Orlak v. Loyola University Health System

delivered the judgment of the court, with opinion.

Justices Freeman, Fitzgerald, and Karmeier concurred in the judgment and opinion.

Justice Kilbride specially concurred, with opinion.

Justice Burke dissented, with opinion.

Chief Justice Thomas took no part in the decision.

OPINION

In July 2002, plaintiff, Diane Orlak, sued defendant Loyola University Health System (Loyola) in the circuit court of Cook County, alleging that Loyola was liable to her for an alleged failure to notify her in a timely manner that she may have contracted hepatitis C (HCV) from a blood transfusion that she received in 1989 during hospitalization for injuries sustained in an accident. The circuit court granted Loyola’s motion to dismiss, finding that plaintiffs action was barred by the statute of repose contained in section 13 — 212(a) of the Code of Civil Procedure (Code) (735 ILCS 5/13 — 212(a) (West 2002)). The appellate court affirmed (No. 1 — 04—0401 (unpublished order under Supreme Court Rule 23)) and we granted plaintiffs petition for leave to appeal (210 Ill. 2d R. 315).

BACKGROUND

Plaintiff was hospitalized at Foster G. McGaw Hospital in Maywood, Illinois, in April and May 1989, for burns suffered during a work-related accident. During the course of her hospitalization, plaintiff was given a blood transfusion. Because plaintiff was unconscious at the time, her mother signed a consent form for the transfusion. That form stated in part, “In making such request and in giving such consent, I hereby acknowledge that I have been informed that there is no known definitive test for the determination of the existence or nonexistence of viral hepatitis in blood and that I fully understand that the transfusion or administration of blood or blood components to me may result in viral hepatitis or other untoward reactions.” Sometime in 1990, Loyola advised plaintiff to be tested for the presence of the human immunodeficiency virus (HIV). Plaintiff underwent testing and tested negative for the presence of the virus. In August 2000, Loyola notified plaintiff by letter that she should be tested for HCV because her blood donor had recently tested positive for the virus. After being tested, plaintiff learned that the test was positive for HCV

In her third amended complaint, plaintiff alleged that following Loyola’s advice to her in 1990 to be tested for HIV she reasonably believed that, after testing negative for that virus, the blood she had received was safe and free from deadly disease. She also took issue with Loyola’s statement in its August 2000 letter that at the time she received her blood transfusion, no reliable tests for HCV were available. She alleged that in 1996, the Food and Drug Administration (FDA) issued a memorandum to hospitals advising them to notify patients who received blood transfusions prior to 1992 to be tested for the presence of HCV Plaintiff also alleged that in 1997 the National Institutes of Health (NIH) published a “Consensus Development Conference Statement,” which found that HCV progresses at a slow rate with no symptoms in the majority of patients during the first 20 years after infection. The NIH also found that HCV patients who consume alcoholic beverages are at greater risk of rapidly developing cirrhosis of the liver and end-stage liver disease. The NIH recommended that individuals who had received blood transfusions prior to 1990 should be tested for HCV According to plaintiff, the NIH report was posted on the Internet in April 1997 and was published in the Journal of Hepatology in September 1997.

Plaintiff’s complaint contained counts alleging constructive fraud, medical negligence, medical battery, and ordinary negligence. In count I, for constructive fraud, plaintiff alleged that Loyola’s failure to inform her of the need to be tested for HCV at the time it advised her to be tested for HIV lulled her into a false sense of security that the blood she had received was free of disease. She alleged that her reliance in that regard was justifiable and reasonable. In count IV for ordinary negligence, plaintiff alleged that in 1996 and 1997 Loyola knew or should have known of the need for plaintiff to be tested for HCV and that, beginning in 1996, or at the latest in March 1997, Loyola owed plaintiff a duty of reasonable care to notify her that she had potentially contracted HCV through her blood transfusion and that she needed to be tested. Plaintiff also alleged that for every day thereafter that the duty existed, Loyola continued to breach its duty of care by failing to notify plaintiff of the potential for infection and the need to be tested.

