Opinion ID: 2231821
Heading Depth: 1
Heading Rank: 4

Heading: Arising Out of Patient Care

Text: The limitations periods provided in section 13-212 apply to any actions whether based upon tort, or breach of contract, or otherwise, arising out of patient care. 735 ILCS 5/13-212(a), (b) (West 2006). In Hayes v. Mercy Hospital & Medical Center, 136 Ill.2d 450, 145 Ill. Dec. 894, 557 N.E.2d 873 (1990), this court explained the purpose behind the General Assembly's enactment of section 13-212 and held that, in light of that purpose, when a cause of action is filed against a physician or other covered medical provider, the legal theory upon which the plaintiff styles his or her claim will not govern whether section 13-212 applies. This court said: As previously discussed by this court (see, e.g., Anderson v. Wagner (1979), 79 Ill.2d 295 [37 Ill.Dec. 558, 402 N.E.2d 560]), when the General Assembly limited the time period in which a party could bring a suit for medical malpractice, it was faced with what it perceived as a medical malpractice insurance crisis. `The crisis resulted from the increasing reluctance of insurance companies to write medical malpractice insurance policies and the dramatic rise in premiums demanded by those companies which continued to issue policies. The difficulty in obtaining insurance at reasonable rates forced many health-care providers to curtail or cease to render their services. The legislative response to this crisis sought to reduce the cost of medical malpractice insurance and to insure its continued availability to the providers of health care.' ( Anderson, 79 Ill.2d at 301 [37 Ill.Dec. 558, 402 N.E.2d 560].) The legislature therefore enacted, among other provisions, an outside time limit of five years, later amended to four, in which an action could be brought against physicians and hospitals for actions arising out of patient care (Pub. Act 79-960, eff. Nov. 11, 1975; Ill.Rev.Stat.1975, ch. 83, par. 22.1). ( Mega v. Holy Cross Hospital (1986), 111 Ill.2d 416, 427 [95 Ill.Dec. 812, 490 N.E.2d 665].) This definite period in which an action could be filed was viewed as necessary to prevent extended exposure of physicians and other hospital personnel to potential liability for their care and treatment of patients, thereby increasing an insurance company's ability to predict future liabilities. (See Anderson, 79 Ill.2d at 307 [37 Ill.Dec. 558, 402 N.E.2d 560].) This increased ability to predict liability was meant to assist in reducing healthcare malpractice insurance premiums. Hayes, 136 Ill.2d at 457-58, 145 Ill.Dec. 894, 557 N.E.2d 873. This court then concluded that the legislature's objective would be advanced only if the statute was read in such a way that it limit[ed] a physician's exposure to liability for damages for injury or death arising out of patient care under all theories of liability. Hayes, 136 Ill.2d at 459, 145 Ill.Dec. 894, 557 N.E.2d 873. Thus, Hayes makes clear that the relevant question in determining whether section 13-212 provides the applicable limitations period is not whether the complaint alleges medical malpractice, but whether the complaint alleges an injury arising out of patient care. Before reaching that question, we must clarify what is not at issue. Both plaintiffs and defendants spend a significant portion of their arguments discussing wholly inapplicable authority. The courts in Mooney v. Graham Hospital Ass'n, 160 Ill.App.3d 376, 112 Ill.Dec. 219, 513 N.E.2d 633 (1987), and Lyon v. Hasbro Industries, Inc., 156 Ill.App.3d 649, 109 Ill.Dec. 41, 509 N.E.2d 702 (1987), did not consider the applicability of section 13-212 or the meaning of arising out of patient care. Rather, the court in each case addressed whether the plaintiff's complaint had to be dismissed because the plaintiff failed to attach an attorney's affidavit and a health professional's report pursuant to section 2-622 of the Code of Civil Procedure (735 ILCS 5/2-622 (West 2006)). Here, there is no section 2-622 issue because plaintiffs attached an attorney's affidavit and a health professional's report. In the health professional's report, a doctor of osteopathic medicine stated that he had reviewed the records and determined to a reasonable degree of medical certainty that the treatment provided to Anna Marie Brucker fell below the minimum standard of care. Moreover, the scope of each of these statutes is different. Section 13-212(b), which is a limitations section, applies to actions 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.  (Emphasis added.) 735 ILCS 5/13-212(b) (West 2006). By contrast, section 2-622, which governs when an attorney's affidavit and a health professional's report are required, applies to any action, whether in tort, contract or otherwise, in which the plaintiff seeks damages for injuries or death by reason of medical, hospital, or other healing art malpractice.  (Emphasis added.) 