Title: County of Santa Clara v. Superior Court
Citation: N/A
Docket Number: S274927
State: California
Issuer: California Supreme Court
Date: July 10, 2023

IN THE SUPREME COURT OF 
CALIFORNIA 
 
COUNTY OF SANTA CLARA, 
Petitioner, 
v. 
THE SUPERIOR COURT OF SANTA CLARA,  
Respondent; 
DOCTORS MEDICAL CENTER OF MODESTO, INC., et al., 
Real Parties in Interest. 
 
S274927 
 
Sixth Appellate District 
H048486 
 
Santa Clara County Superior Court 
19CV349757 
 
 
July 10, 2023 
 
Chief Justice Guerrero authored the opinion of the Court, in 
which Justices Corrigan, Liu, Kruger, Groban, Jenkins, and 
Evans concurred. 
 
1 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
S274927 
 
Opinion of the Court by Guerrero, C. J. 
 
Hospitals and other medical providers are required by law 
to provide emergency medical services without regard to the 
patient’s insurance status or ability to pay.  (42 U.S.C. 
§ 1395dd(b) & (h); Health & Saf. Code, § 1317, subds. (a) & (b).)  
If the patient is enrolled in a health care service plan, by statute 
the plan must reimburse the medical provider for providing such 
emergency care under the Knox-Keene Health Care Service 
Plan Act of 1975.  (Health & Saf. Code, § 1340 et seq.; 
hereinafter Knox-Keene Act; id., § 1371.4, subd. (b).)  If the plan 
does not have a contract with the medical provider addressing 
the reimbursement rate, the plan must pay the provider the 
“reasonable and customary value” of the emergency care 
provided.  (Cal. Code Regs., tit. 28, § 1300.71, subd. (a)(3)(B).)  If 
the plan fails to pay the reasonable and customary value of such 
services, the medical provider may sue the plan directly for 
reimbursement under a quantum meruit theory.  (Prospect 
Medical Group, Inc. v. Northridge Emergency Medical Group 
(2009) 45 Cal.4th 497, 506 (Prospect Medical Group); Bell v. Blue 
Cross of California (2005) 131 Cal.App.4th 211, 216–217 (Bell).)   
We granted review to decide whether a similar claim for 
reimbursement of emergency medical services may be 
maintained against a health care service plan when the plan is 
operated by a public entity, or whether the Government Claims 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
2 
Act (Gov. Code, § 810 et seq.) immunizes a public entity from 
such a claim. 
In this case, Doctors Medical Center of Modesto, Inc., and 
Doctors Hospital of Manteca, Inc., (collectively, the Hospitals) 
provided emergency medical services to three individuals 
enrolled in a health care service plan operated by the County of 
Santa Clara (the County).  The Hospitals submitted 
reimbursement claims to the County, but the County paid only 
a portion of the claimed amounts.  The Hospitals sued the 
County for the remaining amounts based on the Knox-Keene 
Act’s reimbursement provision.  The trial court found that the 
Hospitals could state a quantum meruit claim against the 
County.  On petition for writ of mandate, the Court of Appeal 
disagreed, holding that the County is immune from suit under 
the Government Claims Act and that no exception to immunity 
applies.   
We conclude that the Government Claims Act does not bar 
the Hospitals’ action against the County.  The immunity 
provisions of the Government Claims Act are directed toward 
tort claims; they do not foreclose liability based on contract or 
the right to obtain relief other than money or damages.  (Gov. 
Code, § 814.)  The Hospitals have not alleged a conventional 
common law tort claim seeking money damages.  Instead, they 
have alleged an implied-in-law contract claim based on the 
reimbursement provision of the Knox-Keene Act, and seek only 
to compel the County to comply with its statutory duty.  
Accordingly, the County is not immune from suit under the 
circumstances and the Hospitals’ claim may proceed. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
3 
I.  FACTUAL AND PROCEDURAL BACKGROUND 
The County operates a health care service plan called 
Valley Health Plan, which is licensed and regulated by the 
Department of Managed Health Care (DMHC) under the Knox-
Keene Act.  (Health & Saf. Code, §§ 1341, 1345, subds. (f)(1) & 
(j), 1349.)  The Knox-Keene Act applies to private and public 
entities that operate health care service plans.  (Id., § 1399.5.)  
The Hospitals are licensed acute care hospitals in the Central 
Valley.  The Hospitals do not have a contract with the County 
governing the rates payable for medical services provided to 
Valley Health Plan enrollees.   
As previously explained, state and federal laws require 
hospitals and other medical providers to provide emergency 
medical services regardless of the patient’s insurance status or 
ability to pay.  (42 U.S.C. § 1395dd(b) & (h); Health & Saf. Code, 
§ 1317, subds. (a) & (b).)  If the patient is enrolled in a health 
care service plan, the Knox-Keene Act requires the plan to 
reimburse the medical provider for providing such emergency 
care.  (Health & Saf. Code, § 1371.4, subd. (b).)  If no contract 
exists between the plan and medical provider, the plan must pay 
the “reasonable and customary value” of the emergency care 
provided.  (Cal. Code Regs., tit. 28, § 1300.71, subd. (a)(3)(B).)   
In 2016 and 2017, the Hospitals provided emergency 
medical services to three patients enrolled in Valley Health 
Plan.  The Hospitals submitted to the County claims for 
reimbursement totaling approximately $144,000 for the services 
provided.  The County paid the Hospitals approximately 
$28,500.  The Hospitals challenged the reimbursement decisions 
by submitting written administrative appeals, which the 
County denied.   
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
4 
The Hospitals then sued the County, alleging they are 
entitled to the entire amount claimed for the emergency services 
provided to the three patients enrolled in Valley Health Plan.  
The Hospitals’ operative complaint alleged a single cause of 
action for breach of implied contract.  In that complaint, the 
Hospitals alleged that the Knox-Keene Act imposes a 
mandatory duty on health care service plans to reimburse 
noncontracted providers for emergency medical services and 
that, pursuant to the Act, the Hospitals are entitled to 
reimbursement at a reasonable and customary rate for the 
services provided to the patients enrolled in Valley Health Plan.  
The Hospitals further alleged that the Knox-Keene Act and the 
DMHC’s implementing regulations gave rise to implied-in-law 
agreements between the Hospitals and the County, obligating 
the County to pay for the emergency care provided by the 
Hospitals at a reasonable and customary rate.  The Hospitals 
maintained the reasonable and customary rate for the services 
provided to Valley Health Plan’s enrollees was the $144,000 
claimed by the Hospitals, rather than the $28,500 reimbursed 
by the County.  They also alleged that the County’s conduct, 
including its partial reimbursement for care provided by the 
Hospitals, gave rise to implied-in-fact agreements between the 
Hospitals and the County.   
The County demurred, asserting that the Hospitals’ 
implied contract claim is based on a quantum meruit theory that 
cannot be maintained against the County as a public entity.  The 
trial court overruled the demurrer.  It found that the Hospitals 
had stated facts sufficient to constitute a cause of action, 
“whether fashioned as a cause of action for breach of an implied 
in fact contract or one for quantum meruit.”  The court resolved 
that “the public policy to promote the delivery and the quality of 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
5 
health and medical care to the people of the State of California 
outweighs the policy to limit common law, or implied contract 
claims against public entities.”  It further determined that in 
entering the regulated health care plan market, the County 
“cannot expect to rely on a public policy regarding contracts as 
to public entities so that it can be exempted from those 
regulations.”   
The County sought review through a petition for writ of 
mandate, and the Court of Appeal granted relief.  (County of 
Santa Clara v. Superior Court (2022) 77 Cal.App.5th 1018 
(Santa Clara).)  The Court of Appeal concluded that the 
Government Claims Act immunized the County from the 
Hospitals’ implied-in-law contract claim.  (Santa Clara, at 
pp. 1024–1025.)  The court first construed the Hospitals’ claim 
as seeking relief under a quantum meruit theory.  (Ibid.)  In the 
court’s view, this theory was foreclosed by the immunity 
conferred by Government Code section 815, which provides 
generally that a public entity is not liable for an injury except as 
otherwise provided by statute.  (Santa Clara, at pp. 1028–1029.)  
The Court of Appeal held that Government Code section 815.6’s 
mandatory duty exception to the general rule of immunity did 
not apply because the County retains discretion in determining 
the reasonable and customary value of the Hospitals’ services to 
Valley Health Plan enrollees.  (Santa Clara, at pp. 1029–1032.)  
Having also concluded that the Hospitals could not state a claim 
for breach of an implied-in-fact contract (id. at pp. 1033–1034), 
the appellate court issued a peremptory writ directing the trial 
court to vacate its order overruling the County’s demurrer and 
to enter a new order sustaining the demurrer without leave to 
amend (id. at pp. 1035–1036).   
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
6 
The Court of Appeal acknowledged that under its 
interpretation of the relevant statutes, “a provider has greater 
remedies against a private health care service plan than it does 
against a public entity health care service plan.”  (Santa Clara, 
supra, 77 Cal.App.5th at p. 1032.)  The court viewed that result 
as being “driven by the Legislature broadly immunizing public 
entities from common law claims and electing not to abrogate 
that immunity in the context presented here.”  (Id. at p. 1032, 
fn. omitted.)   
We granted the Hospitals’ petition for review.   
II.  DISCUSSION 
A. Standard of Review  
When the Court of Appeal grants a writ petition 
challenging the trial court’s order overruling a demurrer and 
directs it to sustain the demurrer, “the ordinary standards of 
demurrer review still apply.”  (City of Stockton v. Superior Court 
(2007) 42 Cal.4th 730, 747 (City of Stockton).)  “We give the 
complaint a reasonable interpretation, reading it as a whole and 
its parts in their context.  [Citation.]  Further, we treat the 
demurrer as admitting all material facts properly pleaded, but 
do not assume the truth of contentions, deductions or 
conclusions of law.  [Citations.]  When a demurrer is sustained, 
we determine whether the complaint states facts sufficient to 
constitute a cause of action.  [Citation.]  And when it is sustained 
without leave to amend, we decide whether there is a reasonable 
possibility that the defect can be cured by amendment:  if it can 
be, the trial court has abused its discretion and we reverse.”  
(City of Dinuba v. County of Tulare (2007) 41 Cal.4th 859, 865 
(City of Dinuba); see also Aubry v. Tri-City Hospital Dist. (1992) 
2 Cal.4th 962, 966–967.) 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
7 
B. The Knox-Keene Act and Implementing 
Regulations 
“ ‘The Knox-Keene Act is a comprehensive system of 
licensing and regulation under the jurisdiction of the 
Department of Managed Health Care.’ ”  (Prospect Medical 
Group, supra, 45 Cal.4th at p. 504.)  The Knox-Keene Act 
requires every health care service plan to be licensed by the 
DMHC.  (Health & Saf. Code, § 1349.)  By its terms, the Knox-
Keene Act applies to “any private or public entity” operating a 
licensed health care service plan, subject to narrow exceptions 
not relevant here.  (Id., § 1399.5; see id., § 1345, subds. (f)(1), 
(j).)  The County-operated Valley Health Plan is a licensed 
health care service plan. 
The purpose of the Knox-Keene Act is “to promote the 
delivery and the quality of health and medical care to the people 
of the State of California who enroll in, or subscribe for the 
services rendered by, a health care service plan or specialized 
health care service plan.”  (Health & Saf. Code, § 1342.)  “The 
Legislature sought to accomplish this purpose by, among other 
things, (1) ‘transferring the financial risk of health care from 
patients to providers’ in order to ‘[h]elp . . . ensure the best 
possible health care for the public at the lowest possible cost,’ 
(2) imposing ‘proper regulatory procedures’ in order to 
‘[e]nsur[e] the financial stability’ of the system, and 
(3) establishing a system that ensures health care service plan 
‘subscribers and enrollees receive available and accessible 
health and medical services rendered in a manner providing 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
8 
continuity of care.’ ”1  (Centinela Freeman Emergency Medical 
Associates v. Health Net of California, Inc. (2016) 1 Cal.5th 994, 
1005 (Centinela), quoting Gov. Code, § 1342, subds. (d), (f), & 
(g).)   
In 1994, the Legislature amended the Knox-Keene Act to 
require health care service plans to “reimburse providers for 
emergency services and care provided to its enrollees, until the 
care results in stabilization of the enrollee.”  (Health & Saf. 
Code, § 1371.4, subd. (b), added by Stats. 1994, ch. 614, § 4.)  
According to one legislative analysis, the purpose of Health and 
Safety Code section 1371.4 is to eliminate “incentives for 
carriers to deny care to patients and reduce payments to 
physicians.”  (Sen. Rules Com., Off. of Sen. Floor Analyses, 
Analysis of Sen. Bill No. 1832 (1993–1994 Reg. Sess.) as 
amended May 4, 1994, p. 3.)  As the County acknowledges, the 
Knox-Keene Act imposes a duty on health care service plans to 
reimburse medical providers for the reasonable and customary 
value of the emergency service and care provided. 
The Knox-Keene Act assigns a significant implementation 
role to the DMHC.  “The [DMHC] is charged with the 
administration and enforcement of the laws relating to health 
care service plans.  [Citation.]  To carry out its duties, the 
DMHC is authorized to promulgate regulations.”  (Children’s 
 