Loyola filed a motion to dismiss all counts (735 ILCS 5/2 — 619(a)(5) (West 2002)) oh the ground that plaintiffs action was time-barred. Loyola argued that plaintiffs cause of action arose out of patient care stemming from her 1989 hospitalization and blood transfusion. Thus, the medical malpractice statute of repose (735 ILCS 5/13 — 212(a) (West 2002)) was applicable. Loyola argued that this applied as well to plaintiffs claims for constructive fraud and ordinary negligence. The circuit court agreed and dismissed plaintiffs complaint with prejudice.

The appellate court affirmed. With respect to plaintiffs ordinary negligence claim, the court rejected her argument that because she was no longer a patient and she challenged only the failure to timely give notice of the need for testing, her cause of action did not arise out of patient care. The appellate court also rejected plaintiffs constructive fraud and equitable estoppel claims. No. 1 — 04—0401 (unpublished order under Supreme Court Rule 23).

ANALYSIS

I

A motion to dismiss under section 2 — 619 of the Code admits the legal sufficiency of the complaint, but asserts some affirmative matter that defeats the claim. King v. First Capital Financial Services Corp., 215 Ill. 2d 1, 12 (2005). In ruling on the motion, the circuit court must interpret all pleadings and supporting documents in the light most favorable to the nonmoving party. Borowiec v. Gateway 2000, Inc., 209 Ill. 2d 376, 383 (2004). Our standard of review in this appeal is de novo. DeSmet v. County of Rock Island, 219 Ill. 2d 497, 504 (2006).

II

Plaintiff argues that the circuit and appellate courts erred in holding that the four-year medical malpractice statute of repose applies to bar her claim for ordinary negligence. That statute provides in part:

“Except as provided in Section 13 — 215 of this Act, no action for damages for injury or death against any physician, dentist, registered nurse or hospital duly licensed under the laws of this State, whether based upon tort, or breach of contract, or otherwise, arising out of patient care shall be brought more than 2 years after the date on which the claimant knew, or through the use of reasonable diligence should have known, or received notice in writing of the existence of the injury or death for which damages are sought in the action, whichever of such date occurs first, but in no event shall such action be brought more than 4 years after the date on which occurred the act or omission or occurrence alleged in such action to have been the cause of such injury or death.” (Emphasis added.) 735 ILCS 5/13 — 212(a) (West 2002).

This statute contains both a two-year period of limitations and a four-year period of repose. The two-year limitations period is triggered by the plaintiffs discovery of the injury; in contrast, the four-year repose period is triggered by the occurrence of the act or omission that caused the injury. The only exception to the four-year statute of repose is the fraudulent-concealment exception contained in section 13 — 215 of the Code (735 ILCS 5/13 — 215 (West 2002)). The statute of repose sometimes bars actions even before the plaintiff has discovered the injury. While this may result in harsh consequences, the legislature enacted the statute of repose for the specific purpose of curtailing the “long tail” exposure to medical malpractice claims brought about by the advent of the discovery rule. Anderson v. Wagner, 79 Ill. 2d 295, 312 (1979).

Only claims “arising out of patient care” are affected by the medical malpractice statute of repose. Our analysis of this issue is governed by familiar principles of statutory construction. The cardinal rule of statutory construction is to ascertain and give effect to the intent of the legislature. Murray v. Chicago Youth Center, 224 Ill. 2d 213, 235 (2007). That intent is best gleaned from the words of the statute itself, and where the statutory language is clear and unambiguous, it must be given effect. General Motors Corp. v. State of Illinois Motor Vehicle Review Board, 224 Ill. 2d 1, 13 (2007). A court should interpret a statute, where possible, according to the plain and ordinary meaning of the language used. Paris v. Feder, 179 Ill. 2d 173, 177 (1997). In determining the plain meaning of a statute’s terms, we consider the statute in its entirety, keeping in mind the subject it addresses, and the apparent intent of the legislature in enacting the statute. People v. Perry, 224 Ill. 2d 312, 323 (2007). Issues of statutory construction are reviewed de novo. Paris, 179 Ill. 2d at 177-78.