735 ILCS 5/2-622(a) (West 2006). Section 13-212(b) is broader than section 2-622(a), and it is clear that there are some situations in which a plaintiff would have to file within the time limits prescribed by section 13-212(b), but would not have to attach an attorney's affidavit or a health professional's report. All actions for injury or death arising out of patient care must be filed within the time limits set forth in section 13-212, but only those that allege injuries by reason of healing art malpractice require an attorney's affidavit and a health professional's report to be attached to the complaint. In deciding whether section 2-622 affidavits and medical reports are required in particular cases, courts have focused on the plain meaning of the terms healing, art, healing art and malpractice. See, e.g., Jackson v. Chicago Classic Janitorial & Cleaning Service, Inc., 355 Ill.App.3d 906, 910, 291 Ill.Dec. 469, 823 N.E.2d 1055 (2005); Milos v. Hall, 325 Ill.App.3d 180, 183, 258 Ill.Dec. 965, 757 N.E.2d 654 (2001); Cohen v. Smith, 269 Ill.App.3d 1087, 1090, 207 Ill.Dec. 873, 648 N.E.2d 329 (1995); Lyon, 156 Ill.App.3d at 653, 109 Ill.Dec. 41, 509 N.E.2d 702. Consideration of the definitions of these terms has led courts to focus on three factors in determining the applicability of section 2-622:(1) whether the standard of care involves procedures not within the grasp of the ordinary lay juror; (2) whether the activity is inherently one of medical judgment; and (3) the type of evidence that will be necessary to establish plaintiff's case. See Jackson, 355 Ill.App.3d at 909, 291 Ill.Dec. 469, 823 N.E.2d 1055. This is not the analysis courts have used in determining the applicability of section 13-212. Because the terms healing art and malpractice appear nowhere in section 13-212, [1] an analysis based on the definitions of those terms is not helpful. [2] Thus, we will not consider the portions of the parties' arguments that are based on section 2-622 cases. Not surprisingly, courts that have considered the scope of section 13-212 have focused on the plain meaning of arising out of patient care. In Miller v. Tobin, 186 Ill.App.3d 175, 134 Ill.Dec. 173, 542 N.E.2d 173 (1989), the appellate court, consulting 6 C.J.S. Arise 525, 526 (1975), concluded that the phrase arising out of is broad and generally means `originating from,' `growing out of,' or `flowing from.' Miller, 186 Ill.App.3d at 177, 134 Ill.Dec. 173, 542 N.E.2d 173. Accordingly, the court held the statute applicable to a claim alleging that a psychiatrist violated the Mental Health and Developmental Disabilities Confidentiality Act (Ill.Rev.Stat.1987, ch. 91 ½, pars. 801 through 817 (now 740 ILCS 110/1 et seq. (West 2006))) by revealing confidential information to the plaintiff's wife after the plaintiff had asked the doctor not to reveal the information. The court found that the alleged injury arose out of patient care because the plaintiff and his wife had seen the doctor for medical problems and the information was disclosed during his wife's phase of the treatment. The Miller court noted that [w]hile this section [13-212] applies to malpractice actions against physicians, it is a general limitations section designed to apply to all cases against physicians arising out of patient care. Therefore, the pertinent issue is not whether plaintiff's suit alleges malpractice, but whether plaintiff's injuries arose out of patient care.  (Emphases added.) Miller, 186 Ill. App.3d at 177, 134 Ill.Dec. 173, 542 N.E.2d 173. In Walsh v. Barry-Harlem Corp., 272 Ill.App.3d 418, 208 Ill.Dec. 558, 649 N.E.2d 614 (1995), the court held section 13-212 applicable to a Consumer Fraud and Deceptive Business Practices Act (Ill.Rev. Stat.1989, ch. 121 ½, par. 261 et seq. (now 815 ILCS 505/1 et seq. (West 2006))) claim filed against an eye clinic. The plaintiff alleged in his consumer fraud claim that the doctor intentionally misrepresented that plaintiff needed to have a cataract removed and a new lens implanted. The plaintiff alleged that he did not in fact need these services. The plaintiff argued that section 13-212 was not applicable to his complaint because he was not alleging an injury that resulted from the manner in which patient care and treatment were rendered. Rather, his complaint was about the commercial aspects of the business and the fact that the defendants intentionally misrepresented test results and the need for surgery. He did not allege any deviation from a medical standard of care. The court rejected his argument, finding that his injury did arise out of patient care. The court held that the plaintiff's allegations of misconduct were inextricable from the defendants' diagnosis and treatment of his eyes. Walsh, 272 Ill.App.3d at 425, 208 Ill.Dec. 558, 649 N.E.2d 614. In Stiffler v. Lutheran Hospital, 965 F.2d 137 (7th Cir.1992), the Seventh Circuit noted the broad reach of section 13-212. In that case, the plaintiff brought a products liability action against Lutheran Hospital. Several years after the plaintiff had a prosthetic device implanted in her chest during a hernia operation, the device broke free and became entangled in her intestines. The plaintiff's products liability suit alleged that the hospital was strictly liable as the prosthetic device's distributor. The hospital argued that the suit was barred by section 13-212. The plaintiff contended, inter alia, that section 13-212 did not apply to her claim because she was not alleging an injury arising out of patient care. According to the plaintiff, her injury resulted not from the hospital's medical care, but rather from its negligent choice and distribution of a defective prosthetic device. The Seventh Circuit rejected this argument, noting that arising out of patient care was intended to be construed broadly and that there was not a clear distinction between medical care and the distribution of medical materials. Stiffler, 965 F.2d at 140-41. Moreover, the court found that medical