaintiff’s
vehicle. Plaintiff’s claim arises instead from the alleged breach
of the general duty of care that defendants owed to all other
drivers to safely operate their ambulance on the road. Thus, the
essence of plaintiff’s action was not professional negligence but
rather garden-variety negligence. As such, the two-year statute
of limitations for general negligence claims applies (§ 335.1),
and plaintiff’s suit was timely filed.
26
GUTIERREZ v. TOSTADO
Opinion of the Court by Guerrero, C. J.
III. DISPOSITION
We conclude that the MICRA statute of limitations does
not apply where, as here, the plaintiff’s claim sounds in general
negligence as predicated on the breach of a duty owed to the
public generally. On this basis, we reverse the judgment and
remand this matter to the Court of Appeal for further
proceedings consistent with our opinion. We disapprove
Canister v. Emergency Ambulance Service, Inc. (2008)
160 Cal.App.4th 388 and Lopez v. American Medical Response
West (2023) 89 Cal.App.5th 336 to the extent they are
inconsistent with our opinion.
GUERRERO, C. J.
We Concur:
CORRIGAN, J.
LIU, J.
KRUGER, J.
GROBAN, J.
JENKINS, J.
EVANS, J.
27
See next page for addresses and telephone numbers for counsel who
argued in Supreme Court.
Name of Opinion Gutierrez v. Tostado
__________________________________________________________
Procedural Posture (see XX below)
Original Appeal
Original Proceeding
Review Granted (published) XX 97 Cal.App.5th 786
Review Granted (unpublished)
Rehearing Granted
__________________________________________________________
Opinion No. S283128
Date Filed: July 31, 2025
__________________________________________________________
Court: Superior
County: Santa Clara
Judge: Christopher G. Rudy
__________________________________________________________
Counsel:
Southwest Legal Group, Anthony R. Lopez, Jr.; The Ehrlich Law Firm,
Jeffrey I. Ehrlich; Law Offices of Clinton Ehrlich and Clinton E.
Ehrlich-Quinn for Plaintiff and Appellant.
Ikuta Hemesath, Benjamin T. Ikuta, Michelle B. Hemesath and Janna
M. Trolia for Consumer Attorneys of California as Amicus Curiae on
behalf of Plaintiff and Appellant.
Manning & Kass, Ellrod, Ramirez, Trester, David V. Roth and Mark R.
Wilson for Defendants and Respondents.
Cole Pedroza, Curtis A. Cole and Cassidy C. Davenport for California
Medical Association, California Dental Association and California
Hospital Association as Amici Curiae on behalf of Defendants and
Respondents.
Rob Bonta, Attorney General, and Andrea M. Schoor-West, Deputy
Attorney General, for Insurance Commissioner Ricardo Lara as
Amicus Curiae, upon the request of the Supreme Court.
Counsel who argued in Supreme Court (not intended for
publication with opinion):
Clinton E. Ehrlich-Quinn
Law Offices of Clinton Ehrlich
120 Vantis, Suite 300
Aliso Viejo, CA 92656
(818) 473-5404
Mark R. Wilson
Manning & Kass, Ellrod, Ramirez, Trester LLP
101 Montgomery Street, Suite 2550
San Francisco, CA 94104
(415) 400-0829