Plaintiff argues that the question in this case is whether the injury she has alleged arose from patient care or from an administrative decision by Loyola not to send notice of the need to be tested for HCV She argues that, under the appellate court’s construction of the statute, once a person becomes a patient of a medical provider, virtually any subsequent interaction between the patient and the provider is governed by the statute of repose. According to plaintiff, such a construction would impermissibly expand the scope of the statute beyond its plain language. She points out that her “patient care” ended in 1989 and that she has not alleged any wrongdoing by Loyola during the time she was hospitalized. Plaintiff believes that by using the phrase “arising out of patient care,” the legislature intended the statute of repose to govern claims based on events that involve actual patient care.

Loyola, on the other hand, argues that plaintiff’s interpretation of the phrase “arising out of patient care” is much too narrow. That plaintiffs hospitalization ended long ago is not determinative; it is the nature of the conduct, not the timing thereof, that determines whether a claim arises out of patient care. Loyola argues that accepting plaintiffs interpretation would eviscerate the statute of repose because plaintiffs could avoid the statute by casting their claims as based on a failure to provide follow-up care at a later date. According to Loyola, plaintiffs contention that Loyola breached only an administrative duty by its failure to notify her in 1996 and 1997 would impose a duty with no temporal bounds on Loyola and other health-care providers.

Plaintiff cites several Illinois and foreign cases in support of her argument. Cammon v. West Suburban Hospital Medical Center, 301 Ill. App. 3d 939 (1998), dealt, in relevant part, with a claim against the defendant hospital for spoliation of evidence. One ground upon which the circuit court dismissed the claim was that the action was filed outside the statute of repose. The appellate court disagreed, noting that a negligence action for spoliation of evidence is predicated on a breach of the duty to preserve evidence. It does not involve patient care. Thus, the claim was not governed by the medical malpractice statute of repose. Cammon, 301 Ill. App. 3d at 950. Contrary to plaintiffs argument, Cammon is not applicable to this case. The duty there had nothing whatever to do with patient care. It dealt with a duty imposed on a party to the litigation to preserve evidence relevant to the case. Cammon stands only for the unremarkable proposition that not all negligence actions against physicians or hospitals involve patient care.

Plaintiff also cites a Tennessee case, Estate of Doe v. Vanderbilt University, Inc., 958 S.W.2d 117 (Tenn. App. 1997). There, the plaintiffs decedent received a blood transfusion in 1984 in connection with surgery. The donor blood was not tested for the presence of HIV The decedent was not informed that she had received the transfusion, nor was she advised that she was at risk of having been infected with HIV She later married and became pregnant. It was only when she gave birth to a daughter who had become infected with the virus in útero that the decedent learned of her condition. The infant died of acquired immune deficiency syndrome (AIDS) shortly after her birth and the decedent died of AIDS subsequent to the initiation of a lawsuit against Vanderbilt based on Vanderbilt’s failure to notify the decedent in 1987 and 1988 that the blood she received in the transfusion had not been tested for HIV Vanderbilt admitted that it did not search its records to provide notice to transfusion recipients. The circuit court found that the case was governed by the Tennessee medical malpractice statute and that absent expert testimony that Vanderbilt had deviated from the recognized standard of care for hospitals in the area, no genuine issue of material fact existed and that summary judgment was appropriate. The court of appeals phrased the issue as whether Vanderbilt’s failure to notify decedent and other patients was a medical decision subject to the medical malpractice statute. The court determined that it was not. Extensive evidence had been taken in the circuit court in connection with Vanderbilt’s summary judgment motion. That evidence convinced the court of appeals that the decision not to notify was not a medical one. Doe, 958 S.W2d at 121.

Doe is inapplicable to the instant case. We are not concerned with whether Loyola’s failure to notify in 1996 and 1997 involved the exercise of medical judgment or some other type of judgment. The only inquiry is whether plaintiffs cause of action arose from patient care. This is a completely different standard from the one involved in Doe.

