Holland v. Silverscreen Healthcare, Inc.

IN THE SUPREME COURT OF

CALIFORNIA

JONIE A. HOLLAND et al.,

Plaintiffs and Respondents,

v.

SILVERSCREEN HEALTHCARE, INC.,

Defendant and Appellant.

S285429

Second Appellate District, Division Two

B323237

Los Angeles County Superior Court

22STCV01945

August 14, 2025

Justice Kruger authored the opinion of the Court, in which

Chief Justice Guerrero and Justices Corrigan, Liu, Groban,

Jenkins, and Evans concurred.

HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

S285429

Opinion of the Court by Kruger, J.

As a general rule, plaintiffs cannot be compelled to

arbitrate their disputes if they have not previously agreed to

arbitration. But in Ruiz v. Podolsky (2010) 50 Cal.4th 838

(Ruiz), this court identified an exception for certain wrongful

death claims based on medical malpractice. If a patient agreed

to arbitrate medical malpractice disputes in compliance with the

arbitration provision of the Medical Injury Compensation

Reform Act (MICRA) (codified as Code Civ. Proc., § 1295), the

patient-provider agreement may bind the patient’s heirs in a

wrongful death action, even if the heirs themselves never agreed

to arbitration. (Ruiz, at pp. 849–850.)

The question before us concerns the application of Ruiz in

a recurring context. Plaintiffs sued a 24-hour skilled nursing

facility, alleging that the facility’s neglect caused their son’s

death. Before his death, plaintiffs’ son had signed an agreement

to arbitrate medical malpractice disputes against the facility.

Parting company with appellate courts that had taken different

approaches to the issue, the Court of Appeal held that the

patient-provider agreement binds plaintiffs because their

wrongful death claim based on the nursing facility’s neglect is

necessarily a claim about the manner in which a health care

provider rendered its professional services.

We conclude that the Court of Appeal’s decision in this

case extends Ruiz past statutory bounds. Ruiz does not apply to

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Opinion of the Court by Kruger, J.

every type of wrongful death claim that might be brought

against a health care provider — particularly a provider that,

like the skilled nursing facility in this case, provides both

medical care and day-to-day custodial care of dependent adults.

Under Ruiz, plaintiffs’ claim must be submitted to arbitration

only if they are raising a dispute about medical malpractice as

that term is defined in MICRA’s arbitration provision — that is,

a dispute “ ‘as to whether any medical services . . . were

improperly, negligently or incompetently rendered.’ ” (Code Civ.

Proc., § 1295, subd. (a) (§ 1295(a)).) Ruiz does not require

plaintiffs to arbitrate their disputes about a facility’s neglect of

a resident’s basic welfare and safety needs.

To the extent the plaintiffs’ complaint in this case fails to

detail whether they are alleging deficiencies in the nursing

facility’s rendering of medical services or instead in its provision

of custodial care, we conclude that they should be permitted to

amend their complaint to specify. We reverse the judgment of

the Court of Appeal and remand for further proceedings.

I.

Skyler A. Womack was a dependent adult with physical

and developmental disabilities. In January 2020, he was

admitted as an inpatient at a 24-hour skilled nursing facility

called Asistencia Villa Rehabilitation and Care Center

(Asistencia), operated by Silverscreen Healthcare, Inc.

(Silverscreen). Skyler died on October 29, 2020, while still

residing at Asistencia.

Following his death, Skyler’s parents and heirs, plaintiffs

Jonie A. Holland and Wayne D. Womack, filed suit against

Silverscreen. Plaintiffs’ complaint asserted four causes of

action: (1) dependent adult abuse under the Elder Abuse and

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Opinion of the Court by Kruger, J.

Dependent Adult Civil Protection Act, Welfare and Institutions

Code, section 15600 et seq. (Elder Abuse Act); (2) negligence;

(3) violation of residents’ rights under Health and Safety Code,

section 1430, subdivision (b); and (4) wrongful death. The first

three causes of action are survivor claims brought by Holland as

Skyler’s successor in interest. The wrongful death cause of

action was brought by both plaintiffs in their personal capacity.

In connection with all of these causes of action, plaintiffs

alleged that Silverscreen failed to protect Skyler from “multiple

falls with injury, and infections which caused him pain and

suffering and were substantial factors in his untimely demise.”

Plaintiffs also alleged that Silverscreen failed to “employ an

adequate number of qualified personnel to carry out all of the

functions of the facility”; failed to “keep[] its facility in good

repair at all times”; failed to “correct deficiencies issued by the

State of California’s Department of Public Health”; and failed to

“provid[e] [Skyler] with good nutrition and necessary fluids for

hydration.” In connection with their cause of action under the

Elder Abuse and Dependent Adult Civil Protection Act (Elder

Abuse Act), plaintiffs alleged that Silverscreen “failed to

exercise the degree of care that reasonable persons in a like

position would exercise by denying or withholding goods or

services necessary to meet . . . basic needs” and thus “ ‘neglected’

[Skyler] as that term is defined in Welfare and Institutions Code

§[]15610.57,” a provision of the Elder Abuse Act defining

actionable abuse. Their wrongful death cause of action alleges

that Skyler died “[a]s a proximate result of [this] negligence and

‘neglect,’ ” as that term is defined in the Elder Abuse Act.

