Title: Flores v. Presbyterian Intercommunity Hosp.
Citation: N/A
Docket Number: S209836
State: California
Issuer: California Supreme Court
Date: May 5, 2016

1 
Filed 5/5/16 
 
 
 
IN THE SUPREME COURT OF CALIFORNIA 
 
 
 
CATHERINE FLORES, 
) 
 
 
) 
 
Plaintiff and Appellant, 
) 
 
 
) 
S209836 
 
v. 
) 
 
 
) 
Ct.App. 2/3 B235409 
PRESBYTERIAN INTERCOMMUNITY 
) 
HOSPITAL, 
) 
 
 
) 
Los Angeles County 
 
Defendant and Respondent. 
) 
Super. Ct. No. VC058225 
 
____________________________________) 
 
A personal injury action generally must be filed within two years of the 
date on which the challenged act or omission occurred.  (Code Civ. Proc., § 335.1 
(section 335.1).)  A special statute of limitations applies, however, to actions “for 
injury or death against a health care provider based upon such person’s alleged 
professional negligence.”  (Code Civ. Proc., § 340.5 (section 340.5).)  Unlike most 
other personal injury actions, professional negligence actions against health care 
providers must be brought within “three years after the date of injury or one year 
after the plaintiff discovers, or through the use of reasonable diligence should have 
discovered, the injury, whichever occurs first.”  (Ibid.) 
Plaintiff in this case is a hospital patient who was injured when one of the 
rails on her hospital bed collapsed.  The rail had been raised according to doctor’s 
orders following a medical assessment of her condition.  Plaintiff sued the 
hospital, claiming that it negligently failed to inspect and maintain the equipment.  
The question presented is whether her claim is governed by the special limitations 
 
2 
period in section 340.5 or instead by the usual two-year statute of limitations for 
personal injury actions.  Because plaintiff’s injury resulted from alleged 
negligence in the use and maintenance of equipment needed to implement the 
doctor’s order concerning her medical treatment, we conclude that plaintiff’s 
claim sounds in professional, rather than ordinary, negligence.  Therefore, as the 
trial court correctly ruled, the action is governed by the special limitations period 
in section 340.5 rather than the two-year statute of limitations under section 335.1. 
I. 
On March 5, 2009, plaintiff Catherine Flores, a patient at defendant 
Presbyterian Intercommunity Hospital (PIH Health) in Whittier, was attempting to 
get up from her hospital bed when the latch on the bedrail failed and the rail 
collapsed, causing her to fall to the floor.  Just under two years later, on March 2, 
2011, she filed suit against PIH Health, stating causes of action for general 
negligence and premises liability.  She alleged that defendant had “failed to use 
reasonable care in maintaining [its] premises,” “failed to take reasonable 
precautions to discover and make safe a dangerous condition on the premises,” 
and “failed to give Plaintiff a reasonable and adequate warning of a dangerous 
condition so Plaintiff could have avoided foreseeable harm.”  Flores claimed she 
suffered injury as a result. 
PIH Health demurred to the complaint.  It argued that the complaint was 
governed by section 340.5’s statute of limitations for suits alleging professional 
negligence, that Flores had discovered the injury when she fell out of her hospital 
bed, and that the complaint was untimely because it was filed more than one year 
thereafter.  In her briefs and argument in opposition to the demurrer, Flores 
disputed that her claim arose from professional negligence.  She acknowledged 
that a doctor had made a “medical decision” to order that the rails on her bed be 
raised, following a “medical assessment” of her condition.  But, she argued, “the 
 