Plaintiff also cites a Georgia case, Canas v. Al-Jabi, 282 Ga. App. 764, 639 S.E.2d 494 (2006). The plaintiff in that case had received blood transfusions in 1985 while a pediatric patient at a hospital. The blood was not tested for the presence of HIV The plaintiff developed AIDS, which was not diagnosed until he was a teenager. The hospital considered implementing a notification program, but decided not to do so based on concerns about the expense, logistical complexity, and legal implications of such a program. The relevant inquiry as framed by the Georgia court of appeals was whether the case involved a “medical question,” which the court defined as requiring highly specialized expert knowledge with respect to which a layperson can have no knowledge at all. The court contrasted acts involving such medical questions with administrative, clerical, or routine acts demanding no special expertise. Those acts, the court stated, fall into the realm of ordinary negligence. Canas, 282 Ga. App. at 787-88, 639 S.E.2d at 517. The court noted that the record showed the decision not to notify the plaintiff and others like him of the risk of HIV infection was not based on medical expertise but, rather, was based on administrative concerns. Thus, the court concluded that the plaintiff’s claim was based on ordinary negligence and was not subject to the medical malpractice statutes of limitation and repose. Canas, 282 Ga. App. at 790, 639 S.E.2d at 518.

As with Doe, the Canas case does not support plaintiff’s argument. The statute of repose in Canas stated that an “action for medical malpractice” may not be brought more than five years after the date on which the negligent act or omission occurred. Canas, 282 Ga. App. at 770, 639 S.E.2d at 505-06. In contrast, the Illinois statute of repose encompasses any action for damages arising out of patient care, regardless of whether it arises from a tort, a contract, or from some other source. Indeed, this court has held that the reach of the statute is not limited to actions at law. In Hayes v. Mercy Hospital & Medical Center, 136 Ill. 2d 450, 458 (1990), we held that the legislature intended the phrase “or otherwise” in the statute of repose to be all-inclusive and we concluded that the phrase includes actions for contribution against a physician for injuries arising out of patient care.

Plaintiff also argues the fact that the requirements of section 2 — 622 of the Code (735 ILCS 5/2 — 622 (West 2002)) do not apply to her case provides further support for her contention that her claims against Loyola do not arise out of patient care. Section 2 — 622 requires a plaintiff who seeks damages due to “injuries or death by reason of medical, hospital, or other healing art malpractice” to obtain an attorney’s affidavit and health professional’s report stating that there is a reasonable and meritorious cause for filing a lawsuit. However, section 2 — 622 focuses only on actions involving some form of medical malpractice. As we have stated, the statute of repose at issue here encompasses a much broader range of claims. Nowhere does the statute of repose mention the words “malpractice” or “healing arts malpractice.” Thus, the inapplicability of section 2 — 622 to this case does not impact the issue of whether plaintiffs cause of action arises from patient care.

Courts that have addressed the issue have given the phrase “arising out of patient care” a broad meaning. In Miller v. Tobin, 186 Ill. App. 3d 175 (1989), the plaintiff and his wife were receiving marriage counseling from the defendant, a psychiatrist. The plaintiff alleged that the defendant had disclosed confidential information to the plaintiff’s wife, in violation of the Mental Health and Developmental Disabilities Confidentiality Act. The trial court dismissed the action on the ground that it had not been filed within the two-year statute of limitations in section 13 — 212 of the Code. The appellate court affirmed, rejecting the plaintiff’s argument that because his complaint did not allege malpractice, section 13 — 212 did not apply. The court noted that a statute of limitations is to be construed in light of its objectives and that the phrase “arising out of’ is broad and generally means “originating from,” “growing out of,” or “flowing from.” The court observed that the plaintiffs alleged injury occurred during the course of the defendant’s treatment of the plaintiffs wife; thus, the alleged injury arose from patient care. Miller, 186 Ill. App. 3d at 177-78.