1  
In furtherance of its intent “to ensure that the citizens of 
this state receive high-quality health care coverage in the most 
efficient and cost-effective manner possible,” in enacting the 
Knox-Keene Act the Legislature also found and declared “that it 
is in the public interest to promote various types of contracts 
between public or private payers of health care coverage, and 
institutional or professional providers of health care services.”  
(Health & Saf. Code, § 1342.6.) 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
9 
Hospital Central California v. Blue Cross of California (2014) 
226 Cal.App.4th 1260, 1271 (Children’s Hospital).)   
Following the Legislature’s enactment of Health and 
Safety 
Code 
section 1371.4, 
the 
DMHC 
promulgated 
section 1300.71 of title 28 of the California Code of Regulations 
(hereinafter Regulation 1300.71).  Regulation 1300.71 sets forth 
the 
reimbursement 
standards 
for 
contracting 
and 
noncontracting emergency medical providers.  “The amount of 
reimbursement depends upon whether the hospital and plan 
already have a contract in place . . . .”  (Long Beach Memorial 
Medical Center v. Kaiser Foundation Health Plan, Inc. (2021) 
71 Cal.App.5th 323, 329 (Long Beach Memorial).)  If the hospital 
and plan already have a contract, the plan must pay the “agreed 
upon” contractual rate.  (Regulation 1300.71, subd. (a)(3)(A); see 
also Long Beach Memorial, at p. 329.)  If the hospital and plan 
have not entered into a contract, the plan must pay the 
“reasonable and customary value for the [emergency] health 
care services rendered.”  (Regulation 1300.71, subd. (a)(3)(B); 
see also Long Beach Memorial, at p. 329.)   
Regulation 1300.71, subdivision (a)(3)(B) specifies that the 
“reasonable and customary value for the health care services” 
provided by a noncontracted emergency medical provider must 
be “based upon statistically credible information that is updated 
at least annually and takes into consideration:  (i) the provider’s 
training, qualifications, and length of time in practice; (ii) the 
nature of the services provided; (iii) the fees usually charged by 
the provider; (iv) prevailing provider rates charged in the 
general geographic area in which the services were rendered; 
(v) other aspects of the economics of the medical provider’s 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
10 
practice that are relevant; and (vi) any unusual circumstances 
in the case.”2   
These factors provide a framework for reimbursement, but 
do not necessarily resolve every dispute regarding the proper 
amount of payment.  “In the final statement of reasons for 
[Regulation 1300.71], the DMHC explained that the intent was 
to establish a methodology for determining the reasonable value 
of health care services by noncontracted providers but that the 
criteria specified do not dictate a specific payment rate.  Rather, 
the 
payor 
is 
required 
to 
calculate 
the 
appropriate 
reimbursement based on statistically credible information that 
takes the [specified] factors into consideration.  If a payor fulfills 
its claims payment obligation using these criteria, the DMHC 
will consider the payor compliant with Health and Safety Code 
sections 1371 and 1371.35, i.e., the reimbursement of the claim 
will be deemed timely.  ‘However, the definition is not a 
substitute for traditional forums for contract dispute resolution.  
If a provider disputes the payor’s calculation of the fair and 
reasonable value of the health care services he has rendered, the 
 