On admission to Asistencia, Skyler had signed a

“Resident-Facility Arbitration Agreement.” The agreement

provided for arbitration of malpractice claims, adhering to

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Opinion of the Court by Kruger, J.

statutory language and formatting requirements for medical

services contracts covering disputes as to the “professional

negligence of a health care provider.” (§ 1295(a).) It stated that

“any dispute as to medical malpractice, that is as to whether any

medical services rendered under this contract were unnecessary

or unauthorized or were improperly, negligently or

incompetently rendered, will be determined by submission to

arbitration.” (Quoting § 1295(a).) The agreement further

provided — in its own language — that the agreement was

“binding on all parties, including the Resident’s representatives,

executors, family members, and heirs.”

Based on this agreement and our decision in Ruiz,

Silverscreen filed a motion to compel arbitration of each of the

four causes of action asserted in the complaint. Plaintiffs

opposed the petition. They argued that Ruiz did not apply

because their wrongful death claim was based on Silverscreen’s

“neglect,” as that term is defined under the Elder Abuse Act, and

not its “professional negligence.”

The trial court granted Silverscreen’s motion to compel

arbitration of the three survivor claims but denied the motion

as to plaintiffs’ individual claim for wrongful death.1 Following

the lead of the Court of Appeal in Avila v. Southern California

Specialty Care, Inc. (2018) 20 Cal.App.5th 835, 843 (Avila), the

trial court explained that although “[t]he complaint includes

allegations that could be categorized as professional negligence

1

Skyler’s agreement to arbitrate covered not only medical

malpractice claims under Code of Civil Procedure section 1295,

but also any dispute relating to Skyler’s treatment and care at

Asistencia. Holland did not appeal the trial court’s

determination that the three survivor claims were therefore

subject to arbitration.

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Opinion of the Court by Kruger, J.

as well as elder abuse,” plaintiffs “ ‘chose to plead a cause of

action under the [Elder Abuse Act], and they did so successfully.

The fact that they could have also pleaded a claim for medical

malpractice, had they wished to do so, is irrelevant.

Accordingly, . . . plaintiffs’ claim is not one within the ambit of

section 1295, and therefore, Ruiz’s holding does not apply.’ ”

(Quoting Avila, at p. 843.)

The Court of Appeal reversed. (Holland v. Silverscreen

Healthcare, Inc. (2024) 101 Cal.App.5th 1125 (Holland).) The

court began by explaining that the arbitration agreement

“complies to the letter with section 1295, subdivisions (a) and

(b),” and its “plain language manifests an intent between the

parties to bind Skyler’s heirs . . . to any claims of professional

negligence.” (Id. at p. 1133.)2 The court held that “the parents’

barebones claim . . . sounds in professional negligence” because

“[t]he allegations of understaffing and the failure to prevent

Skyler from falling or developing infections speak to ‘negligent

act[s] or omission[s] to act by a health care provider in the

rendering of professional services’ which proximately caused

Skyler’s death.” (Ibid., quoting Code Civ. Proc., § 1295, subd.

(g)(2).)

The Court of Appeal next rejected plaintiffs’ argument

that their wrongful death claim “is not subject to Ruiz because

it is one for dependent adult abuse, not professional negligence.”

(Holland, supra, 101 Cal.App.5th at p. 1133.) The court

reasoned that even though “neglect can constitute abuse under

2

Plaintiffs have not challenged the Court of Appeal’s

conclusion that the agreement was meant to bind Skyler’s heirs;

we assume for purposes of this opinion that the Court of

Appeal’s conclusion was correct.

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Opinion of the Court by Kruger, J.

the Elder Abuse Act,” only victims and their successors in

interest have standing to pursue remedies under that Act.

(Ibid., citing Quiroz v. Seventh Ave. Center (2006) 140

Cal.App.4th 1256, 1283 (Quiroz) [holding that the enhanced

remedies provided under the Elder Abuse Act are not available

in “a wrongful death action brought by a decedent’s heir on his

or her own behalf”].) “[I]f the parents cannot maintain a claim

for abuse under the Elder Abuse Act in their own name, it makes

no sense for them to be able to pursue a claim for wrongful death

based upon that same alleged abuse.” (Holland, at p. 1134.)

Finally, and in the alternative, the Court of Appeal held

that plaintiffs “do not allege with adequate specificity how their

claims here constitute dependent adult abuse and not

professional negligence.” (Holland, supra, 101 Cal.App.5th at

p. 1134.) Raising concerns about permitting plaintiffs to

“circumvent Ruiz through intentionally opaque pleading,” the

court directed the trial court to order the parents’ wrongful

death cause of action to arbitration. (Id. at p. 1135.)

The Court of Appeal acknowledged several appellate

cases, including Avila, in which courts refused to compel

arbitration of wrongful death claims predicated on allegations

of neglect by nursing homes and similar residential care

facilities. (Holland, supra, 101 Cal.App.5th at p. 1134, citing,

inter alia, Avila, supra, 20 Cal.App.5th at p. 843; Valentine v.

Plum Healthcare Group, LLC (2019) 37 Cal.App.5th 1076, 1084

(Valentine); Daniels v. Sunrise Senior Living, Inc. (2013) 212

Cal.App.4th 674, 677, 683–684 (Daniels); see also Hearden v.

Windsor Redding Care Center, LLC (2024) 103 Cal.App.5th

1010, 1018–1019 (Hearden) [following Avila in decision

published shortly after the Court of Appeal’s decision in this

case].) The Court of Appeal agreed with these cases insofar as

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they “confined Ruiz’s holding to wrongful death claims

predicated on medical malpractice or professional negligence,”

but it disagreed with the cases to the extent they might suggest

that plaintiffs’ claim here falls outside Ruiz. (Holland, at

p. 1134; see id. at pp. 1134–1135.)

II.

A.