In Walsh v. Barry-Harlem Corp., 272 Ill. App. 3d 418 (1995), the plaintiff filed a complaint under the Consumer Fraud and Deceptive Business Practices Act (Consumer Fraud Act), alleging that the defendants falsely represented to the plaintiff that he needed eye surgery and that they altered notes from the plaintiffs eye testing to justify the surgery. The trial court dismissed the complaint as barred by the two-year statute of limitations contained in section 13 — 212 of the Code. The appellate court affirmed, concluding that the limitations period of section 13 — 212 governed, rather than the three-year limitations period applicable to the Consumer Fraud Act. The court rejected the plaintiffs argument that section 13 — 212 was inapplicable because he did not allege any deviation from a standard of care, but only fraud related to the commercial aspects of the defendants’ eye-care business. The court concluded that the defendants’ alleged decision to perform unnecessary surgery on the plaintiffs eye did indeed implicate a standard of care. As such, the plaintiff’s alleged injury arose out of patient care. His allegations of misconduct were “inextricable” from the defendants’ diagnosis and treatment of the plaintiffs eye. Walsh, 272 Ill. App. 3d at 425.

In Stiffler v. Lutheran Hospital, 965 F.2d 137 (7th Cir. 1992), the court, construing Illinois law, held that a products liability action against a hospital for implantation of a defective prosthetic device was governed by the statute of repose contained in section 13 — 212. The court further held that the plaintiffs claim arose from patient care, rejecting the plaintiffs argument that her injury arose, not from medical care, but from the hospital’s negligent choice and distribution of a defective prosthetic device. The court contrasted the plaintiffs situation with a hypothetical example in which a hospital’s activities would not arise from patient care. For instance, the court stated, a hospital-run gift shop might be strictly liable if nonprescription medicine it sold to the general public was proved to be harmful to consumers. In contrast, the defendant hospital in the plaintiffs case did not place the plaintiffs prosthesis in the stream of commerce, it did not promote its purchase to the general public, and it was in no better position than the plaintiff to examine the prosthesis and discover the defect. Stiffler, 965 F.2d at 141.

It is clear that the legislature intended the statute of repose to, operate in a very broad manner and it has been interpreted in that manner by courts addressing the issue. The question is not whether the plaintiff has alleged medical negligence or ordinary negligence. Rather, the sole issue is whether the plaintiff’s claim arose from patient care. The word “arise” is defined in Black’s Law Dictionary as “[t]o originate; to stem (from),” or “to result (from).” Black’s Law Dictionary 115 (8th ed. 2004). “Arise” is also defined elsewhere as “to originate from a source.” Merriam-Webster’s Collegiate Dictionary 66 (11th ed. 2006).

We have very recently discussed the degree of causation required by the phrase “arising out of patient care” in section 13 — 212. In Brucker v. Mercola, 227 Ill. 2d 502 (2007), we construed this phrase “simply as requiring a causal connection between the patient’s medical care and the injury. While the phrase does not need to be construed so broadly as to encompass ‘but for’ causation, it clearly covers any injuries that have their origin in, or are incidental to, a patient’s medical care and treatment.” Brucker, 227 Ill. 2d at 523-24. The broad nature of the phrase “arising out of patient care” is aptly illustrated in Brucker. There, the plaintiff, who was then pregnant, went to the defendant doctor in 1995 for an allergy consultation. The defendant prescribed a nutritional supplement called L-glutamine, one of many that he sold in his office. He provided this service to his patients and made only incidental sales to the general public. The L-glutamine prescribed for the plaintiff was ordered in bulk form and the defendant’s receptionist, who had no medical training, was responsible for transferring the bulk supplement into individual bottles. The receptionist accidentally filled the bottle given to the plaintiff with selenium, rather than L-glutamine. The plaintiff became very ill when she ingested the selenium.

The plaintiff and her husband initially filed a medical malpractice complaint in 1997, but the complaint was voluntarily dismissed and not refiled until 2002. A year later, the plaintiffs amended their complaint to add an additional count that alleged their son, Robert, who was born in January 1996, had been poisoned in útero when his mother ingested the selenium. The defendant filed a motion to dismiss the action on the ground that the eight-year repose period in section 13 — 212(b) of the Code had expired.

