Filed 5/23/24 Lopez v. Dayton CA1/1

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IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION ONE

RICARDO LOPEZ,

 Plaintiff and Appellant,

 v.

MICHAEL DAYTON, et al.,

 Defendants and Respondents.

 

A168458

(Contra Costa County

Super. Ct. No. C21-00204)

Plaintiff Ricardo Lopez appeals an order granting summary judgment 

to defendants Michael Dayton and American Medical Response West (AMR) 

on the grounds that the suit is barred by the one-year statute of limitations of 

the Code of Civil Procedure section 340.5 as a matter of law.

1 We affirm.

I.

INTRODUCTION

Lopez alleges he was injured on April 23, 2019, when his vehicle was 

struck by an ambulance operated by Dayton, a certified EMT and employee of 

AMR. Lopez filed his complaint on January 28, 2021, alleging motor vehicle 

negligence. He appeals from summary judgment in favor of defendants based 

1 All statutory references are to the Code of Civil Procedure unless 

otherwise stated.
2

on the special limitations period applicable to actions for professional 

negligence by health care providers under the Medical Injury Compensation 

Reform Act (MICRA). (§ 340.5.)

This appeal turns on whether MICRA’s limitations period applies when 

a third party in a separate vehicle is injured in a collision with an ambulance 

transporting a patient to a hospital. The trial court determined it did, 

reasoning that Lopez’s claim arose from Dayton’s acts performed while 

providing professional medical services. We agree.

II.

FACTUAL AND PROCEDURAL BACKGROUND

The basic facts are undisputed. In April 2019, Dayton and a fellow 

EMT responded to a 911 call and loaded a patient into an ambulance to 

transport her to a hospital. Dayton drove the ambulance and, in doing so, 

was acting in the course and scope of his employment with AMR. Dayton did 

not use the ambulance’s siren or emergency lights. As Dayton made a righthand turn, there was a collision with Lopez, who was making a left hand turn 

from the other direction. 

Almost two years later, Lopez filed an action against both AMR and 

Dayton, asserting a single cause of action for “motor vehicle” negligence. 

Lopez alleged the defendants’ acts were negligent and the proximate cause of 

his injuries. 

Defendants filed a motion for summary judgment on the grounds that 

the alleged negligence constituted “professional negligence” within the 

meaning of MICRA, and thus MICRA’s one-year statute of limitations barred 

the suit. Defendants also claimed immunity from liability pursuant to the 

EMS Act, California Health & Safety Code section 1792, et seq.
3

The trial court agreed that MICRA’s one year statute of limitations 

applied and granted the motion. The court concluded that because Dayton 

was transporting a patient at the time of the accident, he was rendering 

professional services. Dayton’s alleged negligent provision of those services 

caused Lopez’s injury, and thus the court held MICRA applied to Lopez’s 

claim. It did not reach defendants’ immunity argument. Lopez appealed.

III.

DISCUSSION

A. Legal Standards

The grant of summary judgment is reviewed de novo, viewing the 

evidence in the light most favorable to the losing party. (Lopez v. American

Medical Response West (2023) 89 Cal.App.5th 336, 342 (Lopez).) “When the 

decisive facts are undisputed, we are confronted with a question of law and 

are not bound by the findings of the trial court.” (Ghirardo v. Antonioli

(1994) 8 Cal.4th 791, 799.) Likewise, we independently review issues of

statutory construction. (Canister v. Emergency Ambulance Service, Inc.

(2008) 160 Cal.App.4th 388, 394 (Canister).) Where clear and unambiguous, 

the plain meaning of statutory language governs. (Id. at pp. 399–400.) 

B. MICRA’s Statute of Limitations Bars Lopez’s Claim

Personal injury claims for negligence usually have a two-year statute of 

limitations. (§ 335.1.) But MICRA imposes a one-year limitations period for 

claims against healthcare providers based on “professional negligence.” 

(§ 340.5.) Finding MICRA applicable, the trial court granted summary 

judgment. 

Lopez contends the court erred because MICRA does not apply to 

claims involving “ ‘generally applicable nonprofessional obligations.’ ” In his

view, defendants breached their general duty of care to him as a member of 

the public. He asserts that he could not have sued under a theory of 
4

professional negligence because he was neither defendants’ patient nor an 

occupant in the ambulance and because his claim does not depend on proof of 

defendants’ violation of any professional obligation. As we shall discuss, 

however, such facts are extraneous to determining whether MICRA’s 

limitation period applies to a personal injury claim.

MICRA defines “professional 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 injury or wrongful death,

provided that such services are within the scope of services for which the 

provider is licensed . . . .” (§ 340.5, subd. (2).) Lopez does not contest that 

EMTs are healthcare providers, that the collision was the proximate cause of 

Lopez’s injuries, or that that Dayton was a licensed EMT acting in the course 

and scope of his employment at the time of the accident.