3 
rendition of professional services ended when Defendant medically assessed 
Plaintiff’s condition and medically determined to raise the sidewalls on her bed.”  
PIH Health’s alleged negligent conduct, she argued, was therefore “clearly 
ordinary, and not professional, negligence,” and was therefore subject to the 
ordinary two-year limitations period for personal injury actions (§ 335.1).  The 
trial court agreed with PIH Health, sustained the demurrer without leave to amend, 
and dismissed the lawsuit.  Flores appealed.   
The Court of Appeal reversed, ordering the trial court to reinstate the 
complaint.  The Court of Appeal held that PIH Health’s alleged failure to use 
reasonable care in maintaining its premises and its alleged failure to take 
reasonable precautions to make a dangerous condition safe “sounds in ordinary 
negligence because the negligence did not occur in the rendering of professional 
services.”   
We granted PIH Health’s petition for review. 
II. 
A. 
For most of the 20th century, medical malpractice claims were subject to 
the same one-year limitations period that applied to other personal injury claims.  
(See Code Civ. Proc., former § 340, subd. (3), added by Stats. 1905, ch. 258, § 2, 
p. 232; Neel v. Magana, Olney, Levy, Cathcart & Gelfand (1971) 6 Cal.3d 176, 
181 (Neel); Gopaul v. Herrick Memorial Hosp. (1974) 38 Cal.App.3d 1002, 1005 
(Gopaul).)  But courts had held that in professional malpractice cases, unlike in 
ordinary personal injury actions, the limitations period did not begin to run “until 
the plaintiff discovered his injury, or through the use of reasonable diligence, 
should have discovered it.”  (Stafford v. Shultz (1954) 42 Cal.2d 767, 776; see 
Sanchez v. South Hoover Hospital (1976) 18 Cal.3d 93, 96-97; Huysman v. Kirsch 
(1936) 6 Cal.2d 302.) 
 
4 
In 1970, the Legislature codified this delayed discovery rule in former 
section 340.5, which then applied to any action against specified medical 
professionals, or hospitals employing such professionals, “based upon such 
person’s alleged professional negligence . . . or for error or omission in such 
person’s practice.”  (§ 340.5, as added by Stats. 1970, ch. 360, § 1, p. 772.)  In 
such cases, the Legislature provided that the statute of limitations was one year 
from the date on which the plaintiff discovered or should have discovered the 
injury, but was subject to an outer limit of four years after the date of injury.  
(Ibid.)  The new law was intended “to retain the substance of the common law 
discovery rule, while modifying its ‘open-ended’ operation.”  (Sanchez v. South 
Hoover Hospital, supra, 18 Cal.3d at p. 98.) 
Five years later, the Legislature amended section 340.5 to its present 
version as part of the Medical Injury Compensation Reform Act (MICRA) 
(Stats. 1975, 2d Ex. Sess. 1975-1976, chs. 1, 2, pp. 3949-4007), a wide-ranging 
statutory scheme designed to reduce the cost of medical malpractice insurance “by 
limiting the amount and timing of recovery in cases of professional negligence” 
(Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 
100, 111; see Stats. 1975, 2d Ex. Sess. 1975-1976, ch. 2, § 12.5, p. 4007 [preamble 
to MICRA]).  MICRA amended section 340.5 to shorten the outer limitations 
period from four years to three.  It expanded the coverage of the provision to 
include not only actions against medical professionals and hospitals “as . . . 
employer[s]” of such persons (Code Civ. Proc., former § 340.5), but also actions 
against “ ‘[h]ealth care provider[s],’ ” generally, which it defined to include any 
licensed “clinic, health dispensary, or health facility” (§ 340.5, subd. (1)).  Finally, 
and as particularly relevant here, it amended the description of covered claims, 
stating that the special limitations period applies to “an action for injury or death 
against a health care provider based upon such person’s alleged professional 
 
5 
negligence.”  (§ 340.5.)  MICRA also supplied, for the first time, a definition of 
the term “professional negligence”:  “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 a personal injury or wrongful death, provided that such 
services are within the scope of services for which the provider is licensed and 
which are not within any restriction imposed by the licensing agency or licensed 
hospital.”  (§ 340.5, subd. (2).)1 
For many years after MICRA’s enactment, its special limitations provisions 
were relevant only in cases involving delayed discovery; in all other cases, the 
one-year statute of limitations corresponded to the usual one-year statute of 
limitations for personal injury actions.  In 2002, however, the Legislature enacted 
section 335.1, which established a two-year limitations period for most tort actions 
alleging personal injury or death.2  Because all parties agree that Flores was aware 
                                              