One of the plaintiffs arguments was that the injuries allegedly caused to Robert did not arise out of patient care. This court disagreed, noting that the phrase “arising out of patient care” has been broadly defined and refers to a causal connection. Brucker, 227 Ill. 2d at 521. We concluded that “arising out of patient care” simply requires a causal connection between the patient’s medical care and the alleged injury. Brucker, 227 Ill. 2d at 523. Applying the plain meaning of this phrase to the plaintiffs case, we held that the alleged injury to the plaintiff and Robert did indeed arise out of the patient care received by the plaintiff. The plaintiff consulted the defendant doctor concerning an allergy problem and, based on that consultation, the defendant prescribed L-glutamine for the plaintiff. We rejected the plaintiffs argument that the injuries arose out of the defendant’s sale of nutritional supplements, noting that the defendant did not hold himself out as a retailer of supplements, nor did he maintain a retail area in his office for the sale of the supplements. In addition, the plaintiff was not sold the supplement as a member of the general public, but rather as the defendant’s patient. Accordingly, there was a causal connection between the patient care provided to the plaintiff and her alleged injury. Brucker, 227 Ill. 2d at 524-25.

The question remains whether plaintiff here has alleged an injury arising out of patient care. In addressing this question, plaintiff focuses on Loyola’s failure to notify her and argues that this omission did not involve the provision of medical care. However, the omission itself cannot be viewed in a vacuum. Plaintiffs allegations of a duty to notify her and Loyola’s alleged violation of that duty flows from the blood transfusion she received during her 1989 hospitalization. This case is unlike the situation in Common (claim against hospital for spoliation of evidence was unrelated to any patient care). It is apparent here that there is a causal connection between plaintiff’s 1989 hospitalization and blood transfusion and her current claim against Loyola. Accordingly, her claim arises out of patient care.

Our decision is in keeping with the purpose behind the statute of repose. Were we to endorse plaintiff s position, we would be opening the door to potentially open-ended liability for health-care providers anytime new medical tests were developed that might suggest the need for a notification program for present and former patients. This obligation might even include patients with whom a hospital may have had no contact for many years. Such a result would undermine the purpose behind the enactment of the medical malpractice statute of repose. That statute was part of the legislative response to a medical malpractice insurance crisis; the purpose was to reduce the cost of medical malpractice insurance and to assure its continued availability to medical practitioners. Anderson, 79 Ill. 2d at 301. The crisis was thought to stem from the advent of the “discovery rule” in the late 1960s, in which a cause of action accrued only when a person learned of an injury or reasonably should have learned of it. Because the application of the discovery rule in malpractice actions created a “long tail” of liability, the ability of malpractice insurance companies to predict future liabilities was reduced. Anderson, 79 Ill. 2d at 301. It was in response to this problem that the General Assembly enacted the statute of repose. Allowing plaintiffs action to go forward would be contrary to that purpose. Therefore, we conclude that plaintiffs claim arises out of patient care and is thus subject to the four-year statute of repose contained in section 13— 212(a). Since plaintiff brought this action some 13 years after her claim arose, the trial court properly dismissed her lawsuit.

III

Plaintiff argues that, even if her claims against Loyola are barred by the statute of repose contained in section 13 — 212, Loyola fraudulently concealed the grounds for her cause of action. In the alternative, plaintiff also argues that Loyola should be equitably estopped from asserting the statute of repose as a defense to her action.

Section 13 — 212 explicitly recognizes that fraudulent concealment tolls the running of the statute of limitations/repose. Section 13 — 215 of the Code (735 ILCS 5/13 — 215 (West 2002)) provides that when a cause of action is fraudulently concealed, the plaintiff may bring an action within five years of the discovery of the cause of action.