materials are so inextricably linked with every step of today's treatment processes that their use almost per se arises `out of patient care.' Stiffler, 965 F.2d at 140. Finally, in Cammon v. West Suburban Hospital Medical Center, 301 Ill.App.3d 939, 235 Ill.Dec. 158, 704 N.E.2d 731 (1998), the plaintiff, as administrator of the estate of her deceased husband, filed suit against West Suburban Hospital after her husband died of cardiopulmonary arrest shortly after undergoing surgery. The plaintiff's amended complaint contained several counts seeking recovery for medical malpractice. In count V, however, the plaintiff sought damages based on the hospital's alleged spoliation of evidence. In this count, the plaintiff alleged that the hospital was negligent because it breached its duty to preserve the operative report for the exploratory laparotomy that caused her husband's death, prejudicing her malpractice claims against the hospital and the doctor who performed the surgery. The trial court dismissed count V as time-barred under the four-year repose provision of section 13-212(a) of the Code (735 ILCS 5/13-212(a) (West 1996)). Cammon, 301 Ill.App.3d at 942-43, 235 Ill.Dec. 158, 704 N.E.2d 731. The appellate court reversed. The court first acknowledged that, in a section 13-212 analysis, the relevant question is whether the complaint alleges an injury arising out of patient care. The court then agreed with Miller that, `The phrase arising out of is broad and generally means originating from, growing out of, or flowing from.' Cammon, 301 Ill.App.3d at 950, 235 Ill.Dec. 158, 704 N.E.2d 731, quoting Miller, 186 Ill.App.3d at 177, 134 Ill.Dec. 173, 542 N.E.2d 173. Instead of next considering whether the allegations of the plaintiff's complaint alleged an injury that originated from, grew out of, or flowed from her husband's care and treatment, however, the court shifted gears and considered what breach of duty plaintiff was alleging: The breach of duty necessary to support a medical negligence action is the defendant's deviation from the proper medical standard of patient care. Borowski v. Von Solbrig, 60 Ill.2d 418, 423, 328 N.E.2d 301 (1975). The damages suffered in such an action arise out of inappropriate patient care. By contrast, a negligence action for spoliation of evidence is predicated upon a breach of duty to preserve evidence. Boyd v. Travelers Insurance Co., 166 Ill.2d 188, 195, 209 Ill.Dec. 727, 652 N.E.2d 267 (1995). Although the plaintiff in an action alleging the negligent destruction of evidence resulting in an inability to prove a cause of action for medical negligence must prove the merits of the underlying medical negligence claim (see Boyd, 166 Ill.2d at 197-98, 209 Ill.Dec. 727, 652 N.E.2d 267), the fact remains that the damages suffered by the plaintiff in such a case arise from the defendant's destruction of evidence, not the breach of a medical standard of patient care. Cammon, 301 Ill.App.3d at 950, 235 Ill.Dec. 158, 704 N.E.2d 731. Regardless of whether Cammon's duty analysis was appropriate, however, its conclusion was unquestionably correct. Destroying her husband's operative report after the fact was not part of the care and treatment that the doctor and hospital provided to the plaintiff's husband. The injury that the plaintiff suffered was to her ability to prove her lawsuit, and that injury did not arise out of patient care. Because the applicability of section 13-212 turns on whether the plaintiff alleged an injury arising out of patient care, the courts that focused on the plain meaning of that phrase used the correct analysis. The phrase arising out of has a set meaning in the law. In any context in which it is used, the phrase has been defined broadly and refers to a causal connection. Miller's definition of arising out of as generally mean[ing] `originating from,' `growing out of,' or `flowing from' ( Miller, 186 Ill. App.3d at 177, 134 Ill.Dec. 173, 542 N.E.2d 173) is consistent with definitions found in other authorities. Black's defines arise as [t]o originate; to stem (from) or [t]o result (from). Black's Law Dictionary 115 (8th ed.2004). Webster's defines arise as to originate from a specified source. Webster's Third New International Dictionary 117 (1993). The phrase arising out of is construed most often in workers' compensation proceedings. The Workers' Compensation Act (820 ILCS 305/1 et seq. (West 2006)) provides compensation for injuries arising out of and in the course of employment. 820 ILCS 305/2 (West 2006). This court has placed the following construction on arising out of: The `arising out of' component is primarily concerned with causal connection. To satisfy this requirement it must be shown that the injury had its origin in some risk connected with, or incidental to, the employment so as to create a causal connection between the employment and the accidental injury. Caterpillar Tractor Co. v. Industrial Comm'n, 129 Ill.2d 52, 58 [133 Ill.Dec. 454, 541 N.E.2d 665] (1989). Stated otherwise, `an injury arises out of one's employment if, at the time of the occurrence, the employee was performing acts he was instructed to perform by his employer, acts which he had a common law or statutory duty to perform, or acts which the employee might reasonably be expected to perform incident to his assigned duties. [Citations.] A risk is incidental to the employment where it belongs to or is connected with what an employee has to