1 
An identical definition appears in several other provisions of MICRA:  
Civil Code section 3333.1 (evidence of collateral source payments allowed and 
subrogation by a collateral source precluded in professional negligence actions); 
Civil Code section 3333.2 (noneconomic damages in professional negligence 
actions capped at $250,000); Code of Civil Procedure section 364 (plaintiffs in 
professional negligence actions must give 90-day notice of intent to sue); Code of 
Civil Procedure section 667.7 (judges in professional negligence actions 
authorized to provide for periodic payments of future damages); and Business and 
Professions Code section 6146 (limiting contingent fees in professional negligence 
actions).  We have said that, “[t]o ensure that the legislative intent underlying 
MICRA is implemented, . . . the scope of conduct afforded protection under 
MICRA provisions (actions ‘based on professional negligence’) must be 
determined after consideration of the purpose underlying each of the individual 
statutes.”  (Central Pathology Service Medical Clinic, Inc. v. Superior Court 
(1992) 3 Cal.4th 181, 192.)  
 
2  
The legislative findings accompanying the enactment of section 335.1 
indicate that the Legislature was particularly concerned that, under the previous 
one-year statute of limitations, “residents of California who were victims of the 
 
(Footnote continued on next page.) 
 
6 
of her injury at the time it occurred, the question in this case is whether her claim 
is subject to the two-year statute of limitations under section 335.1, in which case 
her claim was timely, or the one-year statute of limitations under section 340.5, in 
which case it was not.   
B. 
As our courts have long recognized, “the dividing line between ‘ordinary 
negligence’ and ‘professional malpractice’ may at times be difficult to place . . . .”  
(Gopaul, supra, 38 Cal.App.3d at p. 1007.)  Over time, the Courts of Appeal have 
drawn the line differently in cases involving alleged negligence in the use or 
maintenance of hospital equipment or premises.   
In Gopaul, the court considered the proper characterization of such a claim 
under the law as it existed before the enactment of section 340.5.  (See Gopaul, 
supra, 38 Cal.App.3d at p. 1005, fn. *.)  The plaintiff in Gopaul was a hospital 
patient, later diagnosed with bronchial pneumonia, who fell from a gurney during 
a coughing fit while left unattended.  The specific question before the court was 
whether the plaintiff was entitled to the benefit of the judge-made “discovery rule” 
for cases of professional malpractice.  The Gopaul court held that the rule did not 
apply.  The court explained that not every negligent act by a professional is an act 
of professional negligence:  “No reasonable person would suggest that 
‘professional malpractice’ was the cause of injury to a patient from a collapsing 
                                                                                                                                      
 
 
(Footnote continued from previous page.) 
 
terrorist actions of September 11, 2001, must prematurely choose between 
litigation and federal remedies, while residents of other states have more than 
twice as long to pursue their remedies.”  (Stats. 2002, ch. 448, § 1, subd. (c), 
p. 2522.)  The perhaps unintentional effect of the legislation was to create a longer 
limitations period for ordinary negligence actions than for professional negligence 
actions not involving delayed discovery of the injury. 
 
7 
chair in a doctor’s office, or to a client from his attorney’s negligent driving en 
route to the court house, or to a hospital patient from a chandelier falling onto his 
bed.”  (Gopaul, supra, 38 Cal.App.3d at p. 1006.)  Rather, the court held, 
professional malpractice occurs only when “the negligence occurred within the 
scope of the ‘skill, prudence, and diligence commonly exercised by practitioners 
of [the] profession.’ ”  (Id. at p. 1007, quoting Neel, supra, 6 Cal.3d at p. 188.)   
After MICRA was enacted, the Court of Appeal in Murillo v. Good 
Samaritan Hospital (1979) 99 Cal.App.3d 50 (Murillo) took a different approach.  
In Murillo, the court considered the application of section 340.5, as amended by 
MICRA, to a hospital patient’s claim that she fell from her hospital bed while 
sedated after hospital employees negligently left the rails of her bed down during 
the night.  Relying on Gopaul, the hospital argued that the patient’s claim sounded 
in ordinary negligence rather than professional negligence, and thus was not 
subject to the delayed discovery rule of section 340.5.  The Murillo court 
disagreed.  Under section 340.5, it reasoned, “the test is not whether the situation 
calls for a high or a low level of skill, or whether a high or low level of skill was 
actually employed, but rather the test is whether the negligent act occurred in the 
rendering of services for which the health care provider is licensed.”  (Murillo, 
supra, 99 Cal.App.3d at p. 57.)  The court explained that “the professional duty of 
a hospital . . . is primarily to provide a safe environment within which diagnosis, 
treatment, and recovery can be carried out.  Thus if an unsafe condition of the 
hospital’s premises causes injury to a patient, as a result of the hospital’s 
negligence, there is a breach of the hospital’s duty qua hospital.”  (Id. at pp. 56-
57.)  Because the patient’s claim in that case involved the “hospital’s duties to 
recognize the condition of patients under its care and to take appropriate measures 
for their safety,” the court concluded the claim was “squarely one of professional 
negligence.”  (Id. at p. 56; see Bellamy v. Appellate Department (1996) 50 
 