2  
“In defining ‘reasonable and customary value,’ the DMHC 
incorporated language from Gould v. Workers’ Comp. Appeals 
Bd. (1992) 4 Cal.App.4th 1059.”  (Children’s Hospital, supra, 
226 Cal.App.4th at p. 1272.)  In Gould, the Court of Appeal held 
that in deciding whether a medical provider’s fees for treating 
employment-related injuries was reasonable, the Workers’ 
Compensation Appeals Board “may consider evidence regarding 
the medical provider’s training, qualifications, and length of 
time in practice; the nature of the services provided; the fees 
usually charged by the medical provider; the fees usually 
charged in the general geographical area in which the services 
were rendered; other aspects of the economics of the medical 
provider’s practice that are relevant; and any unusual 
circumstances in the case.”  (Gould, at p. 1071, fn. omitted.) 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
11 
provider is free to seek resolution of that dispute in a court of 
law or through any other available civil remedy.’ ”  (Children’s 
Hospital, supra, 226 Cal.App.4th at p. 1273.)   
In this respect, Children’s Hospital further explained that 
in adopting Regulation 1300.71, subdivision (a)(3)(B), “the 
DMHC intended that reasonable value be based on the concept 
of quantum meruit and that value disputes be resolved by the 
courts.  In fact, the DMHC has acknowledged that, unlike the 
courts, it ‘ “lacks the authority to set specific reimbursement 
rates under theories of quantum meruit and the jurisdiction to 
enforce a reimbursement determination on both the provider 
and the health plan.” ’ ”  (Children’s Hospital, supra, 
226 Cal.App.4th at p. 1273.)  In a letter brief filed in Bell, the 
DMHC elaborated on the limits of its authority.3  It explained 
that although it may direct a health care service plan to modify 
its reimbursement methodology if it finds a demonstrable and 
unjust payment pattern (Health & Saf. Code, § 1371.37; 
Regulation 1300.71), “this authority is not equivalent to 
rendering a judicial determination between two parties 
disputing over what constitutes the reasonable and customary 
value of a specific physician’s services.  [¶] . . . [¶] . . . [T]he 
Knox-Keene Act does not authorize the [DMHC] to set specific 
reimbursement levels or to exercise jurisdiction over providers 
by adjudicating individual payment disputes that arise between 
providers and health plans.  Should the [DMHC] attempt to 
adjudicate such claims, its decisions would not be binding upon 
 
3  
Prior to oral argument, we granted Santa Clara’s request 
to take judicial notice of the DMHC’s amicus letter brief filed in 
the Court of Appeal in Bell, supra, 131 Cal.App.4th 211. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
12 
the individual providers or upon health plans that contest the 
[DMHC]’s authority to set reimbursement rates.”   
Thus, as this court and others have previously observed, 
the Knox-Keene Act’s statutory and regulatory scheme 
contemplates that private actions under a quantum meruit 
theory may be used to recoup appropriate reimbursement for 
services rendered.4  (E.g., Prospect Medical Group, supra, 
45 Cal.4th at pp. 505–507; Long Beach Memorial, supra, 
71 Cal.App.5th at p. 329; Bell, supra, 131 Cal.App.4th at 
pp. 216–217; California Emergency Physicians Medical Group v. 
PacifiCare of California (2003) 111 Cal.App.4th 1127, 1134 
(California Emergency Physicians); Health & Saf. Code, 
§ 1371.37, subd. (f) [specifying that the DMHC’s imposition of 
sanctions for unfair payment patterns “shall not preclude, 
suspend, affect, or impact any other duty, right, responsibility, 
or obligation under a statute or under a contract between a 
health care service plan and a provider”].)  With this statutory 
 
