When MICRA Stops at the Curb: California Supreme Court Limits §340.5 to Professional Duties Owed in Rendering Medical Care

Commentary on Gutierrez v. Tostado, Supreme Court of California (July 31, 2025)

Introduction

In Gutierrez v. Tostado, the California Supreme Court resolved an increasingly recurring question at the intersection of tort law and the Medical Injury Compensation Reform Act (MICRA): which statute of limitations governs when a nonpatient alleges ordinary negligence by a health care provider that occurs while the provider is delivering medical services to someone else? The case arose from a rear-end collision in which an ambulance transporting a patient struck the plaintiff’s truck. The defendants—a licensed EMT driver and his ambulance employer—invoked MICRA’s one-year-from-discovery/three-year-outer-limit statute of limitations (Code Civ. Proc., § 340.5), arguing the accident occurred during the rendering of professional services. The plaintiff, a nonpatient third party, sued under the two-year statute of limitations for personal injury based on ordinary negligence (Code Civ. Proc., § 335.1).

The trial court applied MICRA and granted summary judgment; a divided Court of Appeal affirmed. The Supreme Court reversed. Chief Justice Guerrero, writing for a unanimous court, held that MICRA’s limitations period does not apply where the alleged negligence breaches a duty owed to the public at large rather than a professional obligation owed in the rendering of medical care to a patient. The Court anchored its holding in statutory text, legislative purpose and history, and its own precedents distinguishing professional from garden-variety negligence.

Summary of the Opinion

• Holding: MICRA’s statute of limitations (§ 340.5) does not apply to a nonpatient’s claim arising from an ambulance’s alleged negligent driving. The claim sounds in ordinary negligence and is governed by the two-year limitations period in § 335.1.
• Controlling principle: Section 340.5 applies only to actions “for injury or death against a health care provider based upon … professional negligence,” meaning a negligent act or omission in the rendering of professional services that proximately causes injury. The gravamen inquiry controls: the limitations period turns on the nature of the duty violated. A mere temporal connection to the provision of medical services is not enough.
• Result: The Court reversed the Court of Appeal and remanded. It expressly disapproved 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 this opinion.
• Scope clarified: Claims by nonpatients may, in rare circumstances, still fall under MICRA if they necessarily depend on proof of a breach of a professional obligation in the rendering of medical care (e.g., Hedlund). But ordinary duties owed to everyone—such as safe driving—do not trigger MICRA.

The Court’s Legal Framework

The Court proceeded from two baseline principles:

• Gravamen controls limitations: The applicable statute of limitations is determined by “the nature of the right sued upon,” not labels or artful pleading. The analysis centers on the duty allegedly breached.
• MICRA’s definition of “professional negligence” is circumscribed: Section 340.5 applies to negligent acts or omissions “in the rendering of professional services” by a health care provider, where the services are within the scope of licensure and the professional breach proximately causes injury. The “professional services” of interest are the provision of medical care—diagnosis and treatment—to patients, not all tasks licensed entities happen to perform.

Building on Flores v. Presbyterian Intercommunity Hospital (2016) 63 Cal.4th 75, the Court reaffirmed that MICRA’s limitations period covers negligence in services integrally related to a patient’s diagnosis or treatment, but it does not extend to duties hospitals and health care entities owe to the public by virtue of operating facilities or vehicles.

Precedents Cited and Their Influence

Flores v. Presbyterian Intercommunity Hospital (2016)

Flores is the linchpin. There, a patient fell due to a malfunctioning bed rail ordered to be set at a certain height by her physician. The Court distilled four textual elements from § 340.5 and held MICRA applied because the negligent maintenance/use of the bed rail was “integrally related” to the patient’s medical care. Flores drew a bright line between:

• Professional obligations owed by virtue of being a health care provider (e.g., maintaining treatment-related equipment), and
• General duties owed to all members of the public when operating a facility (e.g., keeping waiting room chairs safe or floors dry).

Gutierrez applies that same distinction outside the hospital setting: safe driving on public roads is a general duty, not inherently “professional medical care” to a patient, even if a patient is on board.

Lee v. Hanley (2015) and Escamilla v. Vannucci (2025)

The Court again found instructive the analogous attorney statute of limitations (§ 340.6). In Lee, the Court held § 340.6 applies only if success on the claim necessarily requires proof of a breach of a professional obligation; a claim sounding in general law (e.g., conversion) may fall outside even when an attorney is the defendant. In Escamilla, the Court held a malicious prosecution claim by a nonclient against an attorney was not governed by § 340.6’s one-year period. Gutierrez adopts the same “nature of the duty” approach for MICRA: identity and context do not control; the source of the duty and the elements of proof do.

Hedlund v. Superior Court (1983)

Hedlund applied MICRA’s statute of limitations to third-party claims arising from a therapist’s failure to diagnose/warn about a dangerous patient (a derivative application of Tarasoff). The duty to the third party was “inextricably interwoven” with professional diagnostic and warning duties owed to the patient. Gutierrez distinguishes this paradigm: unlike Hedlund, no professional failure had to be pleaded or proven to resolve a roadway rear-end collision. That is general negligence.