In count I of her third amended complaint, plaintiff alleged a cause of action for constructive fraud. She alleged that because Loyola advised her to be tested for HR/ but did not advise her prior to 2000 to be tested for HCV/ she was falsely led to believe that, following her negative test for HR/ the blood she had received in the transfusion was free of all life-threatening viruses. She alleged that her reliance was reasonable, given that she was not a medical professional and that Loyola ádvised her to be tested for one risk known to the medical community, but not another risk.

The concealment contemplated by section 13 — 215 must consist of affirmative acts or representations calculated to lull or induce a claimant into delaying filing of his or her claim, or to prevent a claimant from discovering a claim. Mere silence on the part of the defendant is insufficient. Smith v. Cook County Hospital, 164 Ill. App. 3d 857, 862 (1987). A plaintiff must plead and prove that the defendant made misrepresentations or performed acts which were known to be false, with the intent to deceive the plaintiff, and upon which the plaintiff detrimentally relied. Foster v. Plaut, 252 Ill. App. 3d 692, 699 (1993).

Plaintiff points to no affirmative acts by Loyola that were calculated to conceal a cause of action. The mere act of notifying plaintiff that she should be tested for HIV cannot be transformed into an affirmative act of concealment of the need for HCV testing. Recognizing the absence of affirmative acts or misrepresentations on Loyola’s part, plaintiff argues that the general rule requiring affirmative acts of concealment does not apply where the parties have a fiduciary or confidential relationship. In such situations, plaintiff argues, the mere failure to disclose material information, standing alone, is sufficient to toll the statute of repose.

In support of her argument, plaintiff cites Hagney v. Lopeman, 147 Ill. 2d 458 (1992), where this court stated:

“ ‘ “[i]t is the prevailing rule that, as between persons sustaining a fiduciary or trust or other confidential relationship toward each other, the person occupying the relation of fiduciary or of confidence is under a duty to reveal the facts to the plaintiff (the other party), and that his silence when he ought to speak, or his failure to disclose what he ought to disclose, is as much a fraud at law as an actual affirmative false representation or act; and that mere silence on his part as to a cause of action, the facts giving rise to which it was his duty to disclose, amounts to a fraudulent concealment ***.” ’ ” Hagney, 147 Ill. 2d at 463, quoting Chicago Park District v. Kenroy, Inc., 78 Ill. 2d 555, 562 (1980), quoting L. Tellier, Annotation, What Constitutes Concealment Which Will Prevent Running of Statute of Limitations, 173 A.L.R. 576, 588 (1948).

Hagney involved a suit by relatives of a decedent against the decedent’s former attorney alleging self-dealing by the attorney while representing the decedent. The attorney allegedly purchased remainder interests for himself in farmland at a time when he was simultaneously representing the decedent in her effort to purchase the same remainder interests.

Plaintiff also points out that this court has held the relationship between patient and physician is a fiduciary relationship. In Witherell v. Weimer, 85 Ill. 2d 146, 159 (1981), we found it beyond doubt that this relationship is one in which the patient places great trust and confidence in the physician’s advice and recommendations. Based upon this relationship, plaintiff argues that it was Loyola’s duty to provide her with notice of the need to be tested for HCV when Loyola was apprised of the need for such testing in 1996 and 1997 and that Loyola’s silence constituted a fraud on plaintiff.

Plaintiff was discharged from Loyola in 1989. Thus, there was no confidential or fiduciary relationship between plaintiff and Loyola in 1996 and 1997, the time plaintiff alleges Loyola should have notified her of the need for HCV testing.

Plaintiff relies on Blaz v. Michael Reese Hospital Foundation, 74 F. Supp. 2d 803 (N.D. Ill. 1999). There, the plaintiff was a patient at the hospital as a child, where he received radiation treatments. He was part of a group of patients who were treated with radiation therapy between 1930 and 1960 for some benign conditions of the head and neck. In 1974, the hospital established a program to gather data and conduct research among those who had received the therapy. In 1975, the program notified the plaintiff that he was at increased risk of thyroid tumors because of the radiation treatment he had received. In 1979, the hospital and the doctor who had been put in charge of the program submitted a research proposal to the NIH stating that a study based on the program showed strong evidence of a connection between radiation treatments and various kinds of tumors, including neural tumors. A 1981 questionnaire sent to the plaintiff by the program along with a letter from the doctor said nothing about a strong connection between the treatments the plaintiff had received and tumors. The plaintiff developed neural tumors in 1996 and he sued the hospital and the doctor, alleging that they failed to notify him of their findings and warn him that he might be at greater risk for neural tumors. Blaz, 74 F. Supp. 2d at 804.