do in fulfilling his duties.' Caterpillar Tractor Co. v. Industrial Comm'n, 129 Ill.2d at 58 [133 Ill.Dec. 454, 541 N.E.2d 665]. Sisbro, Inc. v. Industrial Comm'n, 207 Ill.2d 193, 203-04, 278 Ill.Dec. 70, 797 N.E.2d 665 (2003). The phrase does not encompass but for causation in the Workers' Compensation Act in that it is not enough merely to show that the claimant would not have been at the place where the injury occurred but for his or her employment. Antoszkiewicz v. Industrial Comm'n, 382 Ill. 149, 154, 47 N.E.2d 74 (1943); see Johnson v. Industrial Comm'n, 278 Ill.App.3d 59, 62, 214 Ill.Dec. 802, 662 N.E.2d 156 (1996). It is also not sufficient to show that the accident would not have occurred but for the fact that the claimant's employment placed the claimant in a position in which he was injured by a neutral (neither personal nor related to employment) force. See USF Holland, Inc. v. Industrial Comm'n, 357 Ill.App.3d 798, 803, 293 Ill.Dec. 885, 829 N.E.2d 810 (2005). In other contexts, however, courts have linked arising out of with but for causation. When a statute not only uses the phrase arising out of but also includes the phrases relating to and in connection with, such as in section 5-227 of the Pension Code (40 ILCS 5/5-227 (West 2006)), which provides that a police officer may be disqualified from receiving benefits if he is convicted of a felony relating to or arising out of or in connection with his service as a police officer, this court has found that the statute is broad enough to encompass but for causation. Devoney v. Retirement Board of the Policemen's Annuity & Benefit Fund, 199 Ill.2d 414, 423, 264 Ill.Dec. 95, 769 N.E.2d 932 (2002). When construing an insurance policy, courts have also defined arising out of as referring to but for causation, but that is because the phrase is considered broad and vague and insurance policies must be construed in the insured's favor. See State Automobile Mutual Insurance Co. v. Kingsport Development, LLC, 364 Ill. App.3d 946, 953-54, 301 Ill.Dec. 371, 846 N.E.2d 974 (2006); Liberty Mutual Insurance Co. v. Westfield Insurance Co., 301 Ill.App.3d 49, 54, 234 Ill.Dec. 578, 703 N.E.2d 439 (1998). Considering the above authorities, we construe arising out of patient care 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. [3] This court has been defining arising out of as referring to cause or origin since at least 1917 (see Eugene Dietzen Co. v. Industrial Board, 279 Ill. 11, 15, 116 N.E. 684 (1917)), so we should presume that the legislature was well aware of the judicial construction of this phrase when it used it in section 13-212. [4] Moreover, it is obvious that the term patient care is itself broad, encompassing the entire scope of a person's medical care and treatment. Here, there is no question that plaintiffs' complaint alleged an injury arising out of patient care. The complaint alleged that Anna was Dr. Mercola's patient and that Dr. Mercola prescribed L-glutamine for Anna but dispensed selenium to her instead. The complaint further alleged that Anna and her fetus, Robert, were poisoned when she ingested the selenium. Anna's and Robert's injuries were caused by the care and treatment provided to Anna by defendants. Moreover, it would be preposterous to argue that this was simply a case of but for causation. Anna was not injured by some neutral force that had nothing to do with the care and treatment defendants provided to her. Rather, her injury was caused because she ingested the substance in the bottle that Dr. Mercola sold to her to treat a medical condition that Dr. Mercola had diagnosed. The cases discussed earlier also support the conclusion that Robert's alleged injuries arose out of patient care. The courts in these cases noted that section 13-212 was intended to be broad. Miller found that an injury arose out of patient care when it grew out of or flowed from the plaintiff's and his wife's treatment. Walsh found that the allegations of misconduct were inextricable from the defendants' diagnosis and treatment of the plaintiff. Stiffler found that the use of medical materials are so inextricably linked to patient care that their use almost per se arises out of patient care. All of these conclusions are equally true here, where Dr. Mercola used supplements to treat his patients, bottled them in his office so that his patients could get them at a lower price, recommended one to treat plaintiff, but then sold her a mispackaged bottle. Moreover, this situation is obviously unlike Cammon, where the destruction of medical records was unrelated to the provision of medical care and treatment. Plaintiffs attempt to get around the seemingly inescapable conclusion that their complaint alleged an injury arising out of patient care by arguing that Dr. Mercola wore two hats: he was both a doctor of osteopathic medicine and a retail vendor of supplements. Plaintiffs argue that the negligence alleged here arose solely out of the latter. The Seventh Circuit in Stiffler, when setting forth a hypothetical example of the type of injury that would not arise out of patient care, outlined a scenario in which a medical provider wore two such hats. After noting how broad the term arising out of patient care was intended to be, the Seventh Circuit conceded that there may be some activities undertaken by a hospital that are not part of a patient's medical treatment. The example the Seventh Circuit came up with was the