8 
Cal.App.4th 797, 806-808 (Bellamy) [applying the Murillo test and concluding 
that section 340.5 applied to a patient’s claim that she was injured when hospital 
employees negligently failed to set a brake on a rolling X-ray table or to hold the 
table in place]; see also Flowers v. Torrance Memorial Hospital Medical Center 
(1994) 8 Cal.4th 992, 999, 1002, fn. 6 [noting that Gopaul and Murillo reached 
contrary results, but declining to decide which was correct].) 
Although the Court of Appeal in this case recited Murillo’s rule that the 
governing test “ ‘is whether the negligent act occurred in the rendering of services 
for which the health care provider is licensed’ ” (italics omitted), the court 
disagreed with what it characterized as “Murillo’s dictum that a negligently 
maintained, unsafe condition of a hospital’s premises which causes injury to a 
patient falls within professional negligence.”  The court emphasized that the 
“critical inquiry is whether the negligence occurred in the rendering of 
professional services.”  The court concluded that “Flores’s complaint, which 
alleged she was injured ‘when the bed rail collapsed causing plaintiff to fall to the 
ground,’ sounds in ordinary negligence” because the inspection and maintenance 
of hospital equipment and premises does not constitute “the rendering of 
professional services.” 
III. 
As this case comes to us, the central point of dispute is whether negligence 
in the use or maintenance of hospital equipment or premises qualifies as 
professional negligence subject to the special statute of limitations in section 
340.5.  We begin, as in all cases of statutory interpretation, by examining the text 
of the statute.  The definition of “professional negligence” in section 340.5 has 
four elements:  (1) “a negligent act or omission to act by a health care provider in 
the rendering of professional services,” (2) “which act or omission is the 
proximate cause of injury or wrongful death,” (3) “provided that such services are 
 
9 
within the scope of services for which the provider is licensed,” and (4) “which are 
not within any restriction imposed by the licensing agency or licensed hospital.”  
(§ 340.5, subd. (2).)  The parties do not dispute that three of the four elements are 
satisfied in this case.  The controversy centers on the meaning of the first element, 
whether the negligent act or omission occurred “in the rendering of professional 
services.” 
Flores urges us to interpret the phrase “professional services” to mean 
“services involving a job requiring a particularized degree of medical skill.”  In 
her view, because the maintenance of hospital equipment and premises requires no 
“specialized education, training or skill” it cannot qualify as negligence “in the 
rendering of professional services (§ 340.5).”  PIH Health, drawing on Murillo, 
counters that, under section 340.5, “the test is not whether the situation calls for a 
high or a low level of skill, or whether a high or low level of skill was actually 
employed, but rather the test is whether the negligent act occurred in the rendering 
of services for which the health care provider is licensed.”  (Murillo, supra, 99 
Cal.App.3d at p. 57.)  As amici curiae supporting the hospital point out, the 
statutory and regulatory licensing requirements for hospitals include general 
premises safety and maintenance requirements.  (See, e.g., Cal. Code Regs., tit. 22, 
§ 70837, subd. (a) [“The hospital shall be clean, sanitary and in good repair at all 
times.  Maintenance shall include provision and surveillance of services and 
procedures for the safety and well-being of patients, personnel and visitors.”].)  
According to PIH Health, any failure to use reasonable care in maintaining its 
equipment or premises occurs in the rendering of services for which it is licensed, 
and therefore sounds in professional, rather than ordinary, negligence.  
In our view, neither party accurately captures the meaning of section 340.5:  
Flores’s proposed rule is too narrow, while PIH Health’s proposed rule is too 
broad.  Flores is, of course, correct that the term “professional services,” as it 
 