4  
Although we assume for purposes of this case that the 
Knox-Keene Act does not create a private right of action for 
violations of its provisions, we reaffirm that the absence of a 
private right of action does not foreclose the availability of other 
remedies, such as an action for quantum meruit, brought by 
medical providers.  (See Lu v. Hawaiian Gardens Casino, Inc. 
(2010) 50 Cal.4th 592, 603 [determination that statute “does not 
provide a private cause of action does not necessarily foreclose 
the availability of other remedies”]; Coast Plaza Doctors 
Hospital v. UHP Healthcare (2002) 105 Cal.App.4th 693, 706 
[concluding that the DMHC does not have exclusive jurisdiction 
to enforce the Knox-Keene Act, and that medical providers may 
bring common law and other statutory causes of action]; see id. 
at p. 707 [“The Knox-Keene Act itself contemplates that a 
provider may have a cause of action under a statutory or 
common law theory”].)  
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
13 
and regulatory scheme in mind, we next consider the scope of 
governmental immunity under the Government Claims Act and 
whether it bars the Hospitals’ implied-in-law contract claim 
based on section 1371.4 of the Knox-Keene Act. 
C. The Government Claims Act Does Not Bar the 
Hospitals’ Implied-In-Law Contract Cause of 
Action Based on the Knox-Keene Act 
Government Code section 815 sets forth the general rule 
of immunity for public entities under the Government Claims 
Act.  Government Code section 815 provides that “[e]xcept as 
otherwise provided by statute” “[a] public entity is not liable for 
an injury, whether such injury arises out of an act or omission 
of the public entity or any other person.”  However, another 
provision within the Government Claims Act, Government Code 
section 814, makes clear that “[n]othing in this part affects 
liability based on contract or the right to obtain relief other than 
money or damages against a public entity or public employee.”   
The legislative committee comments to Government Code 
section 815 explain that “[t]his section abolishes all common law 
or judicially declared forms of liability for public entities, except 
for such liability as may be required by the state or federal 
constitution, e.g., inverse condemnation.  In the absence of a 
constitutional requirement, public entities may be held liable 
only if a statute (not including a charter provision, ordinance or 
regulation) is found declaring them to be liable.”  (Legis. Com. 
com., 32 pt. 1, West’s Ann. Gov. Code (2012 ed.) foll. § 815, 
pp. 215–216.)  The comments also state:  “Because of the 
limitations contained in Section 814, which declares that this 
part does not affect liability arising out of contract or the right 
to obtain specific relief against public entities and employees, 
the practical effect of this section is to eliminate any common 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
14 
law governmental liability for damages arising out of torts.  The 
use of the word ‘tort’ has been avoided, however, to prevent the 
imposition of liability by the courts by reclassifying the act 
causing the injury.”  (Id. at p. 216.)  Likewise, the legislative 
committee comments to Government Code section 814 declare 
that “[t]he various provisions of this part determine only 
whether a public entity or public employee is liable for money or 
damages.  These provisions do not create any right to any other 
type of relief, nor do they have any effect on any other type of 
relief that may be available against a public entity or public 
employee.”  (Legis. Com. com., 32 pt. 1, West’s Ann. Gov. Code 
(2012 ed.) foll. § 814, p. 208.)   
The County argues that the immunity conferred under 
Government Code section 815 extends to the Hospitals’ 
quantum meruit claim.  The County takes the position that the 
Government Claims Act’s immunity provisions apply broadly to 
all “non-contractual” claims for money or damages, and it 
maintains that the Hospitals’ quantum meruit claim does not 
sound in contract.  The Hospitals counter that the Government 
Claims Act applies only to torts, and thus it does not bar their 
cause of action involving what they characterize as an implied-
in-law contract.  They also maintain that their claim for 
reimbursement, as mandated by statute, is not a claim for 
“money or damages” under Government Code section 814.5   
 
5  
The County urges us to not consider various arguments 
made by the Hospitals regarding the limited nature of the 
Government Claims Act because they did not raise these specific 
contentions below.  The County cites California Rules of Court, 
rule 8.500(c)(1), which provides that “[a]s a policy matter, on 
petition for review the Supreme Court normally will not 
 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
15 
The impetus for the Government Claims Act and its 
general aims are well understood.  In Quigley v. Garden Valley 
Fire Protection Dist. (2019) 7 Cal.5th 798, 803 (Quigley), we 
recounted that “[f]or many decades before the Act, tort liability 
for public entity defendants was barred by a common law rule of 
governmental immunity.  Over time, however, the common law 
rule became ‘riddled with exceptions,’ both legislative and judge 
made, and in 1961 this court abolished the rule altogether.  
(Muskopf v. Corning Hospital Dist. (1961) 55 Cal.2d 211, 216 
(Muskopf).)  In response to Muskopf, the Legislature 
temporarily suspended the decision’s effect [citation] and 
directed the California Law Revision Commission to complete a 
study of the issue it had begun some years earlier [citations].  
The end product of the commission’s study was a series of 
recommendations [citation], on which the Legislature relied in 
enacting the [Government Claims Act].”  (Quigley, at p. 803, 
fn. omitted.)  “The basic architecture of the [Government Claims 
Act] is encapsulated in Government Code section 815.  
 
consider an issue that the petitioner failed to timely raise in the 
Court of Appeal.”  However, the Hospitals included these 
arguments in their petition for review, and we “may decide any 
issues that are raised or fairly included in the petition or 
answer.”  (Id., rule 8.516(b)(1).)  Moreover, “[i]n a number of 
cases, this court has decided issues raised for the first time 
before us, where those issues were pure questions of law, not 
turning upon disputed facts, and were pertinent to a proper 
disposition of the cause or involved matters of particular public 
importance.”  (People v. Superior Court (Ghilotti) (2002) 
27 Cal.4th 888, 901, fn. 5; see also Today’s Fresh Start, Inc. v. 
Los Angeles County Office of Education (2013) 57 Cal.4th 197, 
215 [“we have discretion to consider on appeal purely legal 
issues raised in a petition for review or answer”].)  Assuming 
that the Hospitals did not specifically raise these arguments in 
the courts below, we exercise our discretion to address them. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
16 
Subdivision (a) of that section makes clear that under the [Act], 
there is no such thing as common law tort liability for public 
entities; a public entity is not liable for an injury ‘[e]xcept as 
otherwise provided by statute.’ ”  (Ibid.)   
This history has informed our repeated characterization of 
the Government Claims Act as concerned with common law 
torts, as opposed to different claims.6  The Government Claims 
Act, we have said, was designed to “govern[] . . . liabilities and 
immunities of public entities and public employees for torts.”  
(Quigley, supra, 7 Cal.5th at p. 803, italics added; see also Kizer 
v. County of San Mateo (1991) 53 Cal.3d 139, 145 (Kizer) 
[explaining 
that 
the 
Government 
Claims 
Act 
“is 
a 
comprehensive statutory scheme that sets forth the liabilities 
and immunities of public entities and public employees for 
torts”], overruled on another ground in Los Angeles Unified 
School District v. Superior Court (2023) 14 Cal.5th 758.)   
In Kizer, supra, 53 Cal.3d 139, we rejected an expansive 
interpretation of the Tort Claims Act, as the statute was then 
called, similar to the one advanced by the County in this case.  
The defendant in Kizer, also a county, was licensed to operate a 
long-term health care facility but failed to comply with the 
statutory scheme regulating such facilities.  (Kizer, at pp. 141–
 