We are therefore left to decide whether a negligent act by a health care 

provider in transporting a patient to the hospital via ambulance and causing

a third party’s injury is “professional negligence” under section 340.5. We 

conclude it is.

1. Personal Injury Claims Arising From Provision Of Medical 

Care To Patients Constitute “Professional Negligence”

Section 340.5 reflects the codification of a judicially created limitations 

period for medical malpractice claims in which discovery of the injury was 

delayed. (Flores v. Presbyterian Intercommunity Hospital (2016) 

63 Cal.4th 75, 80–81 (Flores).) MICRA later amended section 340.5 to its 

present version. (Stats.1975, (1975-1976 2d Ex. Sess.) ch.1, § 25 (pp. 3969–

3970), ch.2 § 1.192 (pp. 3991–3992); Flores, supra, 63 Cal.4th at p. 81.) 

Specifically, MICRA “expanded the coverage of the provision to 

include . . . actions against ‘ “[h]ealth care provider[s]” ’ ” and it “amended the 

description of covered claims, stating that the special limitations period 
5

applies to ‘an action for injury or death against a health care provider based 

upon such person’s alleged professional negligence.’ ” (Flores, supra,

63 Cal.4th at p. 81.)

In Flores, the Supreme Court addressed the meaning of “rendering of 

professional services” under MICRA’s definition of professional negligence. 

(Id. at p. 84.) There, a doctor ordered that the rails on a hospital patient’s 

bed to be raised, but the bedrail’s latch broke causing the patient to fall and 

injure herself. (Id. at p. 79.) The patient sued for negligence, and the 

question before the court was whether the hospital’s duty to the patient was 

that of a medical provider or merely a duty owed to the general public. (Id. at 

pp. 79–80.) The court explained that “an injury resulting from a hospital’s 

breach of a generally applicable obligation to maintain its equipment and 

premises in a safe condition does not fall within section 340.5.” (Id. at p. 88.) 

Nonetheless, it found MICRA applied. (Id. at p. 89.) It concluded the 

patient’s injury resulted from negligence in the provision of professional 

services because it flowed from “the doctor’s order, which was based on a 

medical assessment of her condition, that the rails on her bed be raised.” (Id.

at p. 89.)

In reaching this understanding of “professional services,” Flores relied 

on precedent concerning a similarly worded statute regarding “ ‘action[s]

against an attorney for a wrongful act . . . arising in the performance of 

professional services.’ ” (Lee v. Hanley (2015) 61 Cal.4th 1225, 1229 (Lee).) 

Unlike section 340.5, the statute at issue in Lee did not turn on, or define,

“professional negligence”; but Lee confronted a situation where professional 

obligations “overlap[ped] with obligations that all persons subject to 

California’s laws have.” (Id. at p. 1238; see Flores, supra, 63 Cal.4th at 

pp. 87–88.) Construing a “professional obligation” as one that an “attorney 
6

has by virtue of being an attorney,” Lee held the relevant provision’s “time 

bar applies to claims whose merits necessarily depend on proof that an 

attorney violated a professional obligation in the course of providing 

professional services.” (Lee, at pp. 1236–1237.) 

Following similar logic, Flores held section 340.5 “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.” (Flores, supra, 63 Cal.4th at p. 88.) Thus, the 

Supreme Court circumscribed “professional obligations” and “professional 

services” to those obligations owed and services provided “by virtue of being” 

attorneys and health care providers, respectively. Flores succinctly defined

the latter as “the provision of medical care to patients.” (Ibid.)

2. Section 340.5 Extends to Claims By Non-Patients

Flores did not consider whether MICRA applies where the plaintiff was 

injured as a result of professional services but was not the recipient of those 

services. (See Gutierrez v. Tostado (2023) 97 Cal.App.5th 786, 792–793, 

review granted Mar.20, 2024, No. S238128 (Gutierrez).)

But eight years earlier, the Second District, Division Eight, applied

MICRA’s provisions where a nonpatient claimed the defendants negligently 

failed to advise him to wear a seatbelt in an ambulance transporting a

patient. (Canister, supra, 160 Cal.App.4th at p. 392.)

2 Canister determined 

“as a matter of law” that “transporting patients and driving or operating an 

ambulance” are professional services of a licensed EMT under MICRA 

because they are “[a]n integral part of the duties of an EMT.” (Id. at p. 407.) 