10 
relates to members of a profession, ordinarily is used to refer to “ ‘services . . . 
which can be judged against the skill, prudence, and diligence commonly 
possessed’ ” by other members of the profession.  (Lee v. Hanley (2015) 61 
Cal.4th 1225, 1237 (Lee), quoting Quintilliani v. Mannerino (1998) 62 
Cal.App.4th 54, 64; see Gopaul, supra, 38 Cal.App.3d at p. 1007 [the test for 
determining the existence of “professional malpractice” is “whether the negligence 
occurred within the scope of the ‘skill, prudence, and diligence commonly 
exercised by practitioners of his profession’ ”].)  Flores is also correct that in the 
health care context, the relevant professional service is medical care:  that is, the 
medical diagnosis and treatment of patients.  But this does not mean that section 
340.5 applies only to those specific tasks that require advanced medical skills and 
training.  A medical professional or other hospital staff member may commit a 
negligent act in rendering medical care, thereby causing a patient’s injury, even 
where no particular medical skills were required to complete the task at hand.  A 
hospital’s negligent failure to prevent a patient from becoming separated from an 
oxygen ventilator, for example, occurs in the “rendering of professional services” 
(§ 340.5, subd. (2)), “regardless of whether separation was caused by the ill-
considered decision of a physician or the accidental bump of a janitor’s broom” 
(Taylor v. United States (9th Cir. 1987) 821 F.2d 1428, 1432).  If a doctor has 
determined that a hospitalized patient’s medical needs require a special diet, and 
the patient is injured because a hospital employee negligently gives the patient the 
wrong food, the hospital has inflicted injury in the rendering of professional 
services to the patient.  And if hospital staff place a violently coughing patient on a 
gurney for X-rays, and the patient falls to the ground after the staff negligently 
 
11 
leave her unsecured while the film is developed, the hospital has caused injury in 
the rendering of professional services to the patient, even though fastening straps 
requires no special skill.  (See Bellamy, supra, 50 Cal.App.4th 797.)3   
We thus agree with PIH Health (and by extension, with the Murillo court) 
to this extent:  Under section 340.5, “the test is not whether the situation calls for a 
high or a low level of skill, or whether a high or low level of skill was actually 
employed . . . .”  (Murillo, supra, 99 Cal.App.3d at p. 57.)  But we disagree with 
the remainder of the hospital’s proposed rule.  In our view, a hospital’s negligent 
act or omission does not qualify as negligence “in the rendering of professional 
services” (§ 340.5, subd. (2)) merely because it violates a state licensing 
requirement to maintain the premises in “good repair” (Cal. Code Regs., tit. 22, 
§ 70837, subd. (a)).  Such a rule would collapse the first (“a negligent act or 
omission . . . in the rendering of professional services”) and third (“within the 
scope of services for which the [health care] provider is licensed”) parts of the 
statutory definition, thereby essentially reading out of the statute the independent 
requirement that the negligent act or omission must occur “in the rendering of 
professional services.”  (§ 340.5, subd. (2).)  It would thus sweep in not only 
negligence in performing the duties that hospitals owe to their patients in the 
rendering of medical diagnosis and treatment, but negligence in performing the 
duties that hospitals owe to all users — including personnel and visitors — simply 
by virtue of operating a facility that is open to the public.  (Cal. Code Regs., 
tit. 22, § 70837, subd. (a).)  It would mean, for example, that section 340.5 would 
                                              
3 
To the extent Gopaul, supra, 38 Cal.App.3d 1002, reached a contrary 
conclusion under the law as it existed before the 1970 enactment of section 340.5, 
it sheds no light on the proper interpretation of the operative provisions of the 
statute currently in force. 
 