Code of Civil Procedure 1295 (§ 1295), was enacted as one

of many provisions of MICRA, the Legislature’s “ ‘response to a

perceived crisis regarding the availability of medical

malpractice insurance’ ” due to the high cost of coverage. (Ruiz,

supra, 50 Cal.4th at p. 843, quoting Reigelsperger v. Siller (2007)

40 Cal.4th 574, 577 (Reigelsperger).) Section 1295 was designed

to “ ‘encourage and facilitate arbitration of medical malpractice

disputes,’ ” and thereby to further “MICRA’s goal of reducing

costs in the resolution of malpractice claims and therefore

malpractice insurance premiums” (Ruiz, at p. 844). But the

Legislature that wrote section 1295 also sought to ensure “that

patients are adequately informed of the consequences of

entering into arbitration agreements.” (Ruiz, at p. 849.) To that

end, the Legislature prescribed uniform language and

formatting requirements aimed at informing signatories that

they are giving up their right to bring malpractice claims in

court.

Section 1295(a) prescribes mandatory language for

inclusion in “[a]ny contract for medical services which contains

a provision for arbitration of any dispute as to professional

negligence of a health care provider.” The statute defines the

term “ ‘professional negligence’ ” to mean “a negligent act or

omission to act by a health care provider in the rendering of

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Opinion of the Court by Kruger, J.

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. (g)(2).)

The statute instructs that every contract with such an

arbitration provision “shall have such provision as the first

article of the contract and shall be expressed in the following

language: ‘It is understood that any dispute as to medical

malpractice, that is as to whether any medical services rendered

under this contract were unnecessary or unauthorized or were

improperly, negligently or incompetently rendered, will be

determined by submission to arbitration as provided by

California law, and not by a lawsuit or resort to court process

except as California law provides for judicial review of

arbitration proceedings. Both parties to this contract, by

entering into it, are giving up their constitutional right to have

any such dispute decided in a court of law before a jury, and

instead are accepting the use of arbitration.’ ” (§ 1295(a).)

In addition to the mandatory clause in subdivision (a),

subdivision (b) requires the following notice, in at least 10-point

bold red type, immediately above the signature line: “ ‘NOTICE:

BY SIGNING THIS CONTRACT YOU ARE AGREEING TO

HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED

BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP

YOUR RIGHT TO A JURY OR COURT TRIAL. SEE ARTICLE

1 OF THIS CONTRACT.’ ” (§ 1295, subd. (b).)

In Ruiz, we considered the interaction between section

1295 and the wrongful death statute. Code of Civil Procedure

section 377.60 (section 377.60) provides that specified persons,

including a decedent’s parents, may assert a cause of action for

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death “caused by the wrongful act or neglect of another.” (Id.;

see Norgart v. Upjohn Co. (1999) 21 Cal.4th 383, 390.) In

California, wrongful death claims, unlike survivor claims, are

not derivative of the decedent’s own claims; they are, rather,

independent statutory actions accruing to a decedent’s heirs for

pecuniary injuries suffered by the loss of a relative. (Ruiz,

supra, 50 Cal.4th at pp. 841, 844; see Horwich v. Superior Court

(1999) 21 Cal.4th 272, 283.) Because wrongful death claimants

are entitled to sue in their own right, not merely as successors

in interest to their decedent, they are not ordinarily bound by

any arbitration agreement the decedent may have signed. (See

Ruiz, at pp. 841, 844; Victoria v. Superior Court (1985) 40 Cal.3d

734, 744.)

In Ruiz, however, we concluded that section 1295 marks

an exception to this general rule. As we explained in Ruiz,

section 1295 by its terms applies to agreements to arbitrate

disputes about “ ‘ “professional negligence” ’ ” — a term

specifically defined, as relevant here, to include negligent acts

or omissions that cause “ ‘a personal injury or wrongful death.’ ”

(Ruiz, supra, 50 Cal.4th at p. 849, quoting § 1295, subd. (g)(2).)

Noting that “section 1295 does not distinguish between

malpractice claims asserted by the patient or the patient’s

estate, and wrongful death claims arising out of alleged

malpractice committed against the patient,” we held that

“section 1295 . . . contemplates that all medical malpractice

claims, including wrongful death claims, may be subject to

arbitration agreements between a health care provider and the

patient,” provided that “the language of the agreement

manifests an intent to bind these claimants.” (Ruiz, at pp. 850,

841, italics added & fn. omitted.) This understanding, we

explained, was consistent with the Legislature’s purpose to

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promote arbitration to control the costs of medical malpractice

suits. And a rule permitting patients to bind their heirs to such

an agreement would avoid the practical difficulties and

potential encroachment on a patient’s privacy that would result

from a rule that required a patient’s heirs to sign an agreement

respecting the provision of medical care. (Id. at pp. 850–851.)

Thus, Ruiz held that even if a wrongful death claimant has not

signed an arbitration agreement, under section 1295, the

claimant can nonetheless be bound by the patient’s agreement

to arbitrate medical malpractice claims against a medical

provider.

B.

In the wake of Ruiz, a number of courts have considered

its application in the context of wrongful death suits against

nursing homes or other long-term residential care facilities. In

these cases, courts have examined the interplay between the

Ruiz rule and the Elder Abuse Act.