following: For example, a hospital-run gift shop which sells non-prescription medicine to the general public might be held strictly liable if the product ultimately proved harmful for consumer use. But that is not this case. Stiffler, 965 F.2d at 141. Nor is it this case. The Stiffler hypothetical is notable in that, in order to come up with an example of an injury that did not arise out of patient care, the Seventh Circuit was forced to use an example in which there was no patient. According to the Seventh Circuit, an injury would not arise out of patient care if a hospital gift shop stocked nonprescription medicine, a consumer bought that medication at the gift shop, and it was later determined that this type of medication was not safe for consumer use. Of course, that is not at all what was alleged here. In this case, the plaintiff alleged that she and her fetus were poisoned and that this poisoning occurred because she saw Dr. Mercola for medical treatment, he prescribed L-glutamine for her, and then he sold her a bottle marked L-glutamine that an employee in his office had mistakenly filled with selenium. Unlike the gift-shop consumer in the Stiffler hypothetical, plaintiffs in this case alleged an injury arising out of patient care. Moreover, the record clearly refutes plaintiffs' claim that Dr. Mercola wore the hats of both a doctor of osteopathic medicine and a retail vendor of supplements. Although Dr. Mercola would sell supplements to a member of the general public who requested them, that happened very rarely. When asked about this in his deposition, Dr. Mercola explained that his office was not a retail outlet for supplements. Although his patients would occasionally send their friends or relatives in to buy supplements, 99.5 percent plus of sales were to his patients. Thus, the only evidence in the record on this issue shows that, although Dr. Mercola would sell his supplements to a member of the general public who requested them, this was a service that he provided for his patients. He did not hold himself out as a retailer of supplements and did not maintain a retail area in his office for the sale of supplements. Moreover, it was not one of these members of the general public who was injured in this case; it was plaintiff Anna Brucker, a patient for whom Dr. Mercola prescribed the supplement to treat a medical condition but then sold a mislabeled bottle. The appellate court had it exactly right when it concluded: Perhaps defendants would be liable under ordinary negligence if they had injured a member of the general public by promoting and selling supplements in mislabeled bottles. But that is not this case. Dr. Mercola examined Mrs. Brucker and treated her allergy by recommending, inter alia, L-glutamine. After Dr. Brucker replenished his supply of L-glutamine, Mrs. Brucker returned to his office and purchased the mislabeled bottle. The medical malpractice repose provision applies to count III of plaintiffs' amended complaint because count III alleged an injury that arose out of patient care. 363 Ill.App.3d at 1023, 300 Ill.Dec. 875, 845 N.E.2d 764. In their special concurrences, Justices Kilbride and Burke find it especially relevant that nonpatients could, and sometimes did, purchase supplements from Dr. Mercola. 227 Ill.2d at 557-58, 319 Ill.Dec. at 574-75, 886 N.E.2d at 337-38 (Kilbride, J., specially concurring); 227 Ill.2d at 571, 319 Ill. Dec. at 582, 886 N.E.2d at 345 (Burke, J., specially concurring). The question the concurring justices must consider, however, is whether it would change their view if Dr. Mercola had testified that he would not sell his supplements to a member of the general public who requested him. If that fact would not change the concurring justices' position, then the point is irrelevant and need not be discussed. If it would, then it is incumbent on the concurring justices to explain how Dr. Mercola's relationship with a third party could possibly change the nature of his relationship with his patient, Anna Brucker. Plaintiffs' only other argument on this point is a brief four-sentence argument that section 13-212 does not apply because Barbara Pierce, the employee who filled the L-glutamine bottle with the wrong substance, was an office receptionist, not a licensed health-care provider. Section 13-212 applies to any physician, dentist, registered nurse or hospital duly licensed under the laws of this State. 735 ILCS 5/13-212 (West 2006). This court noted in Solich v. George & Anna Portes Cancer Prevention Center of Chicago, Inc., 158 Ill.2d 76, 82, 196 Ill.Dec. 655, 630 N.E.2d 820 (1994), however, that section 13-212 also covers, in certain circumstances, employees of licensed providers acting within the scope of their employment. Plaintiffs have offered no reasons why this case  in which they sued Pierce as Dr. Mercola's agent, Dr. Mercola placed Pierce in charge of filling the supplement bottles, Pierce filled the bottles in the scope of her employment, and Dr. Mercola testified that it was his responsibility to see that the supplement bottles were filled correctly  would not represent one of those circumstances. Before leaving this issue, we would be remiss if we did not address the special concurrences filed by Justices Kilbride and Burke. Although both justices incorrectly argue that the majority adopts but for causation (seemingly finding it easier to refute what the opinion expressly disavows than what it adopts), the