12 
apply to a visitor’s action for injuries resulting from a custodian’s negligence in 
leaving a broom on a hallway floor, or a doctor’s action against the hospital for 
failure to place a warning sign on a wet, recently mopped floor. 
The rule PIH Health urges would, in short, transform section 340.5’s 
special rule for professional negligence — i.e., negligence in the rendering of 
medical care to patients — into an all-purpose rule covering essentially every form 
of ordinary negligence that happens to occur on hospital property.  Had the 
Legislature intended to craft such a rule, it certainly could have done so.  But it 
chose instead to write a narrower rule, both to cabin the operation of the delayed 
discovery rule that had formerly applied in professional malpractice cases and to 
address “skyrocketing malpractice premium costs . . . resulting in a potential 
breakdown of the health delivery system.”  (Stats. 1975, 2d Ex. Sess. 1975-1976, 
ch. 2, § 12.5, p. 4007 [preamble to MICRA].)  Neither purpose would be served by 
extending the special limitations period of section 340.5 to cases involving 
ordinary negligence that happen to occur on hospital property.4  The rule PIH 
Health urges would, in short, extend section 340.5 well beyond its intended scope. 
The text and purposes underlying section 340.5 instead require us to draw a 
distinction between the professional obligations of hospitals in the rendering of 
                                              
4 
Indeed, at the time MICRA was enacted, such an expansion could well 
have been counterproductive.  As noted above, the limitations periods established 
in section 340.5 as amended by MICRA (one year when the injury was or should 
have been immediately discovered; three years when discovery of the injury was 
delayed; and in some circumstances subject to tolling) were in all circumstances 
equal to or longer than the limitations period in actions for ordinary negligence 
(one year in all cases).  To the extent that MICRA reflected legislative concerns 
about open-ended limitations periods and skyrocketing malpractice rates, those 
concerns would have counseled against treating a garden-variety negligence claim 
as a claim for professional negligence, since doing so could only work to lengthen 
— not shorten — the applicable limitations period. 
 
13 
medical care to their patients and the obligations hospitals have, simply by virtue 
of operating facilities open to the public, to maintain their premises in a manner 
that preserves the well-being and safety of all users.  Our recent decision in Lee, 
supra, 61 Cal.4th 1225, lends support to this conclusion.  The question in that case 
concerned section 340.5’s neighboring provision imposing a one-year statute of 
limitations for “[a]n action against an attorney for a wrongful act or omission, 
other than for actual fraud, arising in the performance of professional services.”  
(Code Civ. Proc., § 340.6, subd. (a) (section 340.6(a)).)  We acknowledged in that 
case that the “statutory text does not by itself make clear whether the phrase 
‘arising in the performance of professional services’ limits the scope of section 
340.6(a) to legal malpractice claims or covers a broader range of wrongful acts or 
omissions that might arise during the attorney-client relationship.”  (Lee, supra, 61 
Cal.4th at p. 1233.)  We therefore proceeded to examine the Legislature’s purpose 
in enacting section 340.6(a) in 1977:  “to ‘reduce[] the cost of legal malpractice 
insurance’ and ‘limit[] the open-endedness’ of the various limitations periods,” as 
well as to avoid evasion of the statute through artful pleading.  (Lee, supra, 61 
Cal.4th at p. 1234.)  In light of the concerns that motivated its enactment, we 
concluded that section 340.6(a) is properly read to apply to claims that “depend on 
proof that an attorney violated a professional obligation in the course of providing 
professional services.”  (Lee, supra, 61 Cal.4th at pp. 1236-1237.) 
In so holding, we rejected the argument that section 340.6(a) applies “to all 
forms of attorney misconduct, except actual fraud, that occur during the attorney-
client relationship or entail the violation of a professional obligation.”  (Lee, 
supra, 61 Cal.4th at p. 1238.)  Section 340.6(a), we explained, does not cover 
“services unrelated to the practice of law, such as concert promotion,” or a 
“garden-variety theft” that “occurs while the attorney and the victim are discussing 
the victim’s legal affairs.”  (Lee, supra, 61 Cal.4th at p. 1237.)  Further, we 
 