The Legislature enacted the Elder Abuse Act to protect

elders and other dependent adults from “gross mistreatment in

the form of abuse and custodial neglect.” (Delaney v. Baker

(1999) 20 Cal.4th 23, 33 (Delaney); see generally ibid. [tracing

the history of the Act].) The central provision of the Act provides

“heightened remedies for reckless, oppressive, fraudulent, or

malicious” abuse, neglect, or abandonment of an elder or

dependent adult. (Covenant Care, Inc. v. Superior Court (2004)

32 Cal.4th 771, 781 (Covenant Care); see Welf. & Inst. Code,

§ 15657.) “ ‘Neglect’ ” under the Act is defined as “[t]he

negligent failure of any person having the care or custody of an

elder or a dependent adult to exercise that degree of care that a

reasonable person in a like position would exercise.” (Welf. &

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Inst. Code, § 15610.57, subd. (a)(1).) The Act lists several

examples of “neglect,” including the failure to: “assist in

personal hygiene, or in the provision of food, clothing, or

shelter”; “provide medical care for physical and mental health

needs”; “protect from health and safety hazards”; and “prevent

malnutrition or dehydration.” (Id., subd. (b)(1)–(4).)

In a number of cases, including this one, the heirs of

persons who have died in the care of long-term care facilities

have brought survival claims under the Elder Abuse Act in their

capacity as the decedent’s successor in interest, as well as

independent wrongful death claims based on allegations of

“neglect” as understood under that Act. (See Welf. & Inst. Code,

§ 15600 et seq.; id., § 15610.57; see, e.g., Avila, supra, 20

Cal.App.5th at pp. 838–839; Daniels, supra, 212 Cal.App.4th at

pp. 676–678; Hearden, supra, 103 Cal.App.5th at pp. 1014,

1019; Valentine, supra, 37 Cal.App.5th at pp. 1083, 1084.) In

cases in which the plaintiff’s decedent signed an arbitration

agreement in compliance with section 1295, the question has

arisen whether Ruiz required the plaintiffs to arbitrate their

wrongful death claims.

In Avila, for instance, plaintiffs brought elder abuse and

wrongful death claims alleging that a long-term acute care

hospital’s failure to provide basic care and services resulted in a

dislodged feeding tube that caused their father’s death. (Avila,

supra, 20 Cal.App.5th at pp. 838, 843.) The court asked whether

“the primary basis for the wrongful death claim sounds in

professional negligence as defined by MICRA” or if “the primary

basis” for the claim is instead “under the Elder Abuse and

Dependent Adult Civil Protection Act.” (Id. at p. 842.) The court

acknowledged that while there was some area of “overlap”

between the two, plaintiffs had chosen to plead that their

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father’s death was caused not by incompetence in the rendering

of medical services, but instead by custodial neglect — that is,

“a ‘conscious and continued pattern of withholding the most

basic care and services.’ ” (Id. at p. 843.) For that reason, the

Avila court concluded that the plaintiffs’ claim did not come

within section 1295 and that the Ruiz rule therefore did not

apply. (Avila, at p. 843.)

Similarly, in Hearden, supra, 103 Cal.App.5th at page

1019, plaintiffs’ “elder abuse cause of action . . . alleged the

failure to adequately staff the facility, provide basic custodial

care to residents, monitor residents, [and] provide sufficient

equipment and training to prevent the spread of COVID-19 in

the facility.” Following the approach set forth in Avila, the court

held that the primary basis for plaintiffs’ wrongful death claim

incorporating these allegations was custodial neglect, not

medical malpractice, and therefore section 1295 did not apply.

(Hearden, at p. 1019.)

Finally, in Valentine, supra, 37 Cal.App.5th at page 1083,

decedent’s husband and children asserted elder abuse and

wrongful death claims for “reckless neglect and abuse,” alleging

that a skilled nursing facility repeatedly failed to treat

infections and monitor the decedent’s worsening condition until

decedent became “ ‘acutely ill’ ” and developed septic shock.

Reasoning that “a patient of a skilled nursing facility can bind

her heirs to arbitrate wrongful death claims arising only from

medical malpractice, but not from elder abuse,” the court held

that the trial court did not abuse its discretion in determining

that the allegations fell into the latter category. (Id. at p. 1084;

see id. at pp. 1085, 1090.)

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In granting Silverscreen’s motion to compel arbitration,

the Court of Appeal expressed qualified disagreement with

Avila and subsequent cases, though it did not elaborate on the

nature of its disagreement. (Holland, supra, 101 Cal.App.5th at

p. 1134.) We granted review to address the resulting tension in

the case law.

III.

As this case has been presented to us, the controversy

between the parties is a relatively narrow one. Although the

Court of Appeal expressed qualified disagreement with Avila,

Silverscreen affirmatively disclaims any disagreement with

Avila or intent to call its holding into question. Silverscreen

instead argues that the Court of Appeal’s decision in this case is

entirely consistent with Avila: The difference is that here,

unlike in Avila, plaintiffs’ claims of neglect necessarily sound in

“professional negligence” within the meaning of section 1295(a),

and they therefore fall under the exception articulated in Ruiz.

(See Holland, supra, 101 Cal.App.5th at p. 1133.) We find the

argument unpersuasive.

A.

Not every claim of injury against a health care provider

qualifies as a claim of professional negligence that comes within

section 1295. By its terms, section 1295 applies only to claims

based on negligence in the provision of medical services: The

mandatory contract language in subdivision (a) is limited to

“ ‘dispute[s] as to medical malpractice, that is as to whether any

medical services rendered under this contract were unnecessary

or unauthorized or were improperly, negligently or incompetently

rendered.’ ” (§ 1295(a), italics added.) But even setting the

contract language aside, our cases are clear that a claim

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qualifies as a claim of “professional negligence” under MICRA

only if the claim is based on negligence in the provision of

medical services.