Other MICRA-line cases

• Johnson v. Open Door Community Health Centers (2017): Patient tripped on a scale placed unsafely; MICRA did not apply because the duty involved safe premises owed broadly to facility users after the consultation concluded.
• Nava v. Saddleback Memorial Medical Center (2016), Mitchell v. Los Robles Regional Medical Center (2021): MICRA applied where the negligence related directly to protection of a patient during care (fall from gurney; nurse judgment about assistance), i.e., integrally related to treatment.
• Aldana v. Stillwagon (2016): MICRA did not apply where a paramedic, driving a nonambulance vehicle to an emergency scene (no patient aboard), caused a crash; driving in that context was not integrally related to a patient’s care.
• Canister v. Emergency Ambulance Service, Inc. (2008) and Lopez v. American Medical Response West (2023): Both had extended MICRA to nonpatient claims tied to ambulance transport. Gutierrez rejects their “occurring during the rendering of services” approach and disapproves them to the extent inconsistent.
• Cabral v. Ralphs Grocery Co. (2011): Reaffirmed the ordinary duty of care in vehicle operation under Civil Code § 1714; used to emphasize the nature of the duty in Gutierrez.

Legislative Purpose and History of MICRA

The Court recounted MICRA’s origins to discipline the delayed discovery rule in medical malpractice and reduce escalating malpractice insurance costs. In 1970, § 340.5 created a medical-negligence-specific limitations framework; MICRA (1975) refined it and added the “professional negligence” definition, while expanding covered health care providers.

Crucially, MICRA’s legislative materials focus on malpractice—i.e., breaches of professional duties in the delivery of care—not on run-of-the-mill negligence claims that any person or business might face (e.g., premises liability, vehicular negligence). Extending MICRA’s shortened and discovery-limited limitations period to general negligence claims would overshoot the Legislature’s malpractice-centered purpose. The 2002 amendment creating a two-year limitations period for general negligence (§ 335.1) further accentuated the mismatch that would result if MICRA were stretched beyond professional negligence.

Legal Reasoning Applied to the Facts

The Court applied a two-step analysis:

1. Identify the duty breached. The alleged breach was negligent driving—a classic duty of ordinary care under Civil Code § 1714 owed to all road users. That duty attaches “simply by virtue of being a driver,” not “by virtue of being a health care provider.”
2. Ask whether success on the claim necessarily requires proving a violation of a professional obligation in the rendering of medical care to a patient. It does not. No element of plaintiff’s claim requires establishing that the EMT violated a professional medical standard owed to the patient in the course of diagnosis or treatment. The mere fact that a patient was being transported is a temporal coincidence; it is not the proximate cause theory of the plaintiff’s injury.

The Court rejected a contrary “during services” test, emphasizing that § 340.5 defines professional negligence by the act’s character and causal role, not by the surrounding context. A temporal link is insufficient; there must be a causal nexus between a breach of a professional medical duty and the plaintiff’s injury.

The Court also noted that § 340.5 by its terms does not reach property damage, underscoring the general negligence character of run-of-the-mill motor vehicle accidents. Whether or not the ambulance was responding to an emergency is immaterial to the characterization; emergency status may inform what ordinary care requires, but it does not transmute the duty into a professional one for MICRA purposes.

Policy Considerations

The Court addressed two central policy objections:

• Divergent limitations for different plaintiffs: It is neither unworkable nor unfair that two plaintiffs from the same incident might face different limitations periods if their claims rest on different duties. This follows directly from the gravamen rule and mirrors the approach in attorney cases like Lee, where some claims are professional and others are not.
• Artful pleading concerns: Plaintiffs cannot manipulate limitations by labeling; courts look to the substance of the allegations and what the plaintiff must prove. Where success requires proving a professional breach in rendering medical care, MICRA applies; where the duty is owed to the public at large, it does not.

The Court declined to credit generalized assertions that excluding third-party vehicular negligence claims from MICRA would raise malpractice insurance costs. Amicus input from the Insurance Commissioner noted that standard professional liability forms do not categorically cover traffic accident claims merely because an ambulance is involved, highlighting that such claims are typically insured and handled as general liability/auto claims.

Complex Concepts Simplified

• Professional negligence (MICRA): Negligence by a health care provider in the act of delivering medical care to a patient (diagnosis, treatment, and services integrally related to that care), where the professional breach proximately causes injury or death. It is about obligations owed because the defendant is a health care provider providing medical care.
• General negligence: Negligence in breaching the default duty of ordinary care owed to others (Civil Code § 1714). Examples: safe driving; keeping floors dry; maintaining chairs; general premises safety. These duties do not depend on professional licensure.
• Gravamen test: Courts examine the essence of the right sued upon. If a plaintiff must prove a professional medical breach to prevail, MICRA applies; if not, general negligence rules apply.
• Proximate cause nexus: MICRA’s definition requires that the injury be caused by the professional breach itself, not merely that the breach happened around the time of the injury.
• Statutes of limitations contrasted:
  • MICRA (§ 340.5): One year from discovery (with a three-year cap from injury), for actions based on professional negligence causing injury or death.
  • General negligence (§ 335.1): Two years for personal injury claims based on breach of ordinary care. The general discovery rule and other tolling doctrines may apply depending on context.