substance of their positions is different. Justice Kilbride agrees with the majority that the appropriate test to determine the applicability of section 13-212 is whether the complaint alleged an injury arising out of patient care, but concludes that the majority has ignored the patient care component and applied the statute to an injury wholly unrelated to patient care. By contrast, Justice Burke argues that the court should ignore the legislature's pronouncement that the statute applies to injuries arising out of patient care and instead construe the statute to mean that it applies to injuries arising out of medical negligence. Both points are easily refuted. We address Justice Kilbride's concurrence first. Justice Kilbride argues that the majority has considered only the arising out of component of arising out of patient care while ignoring the patient care component. Thus, Justice Kilbride contends that we have improperly applied section 13-212 to a situation having nothing to do with patient care. Indeed, Justice Kilbride makes the following representations in his special concurrence: (1) the injury alleged was not based on improper or negligent patient care (227 Ill.2d at 554, 319 Ill.Dec. at 573, 886 N.E.2d at 336 (Kilbride, J., specially concurring)); (2) the legislature did not intend to shield medical providers from liability in all endeavors, including those not associated with patient care (227 Ill.2d at 556, 319 Ill.Dec. at 574, 886 N.E.2d at 337 (Kilbride, J., specially concurring)); (3) the filling of the supplement containers was an activity solely supporting Dr. Mercola's sale of supplements not his medical practice (227 Ill.2d at 557, 319 Ill.Dec. at 574, 886 N.E.2d at 337 (Kilbride, J., specially concurring)); (4) the sale of supplements was completely unrelated to Dr. Mercola's care and treatment of his patients (227 Ill.2d at 560, 319 Ill.Dec. at 575-76, 886 N.E.2d at 338-39 (Kilbride, J., specially concurring)); (5) the legislature did not intend section 13-212 to eliminate medical providers' liability in causes of action unrelated to the `care and treatment of patients' [5] (227 Ill.2d at 560, 319 Ill.Dec. at 576-77, 886 N.E.2d at 339-40 (Kilbride, J., specially concurring)). To reiterate: Dr. Mercola is an osteopath who uses nutritional supplements to treat his patients. As a service to his patients, he stocks the supplements he prescribes in his office so that his patients can have easy access to them and obtain them at a lower price than they could elsewhere. As an additional cost-saving measure, he purchased some of the supplements in bulk form and bottled them in his office. He delegated the task of bottling supplements to a staff person with no medical training. He diagnosed his patient Anna Brucker as having a condition requiring treatment with L-glutamine, one of the supplements that he purchased in bulk form and bottled in his office. This particular supplement was not in stock when he prescribed it for Anna, but he did not recommend that she buy it elsewhere. Rather, he sold it to her when she came in for her next office visit. The employee to whom he had delegated the responsibility for filling the supplement bottles had accidentally filled the L-glutamine bottles with selenium, a dangerous substance that Dr. Mercola kept in an unmarked container. Anna and her fetus were then poisoned when she took the substance in the bottle that Dr. Mercola had sold to her to treat a medical condition that he had diagnosed. Given these facts, it is unclear how Justice Kilbride could possibly conclude that the injuries to Anna and her fetus were not based on improper or negligent patient care; or that Dr. Mercola's sale of supplements was not associated wit h his treatment of patients, was completely unrelated to his care and treatment of patients, and did not support his medical practice. Justice Kilbride appears to base his conclusion on the rule that, in ruling on a section 2-619 motion to dismiss, pleading and supporting documents must be construed in the light most favorable to the plaintiff. 227 Ill.2d at 552, 319 Ill.Dec. at 571-72, 886 N.E.2d at 334-35 (Kilbride, J., specially concurring). Justice Kilbride takes this to mean that we must consider the factual possibility that Dr. Mercola's supplements sales business is separate from his medical practice. 227 Ill.2d at 552, 319 Ill.Dec. at 571, 886 N.E.2d at 334 (Kilbride, J., specially concurring). Here, however, plaintiffs did not plead that Dr. Mercola's distribution of supplements was separate from his medical practice. Rather, plaintiffs pleaded that Dr. Mercola failed to utilize proper and adequate measures to insure that proper dietary supplements and prescriptions were being dispensed to patients like ANNA MARIE BRUCKER. (Emphasis added.) Moreover, the deposition testimony showed conclusively that the two were not separate. The rule of liberal construction of pleadings and supporting documents does not require a court to consider whether the complaint would have been properly dismissed if the plaintiffs had pleaded the opposite of what they did and had the depositions showed the opposite of what they did. Treating patients with supplements was at the very heart of Dr. Mercola's medical practice, and the connection between the treatment provided to Anna and the injuries to her and her fetus is clear, palpable, and obvious. Justice Kilbride's concerns about reading patient care out of the statute would perhaps better be directed at Justice Burke's special concurrence than at the majority opinion, as Justice Burke has made her desire to do so explicit. Justice Burke objects to any attempt to interpret arising out of patient care by considering the meaning of arising out of or patient care. Instead, Justice Burke proposes that we should replace the phrase patient care with either medical malpractice or an error in medical judgment. 