In Flores v. Presbyterian Intercommunity Hospital (2016)

63 Cal.4th 75, for instance, we were tasked with determining

“whether negligence in the use or maintenance of hospital

equipment or premises qualifies as professional negligence”

under MICRA’s statute of limitations provision, Code of Civil

Procedure section 340.5. (Flores, at p. 84; see Code Civ. Proc.,

§ 340.5, subd. (2) [defining professional negligence].) We

concluded that the answer to this question depends on whether

the duty to maintain equipment or premises is one the hospital

owes “by virtue of being a health care provider,” as opposed to a

general duty shared by all business owners. (Id. at p. 88.) The

term “professional negligence” covers “[a] hospital’s negligent

failure to maintain equipment that is necessary or otherwise

integrally related to . . . the provision of medical care to a

patient.” (Ibid.) But it does not cover a situation in which, “for

example, a chair in a waiting room collapses, injuring the person

sitting in it.” (Id. at p. 89.) That is because “the hospital’s duty

with respect to that chair is no different from that of any other

home or business with chairs in which visitors may sit.” (Ibid.)

In other words, in determining the scope of “professional

negligence,” we draw the line at acts or omissions to be judged

against “the standard of care for medical treatment,” not the

“more general duty” shared by all Californians to take care to

avoid harm. (Johnson v. Open Door Community Health Centers

(2017) 15 Cal.App.5th 153, 161.) The relevant question is

whether the “injury [was] suffered as a result of negligence in

rendering the professional services that hospitals and others

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provide by virtue of being health care professionals: that is, the

provision of medical care to patients.” (Flores, at p. 88.)

We have previously had occasion to draw this line in cases

concerning the interplay between MICRA and the Elder Abuse

Act. In Delaney, for example, we were asked to consider whether

“professional negligence” as defined in MICRA’s statute of

limitations encompassed allegations of “neglect” under the

Elder Abuse Act. (Delaney, supra, 20 Cal.4th at p. 27.) We said

no. (Ibid.; see Covenant Care, supra, 32 Cal.4th at pp. 776, 780

[rejecting defendant nursing facility’s argument that plaintiffs’

elder neglect claim was one “arising out of the professional

negligence of a health care provider” for purposes of Code Civ.

Proc. § 425.13, subd. (a)].) “Professional negligence,” we held,

refers to “negligence in the undertaking of medical services,” or

in other words, “to the performance of medical services in a

manner inferior to ‘ “the knowledge, skill and care ordinarily

possessed and employed by members of the profession in good

standing.” ’ ” (Delaney, at p. 34, italics added, quoting Flowers

v. Torrance Memorial Hospital Medical Center (1994) 8 Cal.4th

992, 998; accord, Covenant Care, at p. 783.) By contrast,

custodial neglect refers to the “failure of those responsible for

attending to the basic needs and comforts of elderly or

dependent adults” and applies “regardless of their professional

standing.” (Delaney, at p. 34, italics added.) Thus, as a general

rule, a plaintiff who alleges wrongful death based on custodial

neglect under the Elder Abuse Act is not alleging wrongful death

based on medical malpractice. (See Covenant Care, at p. 783;

Winn v. Pioneer Medical Group, Inc. (2016) 63 Cal.4th 148, 159

(Winn).)

As these cases have recognized, however, there is potential

for confusion “in the fact that some health care institutions, such

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as nursing homes, perform custodial functions and provide

professional medical care.” (Delaney, supra, 20 Cal.4th at p. 34.)

In contrast to a hospital or doctor’s office, where patients

generally go to seek help for discrete medical issues and are

discharged upon receiving treatment, residents at a skilled

nursing facility receive both medical care and around-the-clock

caretaking to satisfy “basic needs that an able-bodied and fully

competent adult would ordinarily be capable of managing

without assistance.” (Winn, supra, 63 Cal.4th at p. 158; see also

Health & Saf. Code, § 1250, subd. (c)(1) [“ ‘Skilled nursing

facility’ means a health facility that provides skilled nursing

care and supportive care to patients whose primary need is for

availability of skilled nursing care on an extended basis”].) In

other words, the facility wears multiple hats, rendering services

in its capacity as a medical provider as well as in its capacity as

custodian of residents’ general well-being, which includes

responsibilities such as providing nutrition and hydration. This

can complicate efforts to draw lines between claims concerning

the provision of professional medical services and other services

the facilities may provide.3

3

In Delaney, we explained that the Elder Abuse Act

“provides the way out” of any “ambiguity” between allegations

of professional negligence and neglect, in that Welfare and

Institutions Code section 15657 reaches only “ ‘acts of egregious

abuse’ against elder and dependent adults” and excludes

“simple” or “mere” negligence in the rendition of medical

services. (Delaney, supra, 20 Cal.4th at pp. 35, 32.) But

returning to the subject in Covenant Care, we never questioned

that “health care provider and elder custodian ‘capacities’ are

conceptually distinct.” (Covenant Care, supra, 32 Cal.4th at

p. 785.) “Statutorily, as well as in common parlance, the

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Our cases offer guidance. We have explained that only

acts or omissions by a skilled nursing facility in its capacity as

a health care provider fall under the banner of professional

negligence. (See Covenant Care, supra, 32 Cal.4th at p. 786.)

By contrast, “a failure to fulfill custodial duties owed by a

custodian who happens also to be a health care provider . . . is

at most incidentally related to the provider’s professional health

care services.” (Ibid.) The failure to provide basic necessities,

such as assistance in personal hygiene, food, hydration, or

clothing, are paradigmatic examples of a failure to fulfill

custodial duties. (See Delaney, supra, 20 Cal.4th at p. 34; Welf.