6 
Indeed, when first enacted, and for decades afterward, 
“the statute was known as the Tort Claims Act.”  (Quigley, 
supra, 7 Cal.5th at p. 803, fn. 1.)  In 2012, the Legislature 
renamed the statute the Government Claims Act (Stats. 2012, 
ch. 759), a title that accounts for the fact that its claims 
presentation requirements, included in part 3 of the Act, sweep 
more broadly than do part 2’s provisions regarding public entity 
liability and immunity.  (Quigley, at p. 803, fn. 1; see City of 
Stockton, supra, 42 Cal.4th at pp. 740–742.)   
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
17 
144.)  The county asserted that the Act shielded it from statutory 
penalties sought by the state.  (Kizer, at p. 144.)  We held 
otherwise, explaining:  “The County argues that the Legislature 
intended to cover a wider range of liabilities than torts.  The 
County points to the comment to Government Code section 815, 
emphasizing this passage:  ‘the use of the word “tort” has been 
avoided . . . to prevent the imposition of liability by the courts by 
reclassifying the act causing the injury.’  The comment, 
however, also states that ‘the practical effect of this section is to 
eliminate any common law governmental liability for damages 
arising out of torts.’  [Citation.]  Moreover, the introductory 
comment to the Tort Claims Act as a whole states that ‘a statute 
should be enacted providing that public entities are not liable 
for torts unless they are declared to be liable by an enactment.’  
[Citation.]  Clearly, the emphasis of the Tort Claims Act is on 
torts.”  (Kizer, at p. 145, fn. 4.)  Read against the background of 
general tort law, we concluded that the Act was intended to limit 
the state’s “exposure to liability for actual compensatory 
damages in tort cases.”  (Kizer, at p. 146.)   
More recently, in City of Dinuba, supra, 41 Cal.4th 859, 
we rejected the County of Tulare’s claim that the Government 
Claims Act immunized it from an action to recover misallocated 
tax revenue, which the county was obligated by statute to 
allocate and distribute.  (City of Dinuba, at pp. 865–868.)  We 
held that the Government Claims Act did not foreclose the 
plaintiffs’ claim for reimbursement, both because the injury 
alleged did not come within the Act’s definition of “ ‘injury’ ” 
(City of Dinuba, at p. 867, citing Gov. Code, § 810.8), and 
because the plaintiffs were not seeking money damages (City of 
Dinuba, at p. 867).  Regarding the latter ground, we explained:  
“[T]he immunity provisions of the Act are only concerned with 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
18 
shielding public entities from having to pay money damages for 
torts.  [Citation.]  Section 814 explicitly provides that liability 
based on contract or the right to obtain relief other than money 
damages is unaffected by the Act.  Plaintiffs do not seek 
damages; they seek only to compel defendants to perform their 
express statutory duty.  While compliance with the duty may 
result in the payment of money, that is distinct from seeking 
damages.”  (Ibid.)  Having also determined that “mandamus 
provides an appropriate remedy for defendants’ failure to 
comply with their statutory duty” (id. at p. 868), we declined to 
resolve “whether plaintiffs could have maintained claims for 
quasi-contract or constructive trust had mandamus not been 
available” (id. at p. 870). 
The Courts of Appeal have likewise recognized that the 
Government Claims Act’s immunity and liability provisions are 
aimed at common law tort claims for money damages.  (See, e.g., 
Schooler v. State of California (2000) 85 Cal.App.4th 1004, 1013 
[“Courts have determined that under section 814, Government 
Code immunities extend only to tort actions that seek money 
damages”]; Cavey v. Tualla (2021) 69 Cal.App.5th 310, 326 
[“The Government Claims Act was enacted in 1963 to provide a 
comprehensive statutory scheme governing the liabilities and 
immunities of public entities and public employees for torts”]; 
Nealy v. County of Orange (2020) 54 Cal.App.5th 594, 601 
[same].)  In various circumstances, the appellate courts have 
construed equitable claims for payment related to statutory 
obligations as not being subject to the Government Claims Act.  
(See, e.g., Piccinini v. California Emergency Management 
Agency (2014) 226 Cal.App.4th 685, 689 [promissory estoppel 
theory against state agency allowed to proceed where statute 
expresses a legislative policy in favor of allowing cause of 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
19 
action]; Utility Audit Co., Inc. v. City of Los Angeles (2003) 
112 Cal.App.4th 950, 958 (Utility Audit) [common count seeking 
refund of overcharges, based on statute, sounded in contract and 
was not prohibited by the Government Claims Act]; Gonzales v. 
State of California (1977) 68 Cal.App.3d 621, 628 [cause of 
action for breach of an implied contract under an unjust 
enrichment theory supported by statute allowed to go forward 
against state as not subject to Government Claims Act]; see also 
Kajima/Ray Wilson v. Los Angeles County Metropolitan 
Transportation Authority (2000) 23 Cal.4th 305, 315 [lowest 
bidding contractor could recover bid preparation costs against a 
public entity for the misaward of a public contract under a 
theory of promissory estoppel; court could use “promissory 
estoppel primarily to further certain public policies by creating 
a damages remedy for a public entity’s statutory violation”].)   
In short, our case law and well-reasoned holdings from the 
Courts of Appeal confirm that the Government Claims Act is 
concerned with shielding public entities from tort claims seeking 
money damages, and not with every conceivable claim that 
might be pressed against a public entity.   
Notwithstanding this authority demonstrating that the 
Legislature was primarily focused on common law tort claims 
when it enacted the Act’s immunity and liability provisions, the 
County maintains that the Government Claims Act forecloses 
the Hospitals’ quantum meruit cause of action.  The County 
argues, first, that the Hospitals’ compliance with the 
Government Claims Act’s claims presentation requirements 
establishes that they seek money or damages covered by the 
Act’s immunity provisions.  We reject this argument.  As noted 
in footnote 6, ante, the claims presentation requirements of the 
Government Claims Act are broader in scope than the Act’s 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
20 
public entity immunity or liability provisions.  (City of Stockton, 
supra, 42 Cal.4th at pp. 738, 741 [a public entity is not immune 
from liability on its contracts, but the claims presentation 
requirements nonetheless apply to such contract actions]; see 
Hart v. County of Alameda (1999) 76 Cal.App.4th 766, 779 [“the 
Legislature intended the claims presentation statutes to broadly 
apply to ‘ “ ‘all forms of monetary demands . . . ,’ ” ’ and the 
earlier conclusion that the Claims Act was limited to tort claims 
was based on the government immunity statutes, which contain 
different statutory language”].)7  The Hospitals’ mere 
compliance with the Act’s claims presentation requirements 
does not control or determine the nature of their action. 
The County also argues that the Government Claims Act’s 
immunity provisions apply broadly to any common law claim, 
other than a claim alleging an express contract, seeking “money 
or damages” (Gov. Code, § 814).  It asserts that “to the extent 
the Legislature considered the existence of a quantum meruit 
claim brought against [a public entity] when drafting the 
Government Claims Act, it would have understood such a claim 
as a non-contractual action for money or damages, and thus a 
‘tort.’ ”  Yet, even if we were to assume that the Government 
Claims Act’s immunity provisions might apply to some claims 
that are not obviously tortious in nature, the contours of which 
we need not delve into here, we are confident that the Act does 
 