14 
explained, the statute does not “necessarily apply whenever a plaintiff’s 
allegations, if true, would entail a violation of an attorney’s professional 
obligations,” because the “obligations that an attorney has by virtue of being an 
attorney are varied and often overlap with obligations that all persons subject to 
California’s laws have.”  (Id. at p. 1238 [offering as an example the professional 
rules barring sexual battery in the context of the attorney-client relationship].)  The 
question, we said, is “whether the claim, in order to succeed, necessarily depends 
on proof that an attorney violated a professional obligation as opposed to some 
generally applicable nonprofessional obligation.”  (Ibid.) 
Although Lee concerned a different statute of limitations, its analysis of the 
similarly worded statute of limitations governing actions against attorneys is 
instructive.  Just as an attorney’s obligations “often overlap with obligations that 
all persons subject to California’s laws have” (Lee, supra, 61 Cal.4th at p. 1238), 
so do the obligations of hospitals.  And just as an attorney’s breach of a generally 
applicable obligation to avoid stealing from or physically harming his or her 
clients does not fall within section 340.6(a), so too, we conclude, 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.  
Rather, the special statute of limitations for professional negligence actions against 
health care providers 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:  that is, the provision of medical care 
to patients. 
Consistent with these considerations, we conclude that whether negligence 
in maintaining hospital equipment or premises qualifies as professional negligence 
depends on the nature of the relationship between the equipment or premises in 
question and the provision of medical care to the plaintiff.  A hospital’s negligent 
 
15 
failure to maintain equipment that is necessary or otherwise integrally related to 
the medical treatment and diagnosis of the patient implicates a duty that the 
hospital owes to a patient by virtue of being a health care provider.  Thus, if the 
act or omission that led to the plaintiff’s injuries was negligence in the 
maintenance of equipment that, under the prevailing standard of care, was 
reasonably required to treat or accommodate a physical or mental condition of the 
patient, the plaintiff’s claim is one of professional negligence under section 340.5.  
But section 340.5 does not extend to negligence in the maintenance of equipment 
and premises that are merely convenient for, or incidental to, the provision of 
medical care to a patient.  Arguably every part of a hospital’s plant would satisfy 
such a standard, since the medical care of patients is, after all, the central purpose 
for which any hospital is built.  (See Murillo, supra, 99 Cal.App.3d at p. 57.)  
Even those parts of a hospital dedicated primarily to patient care typically contain 
numerous items of furniture and equipment — tables, televisions, toilets, and so 
on — that are provided primarily for the comfort and convenience of patients and 
visitors, but generally play no part in the patient’s medical diagnosis or treatment.  
Although a defect in such equipment may injure patients as well as visitors or 
staff, a hospital’s general duty to keep such items in good repair generally overlaps 
with the “obligations that all persons subject to California’s laws have” (Lee, 
supra, 61 Cal.4th at p. 1238), and thus will not give rise to a claim for professional 
negligence.  If, for example, a chair in a waiting room collapses, injuring the 
person sitting in it, the hospital’s duty with respect to that chair is no different 
from that of any other home or business with chairs in which visitors may sit.  
Section 340.5’s special statute of limitations does not apply to a suit arising out of 
such an injury.   
 