& Inst. Code, § 15610.57, subd. (b).) The same is true of a failure

to provide an adequate and habitable living space or protect

from routine safety hazards. (See Delaney, at p. 34; Welf. & Inst.

Code, § 15610.57, subd. (b).) Similarly, a failure of staff to

attend to, monitor, or assist a resident in obtaining appropriate

medical care generally falls on the custodial side of the line

because such omissions involve “not . . . the undertaking of

medical services, but . . . the failure to provide medical care.”

(Covenant Care, at p. 783.)

Applying these principles in Covenant Care, we held that

allegations that a skilled nursing facility failed to provide

“nutrition, hydration, and medication” and left the patient “in

his bed, unattended and unassisted, for excessively long

periods,” causing death from starvation, dehydration, and sepsis

stated a claim of custodial neglect, rather than professional

function of a health care provider is distinct from that of an elder

custodian, and ‘the fact that some health care institutions, such

as nursing homes, perform custodial functions and provide

professional medical care’ [citation] does not mean that the two

functions are the same.” (Id. at p. 786.)

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HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

negligence. (Covenant Care, supra, 32 Cal.4th at p. 778.) We

reached the same conclusion in Delaney, where the complaint

alleged that a skilled nursing facility’s inadequate staffing had

left an elder lying in her own waste and without treatment for

her advanced bedsores over an extended period of time.

(Delaney, supra, 20 Cal.4th at pp. 27, 41.)

B.

Applying the same principles here, we see no way to

square the Court of Appeal’s decision in this case with the

limited scope of section 1295(a), and thus the scope of Ruiz. The

Court of Appeal in this case concluded that plaintiffs’ wrongful

death cause of action must be ordered to arbitration, reasoning

as follows: “[T]he complaint alleges that Asistencia owed Skyler

duties, that Asistencia failed to meet its duties, and that ‘[a]s a

proximate result of negligence and “neglect” . . . [Skyler] died.’

The allegations of understaffing and the failure to prevent

Skyler from falling or developing infections speak to ‘negligent

act[s] or omission[s] to act by a health care provider in the

rendering of professional services’ which proximately caused

Skyler’s death.” (Holland, supra, 101 Cal.App.5th at p. 1133.)

This terse holding is not entirely clear. But to the extent

the court meant to suggest that plaintiffs’ claim falls within

section 1295(a) simply because it involves a nursing facility’s

failure to fulfill its duties to Skyler — no matter the nature of

those duties — the court erred. We have squarely rejected the

contention that whether an action is based on the professional

negligence of a health care provider should “turn on the

custodian’s licensing status.” (Delaney, supra, 20 Cal.4th at

p. 35; see Covenant Care, supra, 32 Cal.4th at p. 784.) In the

context of a skilled nursing facility, the operative question is

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HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

whether such duties are owed by virtue of being a medical

services provider or by virtue of being the custodian of a

dependent adult. Claims premised on the manner in which

skilled nursing or other long-term care facilities protect the

basic welfare and safety of residents fall outside the scope of

section 1295(a), and thus outside the scope of Ruiz.

Silverscreen attempts to defend the Court of Appeal’s

decision on a narrower ground. In Silverscreen’s view, the Court

of Appeal was correct to conclude that plaintiffs’ claims sound in

professional negligence because the claims are based on a failure

to protect Skyler from falls and infection. Silverscreen argues

that because “[f]all protection and infection control are ordinary

and usual parts of medical professional services,” allegations of

harm from falls and infections necessarily fall on the “medical”

side of the line.

Even this narrower argument sweeps too broadly.

Certainly, in some cases, a claim of injury from falls and

infection might be based on negligence in prescribing or

executing a plan to address a resident’s medical needs. But in

other cases, the claim of injury might be based on a failure to

adequately supervise and render assistance to residents as they

undertake daily activities, or the failure to ascertain whether

residents need medical treatment despite easily observable

physical manifestations of possible illness. While the first sort

of claim may sound in professional negligence, the second sort

of claim generally does not. (See Delaney, supra, 20 Cal.4th at

pp. 34–35 [drawing this distinction with respect to an allegation

of injury based on malnutrition].)

Again, we recognize that this distinction is not always an

easy one to draw where, as here, the defendant facility provides

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HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

both medical and custodial care. The challenge of drawing a

bright line in this context is part of what motivated the court in

Avila, which asked whether “the primary basis for the wrongful

death claim sounds in” medical malpractice or in custodial

neglect. (Avila, supra, 20 Cal.App.5th at p. 842, italics added.)

As noted, both parties in this case have agreed that Avila states

the correct rule, so we have no occasion to further address the

issue here. For present purposes, it suffices to observe that

section 1295(a) and Ruiz do require lines to be drawn. Not every

claim of neglect against a long-term nursing facility — not even

neglect that takes the form of failure to prevent falls or

infection — will qualify as a claim of medical malpractice subject

to Ruiz. The critical question remains whether the complaint

alleges negligent acts or omissions by “health care providers in

their capacity as providers” rather than “against custodians and

caregivers . . . that may or may not, incidentally, also be health

care providers.” (Covenant Care, supra, 32 Cal.4th at p. 786.)

To the extent Silverscreen would pull the latter set of claims into

the rubric of Ruiz, it extends that decision beyond its statutory

bounds.

IV.

Silverscreen purports to find additional support for its

position in Quiroz, supra, 140 Cal.App.4th at page 1284, a case

concerning standing to bring claims under the Elder Abuse Act.