7  
The County’s reliance on Canova v. Trustees of Imperial 
Irrigation Dist. Employee Pension Plan (2007) 150 Cal.App.4th 
1487, 1493, is equally unpersuasive because that case also 
concerns the Government Claims Act’s claims presentation 
requirements, and not its immunity and liability provisions. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
21 
not immunize the County from the Hospitals’ quantum meruit 
claim to enforce a statutory duty of reimbursement.   
“Quantum meruit refers to the well-established principle 
that ‘the law implies a promise to pay for services performed 
under circumstances disclosing that they were not gratuitously 
rendered.’  [Citation.]  To recover in quantum meruit, a party 
need not prove the existence of a contract [citations], but it must 
show the circumstances were such that ‘the services were 
rendered under some understanding or expectation of both 
parties that compensation therefor was to be made.’ ”  
(Huskinson & Brown v. Wolf (2004) 32 Cal.4th 453, 458 
(Huskinson & Brown).)  The doctrine manifests “ ‘ “a general 
principle, underlying various legal doctrines and remedies, that 
one person should not be permitted unjustly to enrich himself at 
the expense of another, but should be required to make 
restitution of or for property or benefits received, retained, or 
appropriated, where it is just and equitable that such restitution 
be made, where such action involves no violation or frustration 
of law or opposition to public policy, either directly or 
indirectly.” ’ ”  (Dinosaur Development, Inc. v. White (1989) 
216 Cal.App.3d 1310, 1315; see Rest., Restitution, §§ 113, 114.)  
“In interpreting statutes dealing with claims ‘arising upon 
contract’ to cover quasi-contractual obligations, the term ‘quasi-
contract’ is sometimes applied to statutory obligations that 
cannot be accurately classified as strictly contractual or subject 
to tort liability.”  (1 Witkin, Summary of Cal. Law (11th ed. 
2017) Contracts, § 104, pp. 148–149.) 
In this respect, the Court of Appeal below applied a rubric 
whereby “[w]hether an action sounds in contract or tort for 
purposes of governmental immunity ‘ “ ‘depends upon the 
nature of the right sued upon, not the form of the pleading or 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
22 
relief demanded.  If based on breach of promise it is contractual; 
if based on breach of a noncontractual duty it is tortious.’ ” ’ ”  
(Santa Clara, supra, 77 Cal.App.5th at p. 1033, quoting Roe v. 
State of California (2001) 94 Cal.App.4th 64, 69.)  Although this 
distinguishing principle may be useful in other contexts, we 
regard it as unhelpful in ascertaining the nature of the 
Hospitals’ quantum meruit claim, which is premised on a theory 
of a promise implied in law (see Huskinson & Brown, supra, 
32 Cal.4th 
at 
p. 458), 
and, 
more 
specifically, 
on 
a 
reimbursement duty imposed by statute.  Instead, we draw 
support from our decisions in City of Dinuba and Kizer, which 
share sufficient commonalities with this matter to lead us to 
conclude that the Government Claims Act does not immunize 
the County from the Hospitals’ action.   
In City of Dinuba, the plaintiffs sought to recover 
misallocated tax revenue, which the defendant county was 
obligated by statute to distribute to the plaintiffs.  (City of 
Dinuba, supra, 41 Cal.4th at p. 863.)  We held that the 
Government Claims Act’s immunity provisions did not apply to 
the plaintiffs’ action, in part because we determined that the 
plaintiffs did not seek money damages.  (City of Dinuba, at 
p. 867, citing Gov. Code, § 814.)  We concluded that the plaintiffs 
instead sought “only to compel defendants to perform their 
express statutory duty.  While compliance with the duty may 
result in the payment of money, that is distinct from seeking 
damages.”  (City of Dinuba, at p. 867.)   
Here too, the Hospitals do not seek money damages.  They 
seek to compel the County to comply with its mandatory duty 
under the Knox-Keene Act and its implementing regulations to 
reimburse the Hospitals for the reasonable and customary value 
of their emergency services and care.  Although some differences 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
23 
exist between the claims in City of Dinuba and this matter, the 
nature of the right sued upon — the statutory right to receive 
funds — is analogous.  As we noted in City of Dinuba, 
“Section 814 explicitly provides that liability based on contract 
or the right to obtain relief other than money damages is 
unaffected by the Act.”  (City of Dinuba, supra, 41 Cal.4th at 
p. 867.)  This provision applies with equal force here.  (See Kizer, 
supra, 53 Cal.3d at p. 146 [Government Claims Act was 
intended to limit government “exposure to liability for actual 
compensatory damages in tort cases”]; Utility Audit, supra, 
112 Cal.App.4th at p. 958 [“A claim for refund of overcharges, 
without more, appears to be based upon breach of a contractual 
duty”]; see also Bowen v. Massachusetts (1988) 487 U.S. 879, 893 
[action for reimbursement of withheld Medicaid payments 
federal agency was statutorily obligated to provide is not an 
action for “ ‘money damages’ as that term is used in the 
[Administrative Procedure Act]”].)8   
Certain aspects of our decision in Kizer are also on point.  
In determining that the state’s enforcement action in Kizer did 
not fall within the purview of the Government Claims Act’s 
immunity provisions, we first emphasized that this particular 
action “lies outside the perimeters of a tort action and therefore 
does not readily lend itself to a liability analysis based on tort 
 
8  
As previously noted, in City of Dinuba, supra, 41 Cal.4th 
at page 868, we concluded that the defendants’ failure to comply 
with their statutory duty gave rise to mandamus relief.  The fact 
that an additional form of mandamus relief was appropriate in 
City of Dinuba does not alter our view regarding the nature of 
the underlying claims in this case.  As in City of Dinuba, we are 
persuaded that the action in this case seeks relief other than 
money damages. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
24 
principles.”  (Kizer, supra, 53 Cal.3d at p. 146.)  Based on the 
detailed statutory scheme regulating long-term health care 
facilities, we concluded that “[g]ranting immunity to public 
entities from the [statutory] penalties would be contrary to the 
intent of the Legislature to provide a citation system for the 
imposition of prompt and effective civil sanctions against long-
term health care facilities in violation of the laws and 
regulations of this state.”  (Ibid.)  We also emphasized that 
“nothing in the statutory scheme . . . suggests that state and 
other government health facilities should be treated differently 
than private facilities” (id. at p. 148), and we perceived “ ‘no 
significant public policy reason to exempt a state licensed 
health-care facility from liability for penalties under the [Act] 
simply because it is operated by a public rather than a private 
entity’ ” (ibid.).   
Like the defendant in Kizer, the County is subject to the 
terms of the Knox-Keene Act, a detailed regulatory scheme, 
because it chose to enter the health care plan market and 
operate a licensed health care service plan.  As has been 
discussed, the Knox-Keene Act applies to “any private or public 
entity” operating a licensed health care service plan, subject to 
narrow exceptions not applicable here.  (Health & Saf. Code, 
§ 1399.5; see id., § 1345, subds. (f)(1), (j).)  The statutory and 
regulatory 
scheme 
explicitly 
provides 
for 
mandatory 
reimbursement (id., § 1371.4, subd. (b); Centinela, supra, 
1 Cal.5th at p. 1001; Prospect Medical Group, supra, 45 Cal.4th 
at 
pp. 501, 
504, 
507; 
Long 
Beach 
Memorial, 
supra, 
71 Cal.App.5th at p. 329; Bell, supra, 131 Cal.App.4th at p. 216; 
California Emergency Physicians, supra, 111 Cal.App.4th at 
p. 1131) and specifies, in general but comprehensive terms, how 
to calculate that reimbursement amount (Regulation 1300.71).  
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
25 
(See Long Beach Memorial, at p. 338 [“The underlying duty to 
repay [emergency medical services] is established by the Knox-
Keene Act, . . . while the amount of repayment is governed 
either by contract (when the parties have a preexisting contract) 
or by the quasi-contractual remedy of quantum meruit (when 
they do not)”].)   
As in Kizer, we see “nothing in the statutory scheme that 
suggests that state and other government health [care service 
plans] should be treated differently than private [health plans],” 
nor do we perceive any “ ‘significant public policy reason to 
exempt a state licensed [health care service plan] from 
liability . . . under the [Knox-Keene] Act simply because it is 
operated by a public rather than a private entity . . . .”  (Kizer, 
supra, 53 Cal.3d at p. 148.)  To the contrary, disallowing such a 
claim against the County would undermine an important 
purpose of the Knox-Keene Act, as we and others have 
interpreted it.  As the DMHC, appearing as amicus curiae in 
Bell, 
emphasized, 
“ ‘The 
prompt 
and 
appropriate 
reimbursement of emergency providers ensures the continued 
financial 
viability 
of 
California’s 
health 
care 
delivery 
system. . . .  [D]enying emergency providers judicial recourse to 
challenge the fairness of a health plan’s reimbursement 
determination[] allows a health plan to systematically underpay 
California’s 
safety-net 
providers . . . .’ ” 
 
