In Gutierrez v. Tostado (July 31, 2025), the California Supreme Court issued a unanimous opinion clarifying that the Medical Injury Compensation Reform Act of 1975 (MICRA) does not apply to claims arising from negligent ambulance driving, even when the vehicle is engaged in patient transport. The ruling draws a decisive distinction between professional negligence, governed by MICRA, and general negligence, which remains subject to the state's two-year statute of limitations.
This decision arrives in the wake of MICRA's most sweeping legislative reform in decades, enacted through Assembly Bill 35 in 2023, and has immediate implications for insurers, emergency medical service (EMS) providers, and healthcare institutions that operate or contract for patient transport services.
Factual and Procedural Background
On January 20, 2018, Francisco Gutierrez was driving his truck on a California highway when an ambulance, driven by licensed EMT Uriel Tostado and operated by Tostado's employer, ProTransport-1, LLC, rear-ended his vehicle. Tostado was transporting a patient between medical centers while another EMT attended to the patient in the rear of the ambulance.
Gutierrez sued on January 7, 2020, alleging neck and back injuries from the collision and framing the matter as a general motor vehicle negligence claim. The defendants moved for summary judgment, asserting the action was barred by MICRA's one-year statute of limitations (Code Civ. Proc. §340.5). Gutierrez countered that the two-year general negligence statute (§335.1) applied.
The trial court sided with the defendants, finding that Tostado was a healthcare provider rendering professional medical services at the time of the accident. A divided Court of Appeal affirmed. The majority concluded MICRA applied even where the injured party was not a patient, so long as the negligence occurred while rendering professional services and the injury was foreseeable. The California Supreme Court granted review.
Issue of the Case
The central legal question before the court was: Does MICRA's one year statute of limitations for professional negligence apply to personal injury claims arising from the operation of an ambulance engaged in patient transport, when the alleged negligence concerns driving rather than the provision of medical care?
The One Year Statute of Limitations Under MICRA
MICRA's §340.5 applies to actions against healthcare providers "based upon" alleged "professional negligence," defined as negligent acts or omissions "in the rendering of professional services" within the provider's licensed scope, proximately causing injury or death. As clarified in Flores v. Presbyterian Intercommunity Hospital (2016) 63 Cal.4th 75, the statute covers negligence integrally related to the medical diagnosis or treatment of a patient, which does not necessarily include all acts occurring in a healthcare setting. Flores drew a distinction between:
- Professional negligence, which arises from duties owed by a provider to a patient as part of delivering medical care, and
- Ordinary negligence, which arises from general duties owed to the public at large.
Applying Flores, the Supreme Court concluded that §340.5 does not extend to negligence claims alleging a breach of general public duty, such as safe driving on a public road, where no medical diagnosis or treatment relationship exists between the provider and the plaintiff. Civil Code §1714, subd.(a), imposes such duties on all persons, regardless of profession.
The Court also emphasized that the legislative purpose behind MICRA was to address a perceived crisis in the availability and affordability of medical malpractice insurance by limiting liability for professional negligence claims. Extending MICRA to encompass general negligence unrelated to patient care would, the court reasoned, stretch the statute beyond its intended scope and undermine the balance struck by the Legislature.
Finally, in rejecting the defendant's' position, the Court addressed the 2023 amendments to MICRA. Assembly Bill 35 expanded the statute's applicability to certain non-traditional healthcare settings, including out of hospital and in-field treatment scenarios. However, the amendments were not intended to collapse the distinction between professional and general negligence. Negligent driving, even during patient transport, remains conduct governed by general tort principles.
In sum, Gutierrez's claim arose from an alleged traffic-safety breach and not from negligent rendering of professional medical services, MICRA's one-year limitations period did not apply. Instead, the two-year statute for general negligence §335.1 governed the case.
Moving Forward
The Gutierrez decision reaffirms a critical boundary in California's medical liability framework. MICRA applies only where the gravamen of the claim is professional negligence directly tied to the delivery of medical care to a patient. For insurers, the ruling necessitates adjusted claims handling strategies, reserve planning, and liability assessments for ambulance-related incidents. For EMS providers and healthcare institutions, it underscores the need of robust transportation safety protocols and comprehensive contractual risk allocation with transport vendors.
In the post AB-35 environment, where MICRA's noneconomic damage caps are steadily increasing and stacking rules can magnify exposure, Gutierrez removes another layer of statutory protection in a subset of cases that while arising outside the clinical setting, can still potentially result in substantial financial liability.