2 The pertinent MICRA provision was an exception to the collateral 

source rule in medical negligence cases. (Canister, supra, 160 Cal.App.4th at 

p. 408.) MICRA’s limitations period was not at issue in Canister. 
7

In that case, no professional services were provided to the plaintiff, but the 

court held that MICRA extends “ ‘to any foreseeable injured 

party . . . provided the injuries alleged arose out of professional negligence.’ ” 

(Ibid.) It further held “it [was] foreseeable as a matter of law that a 

[passenger] accompanying [a patient] in an ambulance might be injured in 

the operation of the ambulance.” (Id. at pp. 407–408.)

Last year, Division Five of this district extended that logic to the 

applicability of MICRA’s limitations period. (Lopez, supra, 89 Cal.App.5th at 

p. 347 [applying section 340.5 to ambulance patient’s and accompanying 

passenger’s negligence claims “because their alleged injuries occurred while 

the EMT’s were rendering professional services by transporting plaintiffs in 

an ambulance”] (Lopez).) Relying on both Flores and Canister, Lopez found 

an EMT’s transportation of a patient constituted the “provision of medical 

care” because the alleged negligence in the use of equipment—the 

ambulance—was “ ‘integrally related to her medical diagnosis and 

treatment.’ ” (Id. at p. 347, quoting Flores, supra, 63 Cal.4th at p. 89.) 

Unlike Canister, however, Lopez did not emphasize the foreseeability of the 

injury in extending section 340.5’s applicability to a third party’s claim. 

Instead, Lopez determined that, “under the principles discussed in Flores, 

MICRA’s statute of limitations applie[d] to plaintiffs’ claims because their 

alleged injuries occurred while the EMT’s were rendering professional 

services by transporting plaintiffs in an ambulance.” (Id. at p. 347.)

Even more recently, the Sixth District applied MICRA’s statute of 

limitations to a personal injury action brought against an EMT by another 

motorist. (Gutierrez, supra, 97 Cal.App.5th at p. 789.) Finding Canister and 

Lopez on point, the court held that “transporting a patient in an ambulance 

qualifies as the provision of medical care, and that the act of driving the 
8

ambulance is an integral part of that care.” (Gutierrez, at p. 793.) It 

therefore “conclude[d] that MICRA is 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.” (Id. at p. 794.) 

In sum, courts broadly construe “professional negligence” to claims 

brought by nonpatients. The limiting principle—that the proximate cause of 

the plaintiff’s injury be the provision of medical care—is unambiguous. 

(§ 340.5, subd. (2).) Further, numerous cases have found that transporting a 

patient via ambulance is medical care. (E.g., Canister, supra, 

160 Cal.App.4th at p. 407; see also T.L. v. City Ambulance of Eureka, Inc.

(2022) 83 Cal.App.5th 864, 879.) 

3. The Provision of Medical Care Proximately Caused Lopez’s

Injury

As discussed above, the weight of authority recognizes transporting a 

patient via ambulance as medical care. 

Lopez suggests Flores’ analytical approach and post-Flores case law

calls that conclusion into question. This argument was rejected in Lopez, 

supra, 89 Cal.App.5th at p. 346 and Gutierrez, supra, 97 Cal.App.5th at 

p. 795, and it fails here for the same reason. In short, no authority undercuts

the conclusion that transporting a patient to a hospital in an ambulance is 

medical care because it is integrally related to medical treatment. (Cf.

Aldana v. Stillwagon (2016) 2 Cal.App.5th 1, 8 [distinguishing instance

where a paramedic supervisor was not transporting patient in an ambulance, 

but driving to the scene of an emergency in a truck]; Johnson v. Open Door

Community Health Centers (2017) 15 Cal.App.5th 153, 162 [Canister’s 

“outcome is arguably correct” under Flores because “the EMTs who allegedly 
9

operated an ambulance without due care were rendering professional services 

at the time”].)3

Lopez depicts a parade of horribles unleashed by this result. Such 

concerns are unfounded. Under Flores’ framework, misconduct by medical 

providers will not be transformed into professional negligence merely because 

it occurs contemporaneously with the provision of medical care. Professional 

negligence remains limited to “only that negligent conduct engaged in for the

purpose of (or the purported purpose of) delivering health care to a patient.” 

(So v. Shin (2013) 212 Cal.App.4th 652, 666–667 [finding section 340.5 does 

not apply where doctor “acted for her own benefit . . . not for the benefit of her 

patient”].) Here, Lopez does not question Dayton’s purported intent to

transport the patient to the hospital. (See id. at p. 667 [noting Canister did 

not question the “legitimate medical reason” for the negligent act].)

Lopez also seeks to escape application of MICRA’s limitations period on 

foreseeability grounds. He argues “it was not foreseeable that Dayton’s 

negligence in providing medical care to his patient would cause injury to 

Lopez because Dayton’s provision of services to his patient did not cause the 

collision with Lopez.” But this reflects a misunderstanding of Dayton’s 

professional services—transportation. It is “entirely foreseeable” that the 

“provision of ambulance services” may cause collisions “where third parties 

are injured.” (Gutierrez, supra, 97 Cal.App.5th at p. 794.) 