(Bell, 
supra, 
131 Cal.App.4th at p. 218.)  The Legislature’s purpose in 
enacting section 1371.4 of the Knox-Keene Act would be ill-
served by a rule immunizing public entities that operate 
licensed health care service plans from emergency services 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
26 
reimbursement claims, thus reintroducing the very risk of 
systematic underpayment the Legislature sought to eliminate.9 
Moreover, and as noted ante, the DMHC “ ‘lacks the 
authority to set specific reimbursement rates under theories of 
quantum 
meruit 
and 
the 
jurisdiction 
to 
enforce 
a 
reimbursement determination on both the provider and the 
health plan.  Because the [DMHC] cannot provide an adequate 
forum, health care providers must be allowed to maintain a 
cause of action in court to resolve individual claims-payment 
disputes over the reasonable value of their services.’ ”  (Bell, 
supra, 131 Cal.App.4th at p. 218.)  Under the County’s 
interpretation of the Government Claims Act, emergency 
medical providers without a contract in place with a health care 
service 
plan 
could 
resolve 
individual 
disputes 
over 
reimbursement only if that plan were operated by a private, 
rather than public, entity.  Again, we find this proposed two-tier 
system “contradicts the very public policy that the Legislature 
sought to implement” with the reimbursement provision of the 
Knox-Keene Act.10  (Kizer, supra, 53 Cal.3d at p. 148.) 
 
9  
Indeed, more than a decade after the Legislature enacted 
the Knox-Keene Act’s reimbursement provision, former 
Governor Arnold Schwarzenegger issued an executive order 
reaffirming the public policy in favor of requiring all health care 
service plans to reimburse emergency medical providers at the 
reasonable and customary value.  (Governor’s Exec. Order No. 
S-13-06 (July 25, 2006).)   
10  
Given the DMHC’s express acknowledgment that it 
cannot set specific reimbursement levels or adjudicate 
individual payment disputes between health plans and 
emergency physicians, we also reject the County’s argument 
that a quantum meruit action is unnecessary because the Knox-
 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
27 
We conclude from the foregoing that allowing the 
Hospitals to proceed with their quantum meruit claim premised 
on the County’s statutory obligation of reimbursement violates 
neither the letter nor the spirit of the Government Claims Act.  
It also furthers a fundamental purpose of the Knox-Keene Act, 
protecting the continued financial viability of California’s health 
care delivery system, by ensuring that all emergency medical 
providers have an adequate remedy if there are disputes over 
payment, either by alleging breach of contract (if there is a 
contract between the provider and health care plan), or by 
raising a quantum meruit claim based on the Knox-Keene Act’s 
reimbursement obligation (if there is no contract in place). 
In arguing that the Government Claims Act’s immunity 
provisions extend to quantum meruit claims, the County cites 
three decisions by this court predating the Act in which we 
discussed the availability of quantum meruit claims against 
government entities:  Miller v. McKinnon (1942) 20 Cal.2d 83 
(Miller), Los Angeles Dredging Co. v. Long Beach (1930) 210 Cal. 
348 (Los Angeles Dredging Co.), and Zottman v. San Francisco 
(1862) 20 Cal. 96 (Zottman).  The County asserts that these 
decisions convey a general hostility toward quantum meruit 
claims against the government that was then maintained under 
the Act.   
We draw a more limited rule from these cases.  Each of 
these decisions involved express contracts entered into by public 
entities that were found to be void and unenforceable because 
they were made in violation of a statute or municipal charter.  
(Miller, supra, 20 Cal.2d at p. 86 [contract between county and 
 
Keene Act provides adequate alternative mechanisms for 
resolving reimbursement disputes. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
28 
contractor held illegal because it did not comply with statute 
requiring public agencies to let competitive bidding before 
entering into certain contracts]; Los Angeles Dredging Co., 
supra, 210 Cal. at p. 354 [contract entered into by city without 
letting of bids rendered void because it violated city charter]; 
Zottman, supra, 20 Cal. at pp. 102–103 [same].)  It was in this 
context, of considering contracts entered into by public entities 
in a manner not authorized by statute or charter, that we stated:  
“ ‘[C]ontracts wholly beyond the powers of a municipality are 
void.  They cannot be ratified; no estoppel to deny their validity 
can be invoked against the municipality; and ordinarily no 
recovery in quasi contract can be had for work performed under 
them.  It is also settled that the mode of contracting, as 
prescribed by the municipal charter, is the measure of the power 
to contract; and a contract made in disregard of the prescribed 
mode is unenforceable.’  [Citations.]  And even though the 
person with whom the contract was made has supplied labor and 
materials in the performance of the contract and the public 
agency has received the benefits thereof, he has no right of 
action to recover in quantum meruit the reasonable value 
thereof.”  (Miller, at p. 88, quoting Los Angeles Dredging Co., at 
p. 353.)   
Read together and as relevant here, Miller, Los Angeles 
Dredging Co., and Zottman stand for the narrow principle that 
if a contractor enters into an express contract with a public 
entity, and the contract is later found to be in violation of an 
applicable statute or charter and therefore deemed void, the 
contractor has no right to recover the reasonable value of 
services in quantum meruit.  These decisions are readily 
distinguishable from the Hospitals’ quantum meruit claim 
against the County, which concerns no express contract and is 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
29 
instead based on a statutorily mandated reimbursement 
provision.  We are doubtful that the Legislature understood 
these decisions to mean that a quantum meruit claim for 
payment required by statute and otherwise resembling the claim 
pursued here is “a non-contractual action for money or damages, 
and thus a ‘tort,’ ” as the County asserts it must have.11   
Although other Court of Appeal decisions have broadly 
held that quantum meruit claims may not proceed against 
public entities, those decisions contain thin analyses and are 
distinguishable on their facts.  It has been said, for example, 
that “[a]s a general rule, a public entity cannot be sued on an 
implied-in-law or quasi-contract theory, because such a theory 
is based on quantum meruit or restitution considerations which 
are outweighed by the need to protect and limit a public entity’s 
contractual 
obligations.” 
 
(Lundeen 
Coatings 
Corp. 
v. 
Department of Water & Power (1991) 232 Cal.App.3d 816, 831, 
fn. 9; see also Janis v. California State Lottery Com. (1998) 
68 Cal.App.4th 824, 830; Los Angeles Equestrian Center, Inc. v. 
 