The district court denied the doctor’s motion to dismiss, finding that the doctor had a duty to warn the plaintiff by virtue of his role as the doctor in charge of the program. The court noted that the doctor was responsible for researching the effects of the radiation treatments and for communicating with the former patients who had received those treatments. The district court found that the doctor’s position with respect to the program created the kind of “special relationship” that this court had previously required for a finding of duty in the absence of a doctor-patient relationship. Blaz, 74 F. Supp. 2d at 806-07.

Blaz does not support plaintiffs fraudulent concealment argument. The question in Blaz was whether the doctor had a duty to warn the plaintiff. No issue of fraudulent concealment was raised.

Loyola notified plaintiff of the need to be tested for HCV once it had notice that plaintiff was at risk for HCV due to her blood donor’s positive HCV test. We reject plaintiffs argument that Loyola’s silence in 1996 or 1997, without more, constitutes a fraudulent concealment of a cause of action.

Plaintiff also argues that Loyola should be equitably estopped from relying on the statute of repose because Loyola’s notification to plaintiff in 1990 that she should be tested for HIV lulled her into a false sense of security that she was not at risk for any other diseases stemming from her 1989 blood transfusion. This court has set forth the requirements for equitable estoppel as follows:

“A party claiming estoppel must demonstrate that: (1) the other person misrepresented or concealed material facts; (2) the other person knew at the time he or she made the representations that they were untrue; (3) the party claiming estoppel did not know that the representations were untrue when they were made and when that party decided to act, or not, upon the representations; (4) the other person intended or reasonably expected that the party claiming estoppel would determine whether to act, or not, based upon the representations; (5) the party claiming estoppel reasonably relied upon the representations in good faith to his or her detriment; and (6) the party claiming estoppel would be prejudiced by his or her reliance on the representations if the other person is permitted to deny the truth thereof.” DeLuna v. Burciaga, 223 Ill. 2d 49, 82-83 (2006).

It is not necessary that the defendant intentionally mislead or deceive the plaintiff. All that is required is that the plaintiff reasonably relied on the defendant’s conduct or representations in delaying suit. DeLuna, 223 Ill. 2d at 83.

In the instant case, plaintiff relies on Loyola’s notification to her of the need to be tested for HIV and Loyola’s silence with regard to the need for HCV testing in 1996 and 1997 as somehow misleading plaintiff into believing that the blood she received in the transfusion was free from other diseases. Plaintiff again cites Witherell in support of her argument. However, in that case, the defendant doctors had repeatedly assured the plaintiff that she did not have the condition from which she suffered and that it was not caused by the birth control pills she was taking.

Loyola’s conduct does not meet the requirements of equitable estoppel. That plaintiff was notified to be tested for HIV does not suggest that she was entitled to assume the donated blood was safe from all other risks. Plaintiff points out that it was reasonable for her to conclude that if there was a need for further testing, Loyola would notify her of that fact. However, Loyola did notify plaintiff to be tested for HCV when it learned that she was at risk for that virus. We therefore reject plaintiffs fraudulent concealment and equitable estoppel arguments.

CONCLUSION

We hold that plaintiffs claim arises from patient care and that the statute of repose contained in section 13— 212(a) of the Code applies to bar her action. We also reject plaintiffs allegations of fraudulent concealment and equitable estoppel. Accordingly, we affirm the judgment of the appellate court.

Appellate court judgment affirmed.

CHIEF JUSTICE THOMAS took no part in the consideration or decision of this case.