Moyer v. Southern Illinois Hospital Service Corp.

Case Date: 02/07/2002
Court: 5th District Appellate
Docket No: 5-00-0413 Rel

Notice

Decision filed 02/07/02. The text of this decision may be changed or corrected prior to the filing of a Petition for Rehearing or the disposition of the same.

NO. 5-00-0413

IN THE

APPELLATE COURT OF ILLINOIS

FIFTH DISTRICT


THOMAS MOYER, ) Appeal from the
            ) Circuit Court of
           Plaintiff-Appellant,  )

Jackson County.

)
v. ) No. 99-L-48
SOUTHERN ILLINOIS HOSPITAL SERVICE  )
CORPORATION, d/b/a Memorial Hospital of )
Carbondale, and SANDRA SMITH, R.N.,  )

Honorable

) David W. Watt, Jr.,
Defendants-Appellees.  ) Judge, presiding.

PRESIDING JUSTICE MAAG delivered the opinion of the court:

Thomas Moyer (plaintiff) filed a medical malpractice complaint against SouthernIllinois Hospital Service Corp., doing business as Memorial Hospital of Carbondale(Hospital), and Sandra Smith, a registered nurse (collectively, defendants). Plaintiff filedthe complaint on May 25, 1999, alleging that Smith, a Hospital employee, had beennegligent in providing care to him. The Hospital was sued under a respondeat superiortheory for Smith's alleged negligence. After various motions were filed, the circuit courtdismissed plaintiff's amended complaint without prejudice on April 4, 2000, finding that thephysician's deposition transcript that was attached to plaintiff's complaint did not satisfysection 2-622(a) of the Code of Civil Procedure (Code) (735 ILCS 5/2-622(a) (West 1996)),which requires a plaintiff to file a "written report." Plaintiff then filed a first amendedcomplaint. Defendants filed a motion to strike and dismiss plaintiff's first amendedcomplaint. On May 23, 2000, the circuit court entered an order denying defendants' motionto strike. The court granted defendants' motion to dismiss plaintiff's first amended complaintwith prejudice. Plaintiff filed a motion to reconsider on June 19, 2000, and it was denied. Plaintiff filed a timely notice of appeal.

The relevant facts are as follows. Plaintiff filed a medical malpractice complaintagainst defendants on May 25, 1999. The complaint stated that on May 28, 1997, plaintiffwas taken to the emergency room at the Hospital. Plaintiff had symptoms that caused theemergency room physician, Dr. Stuart Hickerson, to suspect that plaintiff was suffering froma myocardial infarction. Dr. Hickerson ordered certain diagnostic tests and theadministration of, among other things, thrombolytic therapy. Plaintiff claimed that theHospital and Smith had a duty to provide proper care and that they breached that duty byfailing to appropriately deliver thrombolytic therapy.

Pursuant to section 2-622(a)(2) of the Code (735 ILCS 5/2-622(a)(2) (West 1996)),plaintiff's attorney attached an affidavit to the complaint. The affidavit stated, "[Plaintiff'sattorney was] unable to obtain a consultation required by statute because the statute oflimitations would impair the action and a consultation required [sic] could not be obtainedbefore the expiration of the statute of limitations." According to section 2-622(a)(2), "[i]fan affidavit is executed pursuant to this paragraph, the certificate and written report requiredby paragraph 1 shall be filed within 90 days after the filing of the complaint." 735 ILCS5/2-622(a)(2) (West 1996). Hence, plaintiff's affidavit and written report were required tobe filed by August 23, 1999.

Plaintiff's counsel sent a notice of discovery deposition on September 13, 1999,requesting "[a]ll medical records pertaining to any care and treatment of [plaintiff]." OnSeptember 17, 1999, defendants filed a motion for involuntary dismissal stating that plaintifffailed to comply with the requirements of section 2-622(a)(2) in that he failed to file within90 days the certificate and written report as required by that section.

Dr. Frank Bleyer's deposition took place on September 22, 1999. Dr. Bleyer testifiedthat he is a board-certified cardiologist. Dr. Bleyer opined that Smith had deviated from thestandard of care that was necessary for a nurse in her position.

Plaintiff filed a motion for leave to amend plaintiff's complaint and a response todefendants' motion to dismiss on October 4, 1999. The proposed amended complaintcontained portions of the transcript of Dr. Bleyer's deposition. Within said motion, plaintiffalleged that section 2-622(a)(3) (735 ILCS 5/2-622(a)(3) (West 1996)) does not require thatthe affidavit and report be filed until the plaintiff has received the relevant medical records. Plaintiff alleged that he had requested all of the medical records pertaining to the emergencyroom care provided by defendants. Plaintiff claimed that when defendants providedplaintiff's medical records, they failed to provide pertinent information relating to theinfusion process. More specifically, plaintiff claimed that the infusion process did not workproperly and that, for an unknown period of time, he was not properly infused. The medicalrecords provided by defendants failed to indicate any problem with the infusion of thethrombolytic. Plaintiff claimed that the entire incident was contained in an "incident report"which was not released to him. Plaintiff stated that he had requested that the incident reportbe provided to him. Although plaintiff did not initially receive the thrombolyticadministration record from the Hospital's records department, the hospital sent it to plaintiffon August 26, 1999. Plaintiff contended that the thrombolytic administration record doesnot describe what occurred, either.

The circuit court denied defendants' motion to dismiss and granted plaintiff leave tofile an amended complaint. Plaintiff filed the amended complaint claiming that Smith hadbeen negligent, and he sued the hospital under the respondeat superior theory. Attached tothe complaint was an affidavit from plaintiff's attorney and selected pages from the transcriptof plaintiff's treating physician's deposition.

On November 12, 1999, defendants filed a motion to dismiss the amended complaint. Defendants asserted that plaintiff's amended complaint should be dismissed because theattorney's affidavit and physician's deposition transcript did not satisfy the requirements ofsection 2-622(a)(1) of the Code (735 ILCS 5/2-622(a)(1) (West 1996)). Defendantscontended that the physician was not qualified to render an opinion regarding the nurse'sactions. Additionally, defendants claimed that neither the affidavit nor the depositiontranscript set forth the qualifications of the physician to render opinions and that thephysician failed to state in his deposition that a meritorious cause of action existed to bringan action against Smith or the Hospital.

After hearing oral argument on defendants' motion to dismiss, the circuit courtdismissed plaintiff's amended complaint without prejudice on April 4, 2000, finding asfollows: "The attachment of a portion of a physician's deposition [transcript] to plaintiff'scomplaint does not satisfy [section 2-622 (735 ILCS 5/2-622 (West 1996))][,] whichrequires plaintiff to attach an appropriate 'written medical [sic] report.' "

On April 14, 2000, plaintiff filed a first amended complaint. This complaintcontained the same allegