OPINION
ANDELL, Justice.
This is an appeal from take-nothing summary judgments rendered in favor of appel-lees, Gottfried Kaestner, Walter R. Sassard, Brodsky, Kaestner & Sassard, P.A., Kaest-ner, Sassard, Searpino & Finkel, P.A., and George Reul (the doctors), and St. Luke’s Episcopal Hospital, in a medical malpractice action brought by appellants, Fernando and Pauline Rubalcaba and intervenor, Cigna Insurance Co. We affirm.
Factual & Procedural Background
Fernando Rubalcaba injured his back at work and sought medical treatment from an orthopedist, Gottfried Kaestner. After diagnostic scans revealed problems with Ru-balcaba’s spinal discs, Kaestner scheduled surgery. Other tests available before the operation showed Rubalcaba had a calcified aorta, no pedal pulses in his left leg, and had suffered earlier heart attacks. Kaest-ner allegedly did not review these tests nor order a preoperative cardiovascular workup. Kaestner also elected to make his incision through the front, rather than the back, [371]*371which required him to retract the aorta. Kaestner operated with the assistance of George Reul and Walter Sassard. Rubalca-ba had expected only Kaestner to operate.
The surgery itself was apparently unremarkable; hours later, however, as a result of a clot in his femoral artery, Rubalcaba lost circulation in his left leg. This condition necessitated emergency surgery. Over the next 18 months, Rubalcaba underwent nine more surgeries as his doctors attempted to restore circulation and function to the leg. After each operation, he was left increasingly debilitated. Rubalcaba was not happy with his care and began to make inquiries. The hospital and doctors did not respond to many of Rubalcaba and Cigna’s initial attempts to obtain medical records. When complete records were finally obtained, it was evident they had been tampered with.
Rubalcaba sued the doctors and the hospital, and Cigna intervened. All of the defendants moved for summary judgment, based on limitations. Rubalcaba then amended his petition, claiming that (1) the defendants fraudulently concealed his medical records from him, thereby preventing him from discovering his injury and (2) the defendants did not negate the “open courts” doctrine. The trial court rendered summary judgment for all defendants. Cigna nonsuited its claims for wrongful billing and joined Rubalcaba in this appeal.
Rubalcaba contends the trial court erred in finding that the claim was barred by limitations because: (1) the fraud claims are not governed by article 4590i;1 (2) the defendants did not negate the “open courts” doctrine; and (3) he raised fact issues regarding fraudulent concealment. Cigna complains of the same errors and further contends the defendants did not establish the date the tort occurred, establish the last date of hospitalization, or negate the “continuous course of treatment” defense.
Standard of Review
Summary judgment is proper only when the movant shows that there is no genuine issue of material fact and that it is entitled to judgment as a matter of law. Nixon v. Mr. Property Management Co., 690 S.W.2d 546, 548-49 (Tex.1985); Tex.R.Civ.P. 166a(e). For a defendant to prevail on a motion for summary judgment, it must either: (1) disprove at least one element of the plaintiffs cause of action; or (2) plead and conclusively establish each essential element of an affirmative defense to the plaintiffs cause of action. Montgomery v. Kennedy, 669 S.W.2d 309, 310-11 (Tex.1984); Casey v. Methodist Hospital, 907 S.W.2d 898, 900 (Tex.App.—Houston [1st Dist.] 1995, no writ).
Once a movant has produced competent evidence to establish a right to summary judgment, the burden shifts to the nonmov-ant to introduce evidence to raise an issue of fact that would preclude summary judgment. City of Houston v. Clear Creek Basin Auth., 589 S.W.2d 671, 678 (Tex.1979); Casey, 907 S.W.2d at 900. In deciding whether there is a disputed issue of material fact, evidence favorable to the nonmovant will be taken as true. Nixon, 690 S.W.2d at 548-49. Every reasonable inference must be indulged in favor of the nonmovant and any doubts resolved in its favor. Id.
Limitations
Appellees had to prove as a matter of law that the suit was barred by limitations. Delgado v. Burns, 656 S.W.2d 428, 429 (Tex.1983); Casey, 907 S.W.2d at 900. If the defendant conclusively establishes the defense of limitations and the plaintiff resists the summary judgment by asserting the affirmative defense of fraudulent concealment, the plaintiff must produce evidence of fraudulent concealment. Nichols v. Smith, 507 S.W.2d 518, 521 (Tex.1974); Casey, 907 S.W.2d at 901-02.
Applicability of Article 4.590Í
As a threshold matter, Rubalcaba contends his “fraud” claims are not governed by article 4590i. We do not agree. The relevant definitions are:
“Health care” means any act or treatment performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of [372]*372a patient during the patient’s medical care, treatment, or confinement.
“Health care liability claim” means a cause of action against a health care provider or physician for treatment, lack of treatment, or other claimed departure from accepted standards of medical care or health care or safety which proximately results in injury to or death of the patient, whether the patient’s claim or cause of action sounds in tort or contract.
Tex.Rev.Civ.Stat.Ann. art. 4590i, § 1.03(a)(2), (4). Rubalcaba’s claim is for fraudulent concealment, not fraud, and is a defense to limitations, not an independent cause of action. It is governed by the Act.
As a second threshold matter, Cigna contends in point of error 16 that article 4590i does not apply to professional associations of physicians. However, this Court has held that professional associations are covered by the Act. Campbell v. MacGregor, 966 S.W.2d 538, (Tex.App.—Houston [1st Dist.] writ requested) (op. on rehg).
Date From Which Limitations Ran
The applicable statute of limitations is found in article 4590i, § 10.01, which provides:
Notwithstanding any other law, no health care liability claim may be commenced unless the action is filed within two years from the occurrence of the breach or tort or from the date the medical or health care treatment that is the subject of the claim or the hospitalization for which the claim is made is completed....
Thus, under section 10.01, the statute of limitations begins to run from one of three possible dates: (1) the date of the occurrence of the breach or tort; (2) the date the health care treatment that is the subject of the claim is completed; or (3) the date the hospitalization for which the claim is made is completed. Kimball v. Brothers, 741 S.W.2d 370, 372 (Tex.1987); Casey, 907 S.W.2d at 901. Although the statute specifies three dates from which the limitations period may run, a plaintiff cannot simply choose among any of these dates. Kimball, 741 S.W.2d at 372 (Tex.1987). If the injury results from a negligent course of treatment, rather than a specific instance of negligence, the limitations period begins on the last date of treatment. Id. However, when the precise date of the breach or tort is ascertainable, the limitations period begins on that date. Id.; Casey, 907 S.W.2d at 902.
Although Rubalcaba received home health care as late as November 1993, his complaints center solely on the first surgery performed on June 3, 1991. In his fourth amended (live) pleading, each act of medical negligence alleged — misdiagnosis, failure to obtain informed consent, performing unauthorized and unnecessary surgery, and mistreatment — relates exclusively to that initial surgery on June 3, not to any other medical treatment. Although Cigna contends the defendants were required to establish the last day of hospitalization and to negate the “continuing course of treatment” defense, they did not need to do either because the date of the tort was ascertainable. See Kimball, 741 S.W.2d at 372; Casey, 907 S.W.2d at 902. Treatment following surgery does not extend the statute of limitations when the complaint concerns the initial surgical procedure. Marchal v. Webb, 859 S.W.2d 408, 417 (Tex.App.—Houston [1st Dist.] 1993, writ denied).
Rubalcaba and Cigna further contend that, even though the complaints center upon events that occurred solely on June 3, 1991, the date of the tort was not readily ascertainable because the doctors and St. Luke’s refused to provide them with a complete copy of the medical records until after Rubalcaba filed suit. In his response opposing summary judgment, Rubalcaba attached the affidavits of his attorney and expert witnesses stating that an examination of Casey’s medical recoi’ds was necessary to determine if and when medical negligence happened.
According to Tex.Rev.Civ.Stat.Ann. art. 4590i, § 4.01(d) (Vernon Supp.1998), all parties are “entitled to obtain complete and unaltered copies of the claimant’s medical records from any other party within 10 days from the date of receipt of a written request for such records.” In addition, Cigna had a statutory right as a workers’ compensation insurer to obtain the records. Te x.Rev.Civ. StatAnn. art. 8307, § 10 (Vernon 1997). Rubalcaba and Cigna did not obtain full and [373]*373complete hospital, physician, and home health care records2 until February 1995. Although the defendants were required by statute to provide Rubalcaba and Cigna with a copy of all medical records, their failure to do so did not toll the statute of limitations because the injury occurred on a specific, ascertainable date — June 3, 1991. See Casey, 907 S.W.2d at 903; James v. Persona Care of San Antonio, 954 S.W.2d 113, 114 (Tex.App.—San Antonio 1997, no writ).
Nor did their delay cause the statute of limitations to begin to run from the date of Rubalcaba’s hospital discharge or the last date of his treatment. Casey, 907 S.W.2d at 903. Whatever relief may be afforded to a party when a health care provider fails to timely provide a copy of the party’s medical records, the failure does not allow the two-year statute of limitations to run from the last date of treatment or the date of the hospital discharge when the injury occurred on a date certain. Casey, 907 S.W.2d at 904. Article 4590i does not provide for an additional tolling period in the event a defendant does not comply with sec. 4.01(d) of the Act by not providing records. James, 954 S.W.2d at 114.
As a matter of law, Rubalcaba and Cigna’s claims against the doctors and the hospital are based on acts or omissions that occurred on June 3, 1991. Therefore, this is the date that limitations on the claim began to run. Kimball, 741 S.W.2d at 372; Casey, 907 S.W.2d at 903. When a party gives notice of his or her claim to a health care provider before the expiration of the two-year limitation period, the statute of limitations is tolled for 75 days from the date of the notice. Tex.Rev.Civ.Stat.Ann. art. 4590i, § 4.01(e) (Vernon Supp.1998); Rowntree v. Hunsucker, 833 S.W.2d 103, 104-105 n. 2 (Tex.1992); Casey, 907 S.W.2d at 903. Rubalcaba first gave notice of his claim on October 23, 1993, four months and 20 days after limitations had expired, thus he was not eligible for the 75-day tolling period. He sued on December 21,1993, six months and 18 days after limitations had expired.
We hold this claim was barred by the statute of limitations in article 4590i.
We overrule Rubalcaba’s points of error one (a), two (a), three (a), and four (a), and Cigna’s points of error one, two, three, six, seven, eight, 11,12,13, and 16.
Defenses to Limitations
Limitations may be avoided if Rubalcaba can show either (1) it was impossible for him to have discovered his injury before limitations ran, or (2) the hospital and doctors fraudulently concealed from him a cause of action for malpractice. Rubalcaba contends both defenses to limitations are applicable.
Open Courts Doctrine
The Texas Constitution provides, “All courts shall be open, and every person for an injury done him, in his lands, goods, person or reputation, shall have remedy by due course of law.” Tex. Const, art. 1, § 13. The statute of limitations under article 4590i may be challenged under the open courts provision. Morrison v. Chan, 699 S.W.2d 205, 207-08 (Tex.1985). However, it is incumbent on the party seeking to avoid limitations to plead facts showing it was impossible for him to have discovered his injury within two years. Id. at 207; Marchal, 859 S.W.2d at 418.
Rubalcaba cannot demonstrate it was impossible for him to have discovered his injury before limitations ran, thus he cannot avail himself of the open courts exception to limitations. In fact, he was aware of his injury on the day that it occurred. He knew he underwent emergency surgery for a blood clot and that his incision from the back surgery was far more extensive than he anticipated. In deposition testimony, he testified that, while he was still hospitalized in August 1991, he was “dissatisfied” with his care, “blamed” the doctors for his condition, and believed his doctors were “lying” to him.
Cigna contends Rubalcaba was not sophisticated enough to appreciate the nature of his injury, but Rubalcaba’s deposition reflects he knew of his injury when he left the hospital in August 1991 and blamed his doctors for [374]*374his condition. Although Rubalcaba argues his deposition was not properly translated, his language expert’s affidavit shows only that the word “believe” should have been translated as “felt” in several instances. It does not alter the substance of the deposition testimony. Nor does Rubalcaba’s affidavit directly contradict his deposition. Although he expressed some confusion over the course of treatment, and alleged he did not know he had a “cause of action” until his attorney told him he had one, he did not contradict or withdraw his earlier statements indicating he knew of his injury. Accordingly, the open courts exception is inapplicable here.
We overrule Rubalcaba’s points of error one (b), two (b), three (b), and four (b), and Cigna’s points of error four, nine, and 14 Fraudulent Concealment
Rubalcaba and Cigna further argue the defendants did not controvert the pleadings and proof of fraudulent concealment of his medical records, thus limitations should not bar his suit. Rubalcaba’s fourth amended petition alleged that St. Luke’s and the doctors fraudulently concealed from him the nature of his condition and its probable cause by failing to maintain his records in a lawful and proper manner and by not informing him of (1) the injury and damages he had sustained, (2) the persons involved in the injury, and (3) his prognosis and level of permanent damage. Rubalcaba is a migrant worker who speaks only Spanish and who left school in Mexico after the first grade, thus he contends his understanding of his condition was not on a par with a more sophisticated patient.
Fraudulent concealment is an equitable doctrine that, when properly invoked, estops a defendant from relying on the statute of limitations as an affirmative defense to a medical malpractice claim when a defendant is under a duty to make disclosure, but fraudulently conceals the existence of a cause of action from the plaintiff. Borderlon v. Peck, 661 S.W.2d 907, 909 (Tex.1983); Casey, 907 S.W.2d at 903. The defendants deny they committed malpractice, and argue they had nothing to disclose to Rubalcaba. Once a defendant has conclusively established the affirmative defense of limitations, the burden rests with the plaintiff to provide evidence of specific facts demonstrating actual knowledge of a wrong and a fixed purpose to conceal it. Casey, 907 S.W.2d at 903; Arredondo v. Hilliard, 904 S.W.2d 754, 759 (Tex.App.—San Antonio 1995), rev’d on other grounds sub nom. Baptist Memorial Hosp. Sys. v. Arredondo, 922 S.W.2d 120 (Tex.1996).
As in Casey and Arredondo, Rubalcaba and Cigna’s efforts to obtain complete records were repeatedly ignored, resisted, or frustrated by the appellants, even after Cig-na engaged a nurse whose sole function was to obtain and examine the records. The clerk’s record shows St. Luke’s provided the bulk of the hospital records (roughly 900 of 1200 pages) to Rubalcaba and to Cigna in October 1991. On October 8, 1993, after a discharge summary was prepared, the hospital permitted Mary Toney to examine the records. She discovered an additional 300 pages of hospital records that day, but neither party has identified which portions of the record were not originally supplied or which of these additional records were necessary to determine if there was negligence. Toney also testified that in February 1995 she found additional hospital records, alterations to the hospital record, and St. Luke’s home health care records.
Reul’s records custodian, Velma Garcia Moreno, swore in an affidavit she provided Rubalcaba’s records to Cigna in January 1992 and September 1992, including Reul’s post-operative summary of the June 1991 surgery, and that Rubalcaba did not request these records until October 1993. Kaestner’s records custodian, Susan Cummins, swore in an affidavit that she sent all requested records to Cigna and Rubalcaba in 1991, including Kaestner’s post-operative summary of the June 3, 1991 surgery, transcribed on June 7, 1991. Cummins swore she sent each record shortly after it was transcribed.
Rubalcaba and Cigna offered five affidavits setting out in detail the lengths to which they went to obtain records, their attendant lack of success, the changes made to the records, and the consequences of not [375]*375having been able to obtain the records in a timely manner:
(1) an affidavit from Rubalcaba, stating his doctors “reassured” him that his care was proper, and contending they never informed him of his injury, the person(s) responsible, the extent of his disability, or its permanence.
(2) an affidavit from Dr. James Sturm, plaintiffs medical expert, stating it would be “impossible” to determine whether medical malpractice occurred without having complete records to review. Sturm also testified Rubaleaba’s injuries were of a type that the physicians immediately knew had occurred, and how.
(3) an affidavit from James Massey, M.P.H., plaintiffs hospital administration expert, stating that if a hospital does not timely complete a medical record, it is impossible for a patient or his representative to determine what treatment the patient received. He notes the hospital did not provide a “completed” medical record until October 8, 1993.3 Massey notes that one of the purposes of medical records is to protect the legal interest of the patient. He concludes “it is ludicrous to assume that a patient can seek legal counsel to determine if an injury occurred, if there was a departure from standards, and if that departure caused the damages” without a complete record of care.
(4) an affidavit from Susan Dietrich, Cig-na’s workers’ compensation claim representative, detailing the numerous thwarted attempts to obtain records from St. Luke’s and Kaestner during August and September 1991.
(5) an affidavit from Mary Toney, a nurse hired by Cigna in 1993 to obtain and evaluate the hospital records, detailing her two-year effort to obtain complete records. Toney stated the hospital records she carefully marked for copying in October 1993 were not copied, and she was unable to obtain records from the doctors despite several requests. When Toney examined the hospital records again in February 1995, she discovered additional records the hospital had not previously produced in October 1993, plus home health care records. She also noted numerous changes in Rubaleaba’s medical records — changed dates, items crossed out, times not matching, pages filled out in pencil, numerous portions concealed with black marker, and corrections made without complying with standard practices.
As we must, we take as true Rubaleaba’s summary judgment proof that the hospitals and doctors prevented him from obtaining full and complete records before February 1995. However, even if we assume the defendants were attempting to conceal malpractice by not providing the records, we are not persuaded that being unable to acquire his records meant Rubalcaba was unable to determine he had a cause of action for malpractice. For a party to invoke fraudulent concealment as a defense to limitations, he must show that the cause of action has been concealed, not that the records have been concealed. The inability to obtain medical records does not, in and of itself, establish fraudulent concealment. Arredondo, 904 S.W.2d at 758. Rather, it was Rubaleaba’s burden to raise a fact issue on each element of fraudulent concealment of his cause of action for malpractice: (1) actual knowledge of malpractice, (2) a duty to disclose it, and (3) a fixed purpose to conceal it. See Casey, 907 S.W.2d at 903. In Casey, as here, the plaintiff alleged the hospital fraudulently concealed from her the nature of her condition and its probable cause, by failing to timely supply a copy of her medical records. 907 S.W.2d at 903. In support of her contentions, Casey attached the affidavits of her attorney and her expert witness, who stated the records were needed to determine when and if negligence had occurred. Id. Nevertheless, this Court rejected that argument and held the evidence did not establish the hospital had actual knowledge that a wrong occurred or a fixed purpose to conceal it. Id.
[376]*376We are faced here with the same argument, and must likewise reject it. Although we assume Rubalcaba’s summary judgment evidence raises a material issue of fact on each element of fraudulent concealment, he still cannot escape limitations because the concealment must effectively prevent a party from learning he has a cause of action. Fraudulent concealment ceases to be a defense to limitations when a party learns of “facts, conditions, or circumstances which would cause a reasonably prudent person to make inquiry, which, if pursued, would lead to discovery of the concealed cause of action.” Borderlon, 661 S.W.2d at 909. Knowledge of such facts is, in law, equivalent to knowledge of the cause of action. Id.
The record persuades us Rubalcaba knew he had a cause of action for malpractice. First, he knew he was injured. By the time he was discharged from the hospital to home health care in August 1991, Rubalcaba knew he had undergone not one, but two surgeries. He knew the surgery on his leg was not initially contemplated. Despite expecting only one surgeon to operate, he knew other doctors had assisted or performed surgery, and who they were. Second, he blamed his doctors and the hospital for his condition. His deposition clearly shows this:
Q: Okay. At the time you left the hospital in September, 1991, do you remember that time?
A: Yes, more or less.
Q: Do you remember noting that you had a scar on your stomach?
A: Yes.
Q: And did that upset you?
A: Oh yes, yes, it bothers me quite a bit.
Q: And that’s because you thought the surgery was going to be on your back and not your stomach; is that right?
A: Yes.
Q: So you felt at that time that Dr. Kaestner had misrepresented things to you?
A: Yes. He told me lots of lies.
Q: And you knew that when you left the hospital in September, 1991?
A: Yes.