227 Ill.2d at 565, 319 Ill.Dec. at 579, 886 N.E.2d at 342 (Burke, J., specially concurring). No explanation is provided for how these terms became synonymous with patient care. Justice Burke's argument appears to be that, because section 13-212 was enacted in response to a perceived medical malpractice crisis and because courts informally refer to this section as the medical malpractice statute of repose, we are free simply to ignore the language the legislature chose and to insert medical malpractice into the statute. Justice Burke then criticizes the majority for failing to consider whether this is a claim for ordinary negligence rather than medical malpractice because, according to Justice Burke, this is the touchstone for whether the statute applies. The errors in Justice Burke's approach are manifest. First, we have clear evidence that, when the legislature wants to make healing art malpractice the touchstone for a statute's applicability, it knows how to do so. As we explained above, section 2-622(a), which governs when attorneys' affidavits and health professionals' reports are required, applies to any action, whether in tort, contract or otherwise, in which the plaintiff seeks damages for injuries or death by reason of medical, hospital or other healing art malpractice.  (Emphasis added.) 735 ILCS 5/2-622(a) (West 2006). Thus, the legislature knows exactly how to use the term healing art malpractice when that is what it means. Because the legislature instead made section 13-212 applicable when the plaintiff seeks damages for injury or death, whether in tort, breach of contract, or otherwise, arising out of patient care, we must presume that the legislature did not intend patient care to be synonymous with medical malpractice. Perhaps the easiest way to state the point is that all medical malpractice claims involve injuries arising out of patient care, but not all injuries arising out of patient care were by reason of medical malpractice. The canon of statutory construction that Justice Burke cites in support of her interpretation is that courts must presume that the legislature did not intend absurdity, inconvenience, or injustice. 227 Ill.2d at 569, 319 Ill.Dec. at 581, 886 N.E.2d at 344 (Burke, J., specially concurring). We fail to see the absurdity, injustice, or inconvenience in concluding that a statute that covers all actions for injuries arising out of patient care applies to a cause of action alleging that a doctor poisoned his own patient by negligently providing her with the wrong substance to treat a medical condition that he had diagnosed. Second, there is no need to consider whether plaintiffs' claim is one for ordinary negligence or medical malpractice. Both actions are covered by section 13-212(b) if the injury arose out of patient care. Again, section 13-212(b) applies to all actions, whether in tort, breach of contract, or otherwise, arising out of patient care. 735 ILCS 5/13-212(b) (West 2006). Ordinary negligence claims and medical malpractice claims are both tort claims, and both are covered by section 13-212 if the plaintiffs' injury arose out of patient care. The erroneous assertion by Justice Burke that a court must consider whether the claim is one for medical malpractice or ordinary negligence rather than whether the plaintiffs' injury arose out of patient care causes her to see a conflict with Heastie v. Roberts , Ill.2d 515, 315 Ill. Dec. 735, 877 N.E.2d 1064 (2007), where none exists. As Justice Burke acknowledges, Heastie did not address the applicability of section 13-212. Rather, the discussion she references considers whether expert medical testimony would be required to establish the plaintiffs' claim. As we discussed earlier, the class of cases in which a plaintiff would need expert medical opinions is narrower than the class of cases subject to section 13-212. Thus, Justice Burke is wrong when she states that [i]t simply makes no sense that a claim can be found to be ordinary negligence for the purpose of deciding whether expert testimony is required, yet subject to the medical malpractice statute of repose because it is causally connected to the patient's treatment (227 Ill.2d at 569, 319 Ill.Dec. at 581, 886 N.E.2d at 344 (Burke, J., specially concurring)). In fact, it makes perfect sense because ordinary negligence claims are covered by section 13-212 if the plaintiff's injury arose out of patient care. Next, it is unfortunate that both Justices Kilbride and Burke have decided to lace their separate writings with repeated assertions that the majority adopts but for causation when we in fact explicitly reject it. Justice Burke even goes so far as to claim that the majority's interpretation of arising out of patient care would apply to a situation in which a doctor sends a patient to get an X-ray and, while there, the plaintiff slips and falls or is hit on the head by something that falls out of a cabinet. In fact, these are the types of injuries that are explicitly excluded