The Quiroz court held that because “claims and remedies [under

the Act] are afforded only to victims of elder or dependent adult

abuse,” if the victim dies, successors in interest may bring only

a “survivor action . . . on the decedent’s behalf”; they may not

bring a claim seeking to vindicate their own, independent

interests. (Ibid.) Drawing on Quiroz, Silverscreen argues that

plaintiffs cannot avoid arbitration under section 1295 because

20

HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

they lack a cognizable wrongful death claim premised on neglect

of a dependent adult. Echoing the Court of Appeal, Silverscreen

reasons that because “the parents cannot maintain a claim for

abuse under the Elder Abuse Act in their own name, it makes

no sense for them to be able to pursue a claim for wrongful death

based upon that same alleged abuse.” (Holland, supra, 101

Cal.App.5th at p. 1134.)

This argument, too, is unpersuasive. Quiroz concerned

the standing of a decedent’s heirs to assert claims for heightened

statutory remedies afforded under the Elder Abuse Act, not

standing to seek other available remedies for the abuse and

neglect of elders and dependent adults. This context is clearly

distinguishable: Plaintiffs do not seek the Elder Abuse Act’s

heightened remedies for reckless, oppressive, fraudulent, or

malicious abuse and there is no reason to believe plaintiffs must

have standing to pursue those remedies in order to seek

remedies under the wrongful death statute for elder abuse or

neglect causing death. And in any event, the question before us

is not whether plaintiffs have standing to pursue a wrongful

death claim based on elder abuse or neglect; it is whether their

wrongful death claim raises a dispute concerning medical

malpractice within the meaning of section 1295(a) and Ruiz.

As we have noted, section 377.60 authorizes a wrongful

death claim for a death caused “by the wrongful act or neglect”

of the defendant. (§ 377.60.) Plaintiffs here have alleged that

defendants exhibited the requisite “neglect” by committing

“ ‘neglect’ ” as that term is defined in the Elder Abuse Act. (Welf.

& Inst. Code, § 15610.57, subds. (a)(1), (b)(1)–(4).) Plaintiffs’

theory is that insofar as section 377.60 requires that claimants

plead an “underlying tort” (B.B. v. County of Los Angeles (2020)

10 Cal.5th 1, 31 (conc. opn. of Liu, J.)), it “broadly incorporates

21

HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

. . . ‘wrongful acts’ prohibited by other statutes as a basis for a

wrongful death action,” including “a defendant’s ‘wrongful act’

of ‘neglect’ under the Elder Abuse Act.” In other words, their

theory of wrongfulness borrows from the description of conduct

prohibited by the Elder Abuse Act, but their claim remains one

of wrongful death under section 377.60.

Silverscreen contends that plaintiffs have forfeited this

argument. There is no basis for this contention. It should not

come as a surprise to Silverscreen that, in raising a separate

cause of action for wrongful death, plaintiffs were in fact

invoking the wrongful death statute. (Cf. Buxbom v. Smith

(1944) 23 Cal.2d 535, 542 [“The subject matter of an action and

the issues involved are determinable from the facts alleged

rather than from the title of the pleading or the character of

damage recovery”]; People v. Picklesimer (2010) 48 Cal.4th 330,

340 [“ ‘[T]he label given a petition, action or other pleading is

not determinative’ ”], quoting Escamilla v. Department of

Corrections & Rehabilitation (2006) 141 Cal.App.4th 498, 511.)

In any event, plaintiffs repeatedly made clear, including in their

opposition to Silverscreen’s motion to compel arbitration and

their respondents’ brief before the Court of Appeal, that they

brought their wrongful death claim as an independent claim

under section 377.60. And even though the Court of Appeal

adopted Silverscreen’s view of the relevance of Quiroz, it clearly

recognized that plaintiffs’ “cause of action for wrongful death

exists by statute, giving a decedent’s heirs a totally new right of

action,” and it explicitly cited section 377.60. (Holland, supra,

101 Cal.App.5th at p. 1132.)

Silverscreen also argues that even if plaintiffs could bring

a wrongful death claim premised on neglect, their allegations

fail to establish “neglect” as defined under the Elder Abuse Act

22

HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

because “[t]here are no allegations that Silverscreen ‘denied or

withheld goods or services necessary to meet [Skyler Womack’s]

basic needs, either with knowledge that injury was substantially

certain to befall the elder or dependent adult (if the plaintiff

alleges oppression, fraud or malice) or with conscious disregard

of the high probability of such injury (if the plaintiff alleges

recklessness).’ ” (Quoting Carter v. Prime Healthcare Paradise

Valley LLC (2011) 198 Cal.App.4th 396, 406–407.) Silverscreen

appears to be particularly concerned with the mental state

required to trigger heightened remedies under the Elder Abuse

Act. This argument distracts from the question before us, which

concerns not whether plaintiffs have adequately pleaded a claim

of neglect under the Elder Abuse Act, but whether their claims

can be compelled to arbitration because they raise a dispute

about medical malpractice.

We recognize that several Courts of Appeal have

determined whether or not claims are subject to Ruiz by asking

whether the plaintiff “successfully” raised a claim of elder or

dependent adult abuse under the Elder Abuse Act. (Avila,

supra, 20 Cal.App.5th at p. 843; see id. at p. 842 [holding that

because “the primary basis [of the claim] is under the Elder

Abuse and Dependent Adult Civil Protection Act . . . section

1295 does not apply”]; see Hearden, supra, 103 Cal.App.5th at

pp. 1018–1019 [similar].) Properly understood, however, these

cases do not stand for the proposition that the applicability of

Ruiz turns on whether the plaintiff has adequately pleaded a

separate statutory cause of action under the Elder Abuse Act.