11 
Indeed, several other states allowed quasi-contractual 
claims to proceed against public entities under appropriate 
circumstances at the time the Legislature enacted the 
Government Claims Act.  (See, e.g., Hailey v. King County 
(Wash. 1944) 149 P.2d 823, 825 [“the doctrine of implied contract 
has been applied with respect to municipal corporations under 
circumstances where ‘equity and good conscience’ have seemed 
to require it”]; Annot., Liability of Municipality or Other 
Governmental Body on Implied or Quasi Contract for Value of 
Property or Work (1945) 154 A.L.R. 356, 357 [“the rule is well 
settled in most jurisdictions that a municipality or other 
political subdivision may become obligated upon implied or 
quasi contract to pay the reasonable value of benefits accepted 
or appropriated by it as to which it has the general power to 
contract”].)   
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
30 
City of Los Angeles (1993) 17 Cal.App.4th 432, 448–449.)  But 
these cases either directly or indirectly rely on Miller, supra, 
20 Cal.2d 83 for this principle, and as has been explained, Miller 
does not stand for such a broad proposition.  And even this 
principle is explicitly premised on “the need to protect and limit 
a public entity’s contractual obligations” (Lundeen, at p. 831, 
fn. 9), which is not a consideration for all quantum meruit 
claims — the instant claim against the County being just one 
example, since it is based on the County’s statutory duty, not its 
contractual obligation. 
In concluding that Government Code section 815 bars a 
quantum meruit action, the Court of Appeal below relied 
primarily on Sheppard v. North Orange County Regional 
Occupational Program (2010) 191 Cal.App.4th 289.  (See Santa 
Clara, supra, 77 Cal.App.5th at p. 1028.)  The plaintiff in 
Sheppard, a part-time public school instructor, sought 
reimbursement from a public agency for his unpaid time spent 
preparing for teaching.  (Sheppard, at pp. 293–294.)  Notably, 
an express contract existed between the plaintiff and the 
agency.  (Id. at pp. 295, 314.)  The plaintiff’s complaint alleged 
causes of action for violation of the minimum wage law, breach 
of contract, and quantum meruit.  (Id. at p. 294.)  The appellate 
court held that the trial court erred when it sustained the 
agency’s demurrer to the breach of contract claim (id. at p. 313), 
but that it properly sustained the demurrer to the plaintiff’s 
quantum meruit claim because “such a claim cannot be asserted 
against a public entity” (id. at p. 314).  Sheppard cited 
Government Code section 815 and the Legislative Committee 
Comment accompanying that section, which states that this 
section “ ‘abolishes all common law or judicially declared forms 
of liability for public entities, except for such liability as may be 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
31 
required by the state or federal constitution.’ ”  (Sheppard, at 
p. 314.)  The Sheppard court also determined that the plaintiff’s 
quantum meruit claim failed on the additional ground that such 
recovery is unavailable when the parties have an actual 
agreement covering compensation.  (Ibid.)   
Without calling the result in Sheppard into question, to 
the extent it relied on the Government Claims Act, its analysis 
failed to undertake a careful review of the claim before it, 
comparable to our inquiries in City of Dinuba, supra, 41 Cal.4th 
859 and Kizer, supra, 53 Cal.3d 139, before determining 
whether such claim fell within or outside the purview of the 
Government Claims Act’s immunity provisions.  To the extent it 
held that a quantum meruit claim against the public agency was 
unavailable more generally, Sheppard is plainly distinguishable 
because an express contract existed between the parties. 
To summarize, we are not persuaded that the Legislature 
intended to foreclose all quantum meruit claims against public 
entities when it drafted the Government Claims Act’s immunity 
and liability provisions, and certainly not the claim at issue in 
this case. 
In light of our holding that the Government Claims Act 
does not immunize the County from the Hospitals’ action for 
reimbursement as mandated by section 1371.4 of the Knox-
Keene Act, we need not address the Hospitals’ alternative 
argument that the mandatory duty exception to governmental 
immunity under Government Code section 815.6 also applies. 
COUNTY OF SANTA CLARA v. SUPERIOR COURT 
Opinion of the Court by Guerrero, C. J. 
 
32 
III.  DISPOSITION 
We reverse the judgment of the Court of Appeal and 
remand the matter for further proceedings consistent with this 
opinion. 
 
GUERRERO, C. J. 
 
We Concur: 
CORRIGAN, J. 
LIU, J. 
KRUGER, J. 
GROBAN, J. 
JENKINS, J. 
EVANS, J. 
 
 
See next page for addresses and telephone numbers for counsel who 
argued in Supreme Court. 
 
Name of Opinion  County of Santa Clara v. Superior Court 
__________________________________________________________  
 
Procedural Posture (see XX below) 
Original Appeal  
Original Proceeding 
Review Granted (published) XX 77 Cal.App.5th 1018 
Review Granted (unpublished)  
Rehearing Granted 
__________________________________________________________  
 
Opinion No. S274927 
Date Filed:  July 10, 2023 
__________________________________________________________  
 
Court:  Superior  
County:  Santa Clara 
Judge:  Maureen A. Folan 
__________________________________________________________   
 
Counsel: 
 
James R. Williams, County Counsel, Douglas M. Press, Assistant 
County Counsel, Melissa R. Kiniyalocts, Susan P. Greenberg, David P. 
McDonough and Hannah M. Begley, Deputy County Counsel, for 
Petitioner. 
 
Aurelia M. Razo, Deputy County Counsel (San Diego); and Jennifer B. 
Henning for California State Association of Counties as Amicus Curiae 
on behalf of Petitioner. 
 
Olson Remcho, Margaret R. Prinzing and Ilan Zur for National Health 
Economics and Policy Scholars as Amici Curiae on behalf of Petitioner. 
 
Daponde Simpson Rowe, Michael J. Daponde and Darcy L. Muilenburg 
for Local Health Plans of California as Amicus Curiae on behalf of 
Petitioner.  
 
No appearance for Respondent. 
 
 
 
Helton Law Group, Edward Stumpp, Mikaela Grace Cox, Casey E. 
Mitchnick, Faatima Seedat; Horvitz & Levy, Mitchell C. Tilner, Peder 
K. Batalden and Beth J. Jay for Real Parties in Interest.  
 
Athene Law, Long X. Do, Felicia Y. Sze, Eric D. Chan; King & 
Spalding, Glenn Solomon, Paul R. Johnson and Jonathan Shin for the 
California Medical Association and the California Hospital Association 
as Amici Curiae on behalf of Real Parties in Interest. 
 
King & Spalding, Glenn Solomon, Paul R. Johnson and Jonathan Shin 
for San Jose Healthcare System, L.P., and Good Samaritan Hospital, 
L.P., as Amici Curiae on behalf of Real Parties in Interest.
 
 
Counsel who argued in Supreme Court (not intended for 
publication with opinion): 
 
Susan P. Greenberg 
Deputy County Counsel 
70 West Hedding Street, East Wing, 9th Floor 
San Jose, CA 95110 
(408) 299-5900 
 
Mitchell C. Tilmer 
Horvitz & Levy LLP 
3601 West Olive Avenue, 8th Floor 
Burbank, CA 91505-4681 
(818) 995-0800