under our test. See 227 Ill.2d at 521-24, 319 Ill.Dec. at 554-56, 886 N.E.2d at 317-19. When the only connection between the treatment and the injury is that the patient would not have been at a place where an injury occurred but for his treatment or that the treatment placed the plaintiff in a position where he was injured by a neutral force, the injury does not arise out of patient care. 227 Ill.2d at 523, 319 Ill.Dec. at 555, 886 N.E.2d at 318. In Justice Burke's hypothetical, the accident would not have occurred but for the fact that the patient went to this particular medical provider for treatment, just as it would not have happened but for the fact that the plaintiff was born, or that the plaintiff decided not to cancel the doctor's appointment to go to a baseball game, etc., but the injury was not caused by the patient's care and treatment. By contrast, in the case before us, the plaintiffs' injury was caused directly by Anna's treatment. Dr. Mercola diagnosed her with a medical condition, decided to treat the condition by selling her a substance that he had bottled in his office, and Anna and her fetus were injured because an employee acting under Dr. Mercola's direction placed the wrong substance in the bottle. We are confident in the bench's and bar's ability to see the distinction. Perhaps the most significant error in both special concurrences, however, is that their analyses are completely divorced from the complaint that plaintiffs filed. Justice Kilbride states that patient care was not implicated in the faulty preparation of the supplement containers (227 Ill.2d at 560-61, 319 Ill.Dec. at 576-77, 886 N.E.2d at 339-40 (Kilbride, J., specially concurring)), and that Dr. Mercola's potential liability arises, not from the care and treatment he rendered to his patient Anna Marie, but from a nonmedical staff member's negligence in performing ministerial tasks associated with Dr. Mercola's separate supplement sales business, not his medical practice. [6] After ironically stating that the majority never considers the nature of plaintiff's complaint (227 Ill.2d at 567, 319 Ill.Dec. at 579-80, 886 N.E.2d at 342-43 (Burke, J., specially concurring)). Justice Burke claims that the negligence which led to Anna Marie's poisoning    is based on Pierce's failure to fill containers correctly (227 Ill.2d at 567, 319 Ill.Dec. at 579-80, 886 N.E.2d at 342-43 (Burke, J., specially concurring)). Again, the specific allegations of negligence that plaintiff pleaded are: (a) Improperly distributing selenium to plaintiff ANNA MARIE BRUCKER, (b) Failed to maintain proper control measures in the distribution of dietary supplements and prescriptions, (c) Failed to follow reasonable and necessary precautions to determine that proper dietary supplements were being prescribed and distributed, (d) Dispensed selenium to plaintiff ANNA MARIE BRUCKER in a toxic dosage, (e) Failed to utilize proper and adequate measures to insure that proper dietary supplements and prescriptions were being dispensed to patients like ANNA MARIE BRUCKER, and (f) Were otherwise careless and negligent. The specially concurring justices may have concluded for themselves that this case is simply about the retail sale of supplements and errors committed by nonmedical personnel, but that is not the lawsuit that plaintiffs filed and those are not the facts that plaintiffs have indicated that they intend to prove. Rather, plaintiffs have alleged that Dr. Mercola  an osteopath whose medical practice consists of treating patients with nutritional supplements  failed to maintain sufficient control procedures over the distribution of supplements to his patients, and that as a direct result of that negligence, his patient, Anna Brucker, was poisoned. Plaintiffs have obtained a report from another osteopath who has reviewed the records and opined that the care and treatment Dr. Mercola provided to Anna Brucker fell below the minimum standard of care and constituted negligence. Several of the plaintiffs' allegations of negligence concern acts that could have been committed only by Dr. Mercola. The specially concurring justices never explain how they have determined that the only allegation of negligence is that Barbara Pierce filled supplement bottles incorrectly. Finally, it is worth noting that, even under the standard proposed by Justice Burke  there must be an allegation that the medical provider committed an error in judgment or breached a medical standard of care (227 Ill.2d at 565, 319 Ill.Dec. at 579, 886 N.E.2d at 342 (Burke, J., specially concurring)), this complaint alleged an injury arising out of patient care. The allegations of negligence center largely on the control procedures in the office, and the record unquestionably shows that Dr. Mercola did exercise judgment in deciding to place a person with no medical training in charge of bottling substances that he intended to use to treat his patients and also in deciding to keep in the office dangerous look-alike substances in unmarked containers. Moreover, plaintiffs have already obtained and attached to their complaint a report from an osteopath stating that Dr. Mercola breached the relevant standard of care. Thus, even if Justice Burke were correct that section 13-212(b) applies only when a complaint alleges that a medical standard of care was breached or when a medical provider's exercise of judgment is involved, plaintiffs' complaint falls within that test.