16 
 
IV. 
In this case, Flores’s complaint alleges that she was injured when the latch 
on the rail on her hospital bed malfunctioned.  Flores further alleges that PIH 
Health negligently failed to discover or repair the malfunctioning latch and 
negligently failed to warn her that it was not working properly.  Although Flores’s 
complaint does not describe precisely the events that led to the decision to raise 
her bedrail, we may consider factual concessions made in her briefs or at oral 
argument.  (See Hernandez v. City of Pomona (2009) 46 Cal.4th 501, 506, fn. 1.)  
As noted, in her brief and argument opposing PIH Health’s demurrer, Flores 
explained that a doctor had made a “medical decision” to order that the rails on her 
bed be raised, that this order followed from a “medical assessment” of her 
condition, and she was thereafter injured when, “while grasping [the] rail and 
attempting to exit the bed, the siderail collapsed causing Plaintiff to fall to the 
floor and injure herself.”   
Flores thus alleges, in essence, that PIH Health failed to properly 
implement the doctor’s order, which was based on a medical assessment of her 
condition, that the rails on her bed be raised.  Flores’s injuries therefore resulted 
from PIH Health’s alleged negligence in the use or maintenance of equipment 
integrally related to her medical diagnosis and treatment.  When a doctor or other 
health care professional makes a judgment to order that a hospital bed’s rails be 
raised in order to accommodate a patient’s physical condition and the patient is 
injured as a result of the negligent use or maintenance of the rails, the negligence 
occurs “in the rendering of professional services” and therefore is professional 
negligence for purposes of section 340.5.  As a result, the trial court correctly 
determined that section 340.5 was the applicable statute of limitations, and the 
Court of Appeal erred in holding to the contrary.   
 
17 
 
 
DISPOSITION 
The judgment of the Court of Appeal is reversed. 
 
 
 
 
 
 
 
KRUGER, J. 
 
WE CONCUR: 
 
CANTIL-SAKAUYE, C. J. 
WERDEGAR, J. 
CHIN, J. 
CORRIGAN, J. 
LIU, J. 
CUÉLLAR, J. 
 
 
See next page for addresses and telephone numbers for counsel who argued in Supreme Court. 
 
Name of Opinion Flores v. Presbyterian Intercommunity Hospital 
__________________________________________________________________________________ 
 
Unpublished Opinion 
Original Appeal 
Original Proceeding 
Review Granted XXX 213 Cal.App.4th 1386 
Rehearing Granted 
 
__________________________________________________________________________________ 
 
Opinion No. S209836 
Date Filed: May 5, 2016 
__________________________________________________________________________________ 
 
Court: Superior 
County: Los Angeles 
Judge: Yvonne T. Sanchez 
 
__________________________________________________________________________________ 
 
Counsel: 
 
Edward W. Lloyd & Associates and Edward W. Lloyd for Plaintiff and Appellant. 
 
Steven B. Stevens; Agnew & Brusavich and Tobin D. Ellis for Consumer Attorneys of California as 
Amicus Curiae on behalf of Plaintiff and Appellant. 
 
Fonda & Fraser, Fonda, Hester & Associates, Fonda & Associates, Peter M. Fonda, Kristen J. Heim and 
Rachael C. Kogen for Defendant and Respondent. 
 
Dummit Buchholz & Trapp, Craig S. Dummit and Darren W. Dummit for Stanford Hospital and Clinics, 
Doctors Medical Center of Modesto, Doctors Hospital of Manteca, Community Hospital of Los Gatos, 
Doctors Hospital of Lakewood, Los Alamitos Hospital and Medical Center, Garfield Medical Center, 
Monterey Park Community Hospital, Valley Presbyterian Hospital, Integrated Healthcare Holdings, Prime 
Healthcare Management, Inc., Memorial Health Services, Universal Health Services, Inc., Sharp 
Healthcare and North American Health Care as Amici Curiae on behalf of Defendant and Respondent. 
 
Cole Pedroza, Curtis A. Cole, Kenneth R. Pedroza and Matthew S. Levinson for California Medical 
Association, California Dental Association and California Hospital Association as Amici Curiae on behalf 
of Defendant and Respondent. 
 
 
 
 
 
 
 
 
 
 
 
Counsel who argued in Supreme Court (not intended for publication with opinion): 
 
Edward W. Lloyd 
Edward W. Lloyd & Associates 
2900 Adams Street, #C130 
Riverside, CA  92504 
(951) 656-1203 
 
Peter M. Fonda 
Fonda & Associates 
11900 Olympic Boulevard, Suite 810 
Los Angeles, CA  90064-1046 
(310) 553-3320 
 
Kenneth R. Pedroza 
Cole Pedroza 
2670 Mission Street, Suite 200 
San Marino, CA  91108 
(626) 431-2787