In his reply briefing, Lopez notes the Gutierrez dissent lodged a related 

criticism, asserting that the result was “unpredictable and surprising” and 

departed from the approach espoused in Lee. (Id. at p. 796 (dis. opn. of 

3 We emphasize that Flores rejected a narrow rule limiting professional 

services to tasks requiring “ ‘a particularized degree of medical skill.’ ” 

(Flores, supra, 63 Cal.4th at pp. 84–85.) 
10

Bromberg, J.).) The dissent insisted section 340.5 should “appl[y] only if a 

plaintiff asserts a claim requiring proof that a health care provider’s 

professional obligation has been violated” because “the plaintiff will always 

know if his or her claim is based upon professional negligence and there will 

no surprise or unfairness.” (Id. at p. 797.)4 It found this approach was in 

accord with the holding in Lee on which Flores relied. (Gutierrez, at p. 797.)

But while Flores found Lee “instructive,” it did not hold that

section 340.5 only applies to claims “whose merits necessarily depend on 

proof” that a health care provider violated a professional obligation while 

rendering professional services. (Compare Lee, at pp. 1236–1237 with Flores,

supra, 63 Cal.4th at p. 88.) As discussed above, Flores looked to Lee in 

construing “professional services” as those “provide[d] by virtue of being 

health care professionals.” (Flores, at p. 88.) In the context of lawyers, Lee 

determined the delineation between professional and general obligations 

could only be discerned by the proof required to show the alleged violation of 

an obligation. (Lee, supra, 61 Cal.App.4th at pp. 1236–1237.) But in the 

health care context, professional services are readily identified as those 

necessary for the provision of medical care. (Flores, at p. 88; So v. Shin,

supra, 212 Cal.App.4th at pp. 666–667.). 

4 We note that perceived “unfairness” in applying the limitations period 

is not a valid reason to ignore the statute’s plain text. (See Sanford v.

Garamendi (1991) 233 Cal.App.3d 1109, 1125 [“Our preference for literalism 

is compelled by the constitutional doctrine of separation of powers”].) We 

note that civil limitations periods “ ‘are by definition arbitrary, and their

operation does not discriminate between the just and the unjust claim.’ ” 

(Roman Catholic Bishop of Oakland v. Superior Court (2005) 128 Cal.App.4th 

1155, 1161.) Again, case law clearly establishes that transporting a patient 

via ambulance constitutes the “rendering of professional services.” Thus, 

plaintiffs are on notice to not sleep on their rights following traffic accidents 

with ambulances.
11

The instant collision occurred while Dayton was rendering professional 

services to a patient—i.e., transporting the patient in the AMR ambulance. 

Thus, Dayton’s allegedly negligent provision of professional services was the 

proximate cause of Lopez’s injury. Accordingly, under the analytical 

framework adopted in Flores, Lopez’s claim flows from professional 

negligence, invoking MICRA’s special one-year statute of limitations.

4. Lopez’s Other Arguments Fail

Lopez asserts that the special limitation period provided in 

section 340.5 was “expressly intended for medical malpractice cases.” (See 

also Gutierrez, supra, 97 Cal.App.5th at p. 798 (dis. opn. of Bromberg, J.) [no 

“reason to believe that traffic accident claims involving ambulance drivers 

are covered by medical malpractice insurance”].)

This critique conflates one of MICRA’s objectives with section 340.5’s 

reach. MICRA’s modification of section 340.5 was “designed to reduce the 

cost of medical malpractice insurance ‘by limiting the amount and timing of 

recovery in cases of professional negligence.’ ” (Flores, supra, 63 Cal.4th at p. 

81.) But there is no authority for the proposition that the applicability of 

MICRA is limited to medical malpractice claims.

Lopez also contends defendants “failed to meet their initial burden to 

show a lack of triable issues of fact” because there is “no evidence that Lopez 

ever engaged [defendants] to provide him with any professional services” or 

“that either Dayton or AMR ever tendered Lopez’s claim to their professional 

liability insurer.” For the discussed reasons above, such facts are irrelevant

as a matter of law.

Because we find the trial court correctly applied MICRA’s one-year 

statute of limitations applied to Lopez’s claim, we need not resolve AMR’s 

and Dayton’s claims of limited immunity under the EMS Act.
12

IV.

DISPOSITION

The order is affirmed. Dayton is entitled to costs on appeal. (Cal. 

Rules of Court, rule 8.278, subd. (a)(2).)
13

LANGHORNE WILSON, J.

WE CONCUR:

HUMES, P. J.

BANKE, J.

A168458N