Rather, as explained above, determining whether the complaint

alleges wrongful death through “neglect,” as that term is defined

in the Elder Abuse Act, serves as a useful shorthand for the

inquiry prescribed by Ruiz because elder or dependent adult

23

HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

neglect is defined in a way that excludes “professional

negligence” as understood in the MICRA context. (See Hearden,

at pp. 1018–1019 [“Elder neglect does not refer to substandard

performance of medical services but rather the failure of those

responsible for attending to the basic needs and comforts of

elderly or dependent adults, regardless of their professional

standing, to carry out their custodial obligations”]; Covenant

Care, supra, 32 Cal.4th at p. 783; Delaney, supra, 20 Cal.4th at

pp. 31, 34.) The dispositive inquiry for purposes of Ruiz is

ultimately whether the plaintiff is raising a dispute about

medical malpractice, not whether the plaintiff has adequately

alleged a claim under any particular statutory or common law

cause of action.

V.

Finally, again echoing the Court of Appeal, Silverscreen

argues that even if “a cause of action for statutory dependent

adult abuse is distinct from one for medical malpractice,”

plaintiffs cannot avoid arbitration under section 1295 because

they “do not allege with adequate specificity how their claims

here constitute dependent adult abuse and not professional

negligence.” (Holland, supra, 101 Cal.App.5th at p. 1134.)

Silverscreen contends that, in the words of the appellate court,

allowing plaintiffs to avoid arbitration despite their “barebones

claim” would effectively allow them “to circumvent Ruiz through

intentionally opaque pleading.” (Id. at pp. 1133, 1135.)

We can readily agree with Silverscreen and the Court of

Appeal that plaintiffs’ pleadings in this case are spare. Most

critically, the complaint lacks allegations connecting the factual

predicate of the claim to the claim of injury: The complaint

states that Skyler’s falls and infections occurred as a result of

24

HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

Asistencia’s neglect but does not explain how Asistencia’s

alleged understaffing, failure to keep its facility in good repair,

and failure to attend to Skyler’s basic needs caused Skyler to fall

or incur infections, leading to his eventual death. Without more

information, it is impossible to assess whether plaintiffs’

wrongful death claim is based on the negligent rendering of

medical services (in which case Ruiz applies), or instead on the

facility’s nonmedical neglect (in which case it does not).

But we see no evidence that plaintiffs intentionally sought

to circumvent application of section 1295 through opaque

pleading. While the complaint would undoubtedly benefit from

greater specificity in its allegations, we cannot agree with

Silverscreen that it is appropriate to compel arbitration at this

juncture, while there remains substantial uncertainty about

whether plaintiffs seek to challenge the defendants’ provision of

medical care, its provision of custodial care, or both. As

plaintiffs note, “the purpose of a motion to compel arbitration is

not to test the legal sufficiency of a plaintiff’s claims; it is to

compel the plaintiff to litigate those claims in an arbitral forum.”

We conclude that the appropriate disposition in this procedural

posture is to give plaintiffs a chance to provide additional details

on remand before determining whether their wrongful death

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HOLLAND v. SILVERSCREEN HEALTHCARE, INC.

Opinion of the Court by Kruger, J.

claim falls within the scope of section 1295 and thus must be

ordered to arbitration.4

VI.

We reverse the judgment of the Court of Appeal and

remand for proceedings consistent with this opinion.

KRUGER, J.

We Concur:

GUERRERO, C. J.

CORRIGAN, J.

LIU, J.

GROBAN, J.

JENKINS, J.

EVANS, J.

4

At oral argument, Silverscreen acknowledged that

allowing plaintiffs leave to amend is the procedurally

appropriate course if we believe more specific allegations are

necessary to determine whether plaintiffs’ wrongful death claim

is premised on a legal theory that renders the claim subject to

arbitration under section 1295 and Ruiz.

26

See next page for addresses and telephone numbers for counsel who

argued in Supreme Court.

Name of Opinion Holland v. Silverscreen Healthcare, Inc.

__________________________________________________________

Procedural Posture (see XX below)

Original Appeal

Original Proceeding

Review Granted (published) XX 101 Cal.App.5th 1125

Review Granted (unpublished)

Rehearing Granted

__________________________________________________________

Opinion No. S285429

Date Filed: August 14, 2025

__________________________________________________________

Court: Superior

County: Los Angeles

Judge: Michelle Williams Court

__________________________________________________________

Counsel:

Lewis Brisbois Bisgaard & Smith, Lann G. McIntyre, Tracy D.

Forbath, Kathleen M. Walker, Jeffrey S. Healey and Raymond K.

Wilson, Jr., for Defendant and Appellant.

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 Defendant and

Appellant.

Hooper, Lundy & Bookman and Mark E. Reagan for California

Association of Health Facilities, Flagstone Healthcare North, LLC,

Flagstone Healthcare Central, LLC, and Flagstone Healthcare South,

LLC, as Amici Curiae on behalf of Defendant and Appellant.

Peck Law Group, Steven C. Peck, Adam J. Peck; Klapach & Klapach

and Joseph S. Klapach for Plaintiffs and Respondents.

Counsel who argued in Supreme Court (not intended for

publication with opinion):

Tracy D. Forbath

Lewis Brisbois Bisgaard & Smith LLP

550 West C Street, Suite 1700

San Diego, CA 92101

(619) 699-4964

Joseph S. Klapach

Klapach & Klapach, P.C.

15303 Ventura Boulevard, Suite 1510

Sherman Oaks, CA 91403

(310) 525-3724