Failure to Maintain Equipment “Integrally Related” to Medical Diagnosis or Treatment Resulting in an Injury is Professional Negligence Under MICRA and Therefore Subject to a One Year Statute of Limitations

By: Kacey R. Riccomini
September 30, 2016

Recently, in Flores v. Presbyterian Intercommunity Hospital (2016) 63 Cal.4th 75, the California Supreme Court clarified whether and when the general negligence statute of limitations or, alternatively, the Medical Injury Compensation Reform Act’s (“MICRA”) special statute of limitations, applies to health care providers. Generally, a two-year statute of limitations for general negligence applies to personal injury actions. (Code Civ. Proc. §335.1.) However, under MICRA, claims for professional negligence against health care providers must be brought within the earlier of (1) “three years after the date of injury,” or (2) “one year after the plaintiff discovers, or…should have discovered, the injury.”  (Code Civ. Proc. §340.5.)

In Flores, the plaintiff was injured when one of the rails on her hospital bed collapsed. The rail had been raised per the doctor’s orders following a medical assessment of her condition. Almost two years later, Flores sued the hospital, claiming that it negligently failed to inspect and maintain the equipment. The hospital, Presbyterian Intercommunity Hospital (“PIH”), sought to dismiss the claim by way of a demurrer, arguing that the claim was barred by §340.5’s one-year statute of limitations since Flores knew about her injury when she fell out of her hospital bed over a year before filing suit. Flores, on the other hand, argued that PIH’s conduct was ordinary negligence, subject to the two-year statute of limitations under §335.1. The trial court agreed with PIH, and sustained the demurrer without leave to amend.

Subsequently, the Court of Appeal reversed the trial court’s ruling, instead holding that PIH’s failure to use reasonable care in maintaining its premises was ordinary negligence as it did not occur in the rendering of professional services. On review, the California Supreme Court reversed the Court of Appeal’s decision, finding that, because Flores’ injury resulted from “alleged negligence in the use and maintenance of equipment needed to implement the doctor’s order concerning her medical treatment,” Flores’ claim was one for professional negligence barred by §340.5’s one-year statute of limitations.

Notably, MICRA amended §340.5, including a revised definition of covered claims to include “an action for injury or death against a health care provider based upon such person’s alleged professional negligence.” It defined “professional negligence” as having 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 a personal injury or wrongful death,” (3) “provided that such services are 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.” In Flores, the parties’ dispute was the meaning of the first element.

Specifically, Flores contended that “professional services” referred to those “requiring a particularized degree of medical skill.” The Court disagreed, finding that “professional services” did not necessarily require advanced medical skills and training, and that negligent acts could occur in staff rendering medical care, including, for example, a doctor or janitor accidentally disconnecting an oxygen ventilator, a hospital providing the wrong food to a patient whose medical needs require a special diet, or a violently coughing patient falling after hospital staff leave the patient on a gurney unsecured for X-rays.

However, the Court also disagreed with the hospital’s argument that its act or omission in rendering medical services was “professional negligence” merely because such act or omission violated a state licensing requirement to maintain the premises. Rather, the Court reasoned that the hospital’s argument would remove the requirement that the negligent act occur “in the rendering of professional services,” and that it could be conflated to apply to general duties that hospitals owe all users, including employees and visitors.

The Court compared the legislative purposes underlying §340.5 with the similarly worded §340.6, the statute of limitations for professional negligence actions against attorneys, which was to limit claims that “depended on proof that an attorney violated a professional obligation as opposed to a generally applicable nonprofessional obligation.” Similarly, the Court reasoned that “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.”

Accordingly, because the negligence leading to Flores’ injuries was in the maintenance of equipment reasonably required to treat her condition, per her doctor’s orders following a medical assessment, Flores’ claim was one for professional negligence under §340.5. However, the Court explicitly stated that §340.5 did not extend to equipment that was provided primarily for comfort or convenience, and played no part in the patient’s medical diagnosis or treatment, such as tables, televisions and toilets.

Following the California Supreme Court’s decision in Flores, courts will be more likely to find that acts and omissions related to equipment reasonably required for diagnosing or treating medical conditions are subject to §340.5. Thus, more medical malpractice actions, however artfully pleaded, likely will be barred by a one-year, rather than two-year, statute of limitations, consistent with the purpose of MICRA. Additionally, due to this decrease of potential tort liability, health care providers may ultimately benefit from reduced premiums for medical malpractice liability insurance.

About the author

Kacey R. Riccomini

Ms. Riccomini is an Associate at Chapman Glucksman Dean Roeb & Barger.

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