Impact and Implications

For litigants and counsel

• Nonpatient third-party claims: Vehicle collisions involving ambulances are presumptively governed by § 335.1, absent a theory that ties the plaintiff’s injury to a breach of a professional duty in rendering care to a patient.
• Patient and derivative claims: Wrongful death and loss of consortium claims tied to a patient’s injury allegedly caused by professional negligence still fall within MICRA because they depend on proving a professional breach to the patient. Third-party claims analogous to Hedlund—where the duty to the third party is inextricably tied to diagnosis/treatment of a patient—may also trigger MICRA.
• Pleading and proof strategy: Parties should frame and challenge claims according to the duty actually at issue. Defense attempts to recast general negligence as professional negligence based solely on context (“it happened during medical services”) will fail under Gutierrez.
• Mixed claims: A single lawsuit can contain both MICRA-governed claims and general negligence claims, potentially subject to different limitations periods. Courts will parse by cause of action and theory. Property damage claims remain outside § 340.5 in any event.
• Disapproved precedents: Canister and Lopez are no longer reliable to the extent they treated injuries that occurred during ambulance transport as categorically within MICRA. Practitioners should use Flores/Gutierrez as the governing framework.

For health care providers, EMS agencies, and insurers

• Risk classification and coverage: General-liability and auto policies, not professional liability (“med mal”), will generally respond to third-party vehicle accident claims. Claims handling and reporting protocols should reflect the applicable two-year limitations period.
• Training and policies: Emphasize safe driving protocols and compliance with traffic laws. The presence of a patient in the vehicle does not transform the duty to drive safely into a professional duty for limitations purposes.
• Other MICRA provisions: Although Gutierrez resolves only § 340.5, its reasoning suggests courts will use the same “nature of the duty” analysis when considering other MICRA provisions (e.g., Civil Code §§ 3333.2 damages cap; 3333.1 collateral source). Whether those provisions apply to nonpatient, general-duty claims remains context- and duty-dependent.

For courts

• Decision framework: Apply the gravamen test: identify the duty; ask whether professional medical obligations are elements of the claim; require a proximate causal nexus between a professional breach and the injury to invoke § 340.5.
• Consistency across professions: The Court’s parallel treatment of attorney (§ 340.6) and health care (§ 340.5) limitation statutes promotes doctrinal coherence. Expect the “nature of the duty” analysis to continue governing professional-vs-general negligence demarcations.

Practical Guidance and Examples

Decision tree: Does § 340.5 apply?

1. Is the defendant a “health care provider” and is the conduct within the scope of licensure? If no, § 340.5 does not apply.
2. Is the claim “based upon … professional negligence”—i.e., must the plaintiff prove a breach of a professional medical obligation in the rendering of care to a patient? If no, § 340.5 does not apply.
3. Was the professional breach the proximate cause of the plaintiff’s injury? If no (mere temporal connection), § 340.5 does not apply.
4. If yes to all, MICRA’s one-year-from-discovery/three-year-outer-limit governs; otherwise, § 335.1 (two years) applies to personal injury claims.

Illustrative scenarios

• Ambulance rear-ends another car while transporting a patient: General negligence (§ 335.1). The duty breached is safe driving owed to the public.
• Visitor slips on wet hospital lobby floor: General negligence. Duty of safe premises owed to all users.
• Patient falls from gurney while being moved for imaging: Professional negligence (likely MICRA), because safe transfer is integrally related to the patient’s care.
• Nurse decides patient does not need escort and patient falls: Professional negligence (likely MICRA); clinical judgment about patient safety during care.
• Therapist fails to warn known victim of dangerous patient who later harms a bystander who is the known victim’s close relation: Professional negligence (MICRA), per Hedlund, because the duty to the third party derives from diagnostic and warning duties owed to the patient.
• Property damage only (e.g., ambulance strikes a parked car): Outside § 340.5 by its terms; governed by general limitations and rules applicable to property damage.

Conclusion

Gutierrez v. Tostado delivers a clear, workable boundary for MICRA’s statute of limitations: it applies when a plaintiff’s injury is proximately caused by a breach of professional medical obligations in the rendering of care to a patient, not merely because the injury happened during the provision of medical services or at a health care facility. The decision reinforces the gravamen-based approach: courts must look to the duty at issue and whether success requires proving a professional breach. By disapproving expansive “occurring during” interpretations in Canister and Lopez, the Court restores the focus of § 340.5 to malpractice and aligns MICRA with its text, its history, and its cost-containment purpose.

Practically, the case ensures that ordinary negligence claims against health care providers—like vehicle collisions and general premises incidents—remain subject to the two-year limitations period and the broader suite of general negligence rules. At the same time, the Court preserves MICRA’s application to claims that truly sound in professional negligence, including certain third-party scenarios where a professional medical breach to a patient proximately causes injury to others. The opinion thus provides litigants, insurers, and courts with a principled, predictable framework to determine which limitations regime governs.