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Q: Okay. So you felt at the time you left St. Luke’s Hospital in September, 1991 that Dr. Kaestner had done you wrong?
A: Yes.
Q: Okay. You felt in September, 1991 when you left St Luke’s Hospital that Dr. Kaestner had not represented the truth to you?
A: Yes.
Q: All right. Now, you understood when you left the hospital in September, 1991 that there were other doctors besides Dr. Kaestner that had eared for you?
A: Yes.
Q: And you felt that those doctors along with Dr. Kaestner had done you wrong?
A: Yes.
Q: And for that matter, you felt that the hospital personnel had done you wrong?
A: Yes.
Q: Especially because the hospital personnel were involved with your care?
A: Yes.
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Q: In September, 1991 when you left St. Luke’s Hospital, you knew that Dr. Kaestner and the other doctors you have sued and St. Luke’s Hospital had deceived you?
A: Yes.
Q: And that was knowledge you had when you left the hospital in September, 1991?
A: Yes, because of what they had done. I didn’t imagine it, what they had done to me.
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Q: In September, 1991 when you left St. Luke’s hospital, you felt Dr. Kaestner, the other doctors you’ve sued in this lawsuit and St. Luke’s Hospital were to blame for the complaints you have alleged in this lawsuit?
A: I believe they are to blame.
[377]*377Q: Uh-huh. And that was your opinion back in September, 1991 when you left St. Luke’s Hospital?
A: I didn’t believe I would have come out like this.
Q: Okay. So you felt they were to blame in September, 1991 when you left the hospital?
A: Yes.
Third, Michael Giblin, a Cigna claims specialist testifying as the company’s records custodian, explained the notations made in Rubal-caba’s insurance file as follows:
Q: If you’ll look at the September 5, ’91 entry, on that date, there’s a comment being made that “Continued rehab is expected. Return to work not expected. Subro will be involved, as the plaintiff attorney is expected to file a med malpractice suit against the treating physician.” Is that what it says?
A: Yes, it does.
Q: What does it mean that “subro will be involved”?
A: If we — if an adjustor believes that there is any type of third party involvement, we have a separate department that we refer all of the cases to for their review. And this — this adjustor apparently felt that there was some kind of third party involvement out there, and he’s implying that they are going to refer that to them for review.
Q: Meaning that the subrogation that CIGNA has filed in this case was at least being contemplated as of September 1991?
A: According to what it says there.
Q: And that’s because the plaintiffs attorney was expected to file a medical malpractice suit?
A: That’s what it says.
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Q: The entry of January 13, 1992, it says “claimant still apparently researching possibility of med mal. Two attorneys have rejected case. Another is now reviewing.” Is that correct?
A: That’s correct.
This evidence satisfies us that Rubalcaba knew both of his injury and of his cause of action for malpractice before he even attempted to obtain his records. At the least, it shows knowledge of “facts, conditions, or circumstances which would cause a reasonably prudent person to make inquiry, which, if pursued, would lead to discovery of the concealed cause of action,” thus ending the estoppel effect of fraudulent concealment. In addition, despite his claim that he could not sue until he could determine from his complete records if he had a cause of action for malpractice, Rubalcaba did just that — he sued in December 1993, before Toney had obtained the full and complete records in February 1995.
The necessity of filing an expert medical opinion within 180 days of filing suit in a medical malpractice action under article 4590i is a stringent requirement, but it is up to the legislature to address what penalties it will impose when providers withhold records. Even in a medical malpractice action, a party cannot wait to file suit until his attorney tells him he has a cause of action, and thereby avoid limitations. LaGesse v. Primacare, Inc., 899 S.W.2d 43, 45 (Tex.App.—Eastland 1995, writ denied); Adkins v. Tafel, 871 S.W.2d 289, 294 (Tex.App.—Fort Worth 1994, no writ). Had Rubalcaba sued before limitations ran, and still been unable to obtain his records, he could have invoked the power of the court to avail himself of various remedies.4
We overrule Rubalcaba’s points of error one (c), two (c), three (c), and four (c), and Cigna’s points of error five, 10, and 15.
We affirm the judgment.
Justice COHEN concurring.
Justice O’CONNOR dissenting.