California Supreme Court limits use of MICRA in negligence suits

When an ambulance transporting a patient rear-ends another vehicle and injures the driver, does California's medical malpractice shield law apply in defending against the resulting negligence lawsuit?

No, a unanimous state Supreme Court ruled on Thursday in an important decision that narrowed negligence claims under the Medical Injury Compensation Reform Act, to violations of the professional obligations that health care providers owe to patients.

 Violations of the duties that providers owe the public are different from those covered by MICRA's protections, the justices held. 

Reversing lower courts, the high court revived the injured driver's lawsuit against the ambulance driver and his employer. Gutierrez v. Tostado et al., S283128 (Ca. S.Ct., op. filed July 31, 2025).

Plaintiff Francisco Gutierrez was stopped on the I-280 freeway in Santa Clara County when he was rear-ended by an ambulance driven by Uriel Tostado, an EMT employed by ProTransport-1 LLC. 

Although the injured Gutierrez's lawsuit was filed after MICRA's one-year statute of limitations had expired--causing the lower courts to dismiss it as time-barred--the Supreme Court said the suit can proceed because it was filed before the end of the two-year time limit for general negligence claims.

The issue central to Thursday's opinion was which statute of limitations should apply. But the court went further to rein in an expansive view of MICRA's protections long promoted by the defense bar over protests by plaintiff lawyers. 

"This is the most important MICRA decision the Supreme Court has ever issued," said the lawyer who represented the injured driver at oral argument, Clinton E. Ehrlich of Trial Lawyers for Justice. "The facts in our case involved an ambulance accident, but the Supreme Court has adopted a much deeper rule: MICRA does not apply to breaches of general duties of care, full stop."

Added Benjamin T. Ikuta of Ikuta Hemesath LLP, who drafted a friend of the court brief for Consumer Attorneys of California, "This opinion marks a step toward restoring the statute to what it was meant to be: tort reform targeted at classic medical malpractice, not general tort immunity for anyone in scrubs."

Mark R. Wilson of Manning & Kass, Ellrod, Ramirez, Trester LLP, who argued for the defense, did not immediately return a message seeking comment. In court papers he contended that "the negligent operation of an ambulance transporting a patient constitutes professional negligence within the meaning of MICRA because a patient was injured during the rendering of professional medical services."

Supporting the defense on behalf of the California Medical Association and others, Curtis A. Cole of Cole Pedroza LLP wrote, according to plaintiffs, "all health care providers, not just ambulance owners and drivers, would be adversely impacted whenever plaintiffs allege negligence in the rendition of professional services is 'general negligence' rather than 'professional negligence.'"

MICRA was enacted in 1975 to cap health care providers' liability on non-economic damages at $250,000, with its statute of limitations shortened to one year. The plaintiff bar sponsored a failed repeal referendum in 2014 plus unsuccessful reform legislation and a rejected constitutional challenge in 2015.

Another reform bill in 2022 installed a gradual rise in the cap to $1 million in death cases. The "manifest purpose of the legislation was to reduce costs associated with medical malpractice insurance," wrote Chief Justice Patricia Guerrero in Thursday's opinion, surveying the history and purpose of the law.

Guerrero distinguished between plaintiffs' claims against health care providers for allegedly failing to fulfill their professional duties and claims regarding the duty to exercise ordinary care that is owed to the public generally. MICRA "may not be 'strictly limited to classic sponge-in-the-patient medical malpractice actions,'" she wrote, quoting from another case. 

But "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," Guerrero added, referring to limits the high court imposed in a 2016 MICRA case, Flores v. Presbyterian Intercommunity Hospital, 63 Cal.4th 75. Thursday's opinion extended Flores to exclude injuries to members of the public caused by negligent health care providers anywhere.

It would be "obvious unfairness," Guerrero wrote, if "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 a different opinion the court issued on Thursday, the justices ruled that the Legislature's 2020 change to the Penal Code limiting probation for most felonies to two years can be applied retroactively. That meant relief for a man on four-year probation whose suspended sentence was executed for acts he committed beyond the two-year period. People v. Faial, S273840 (Ca. S.Ct., op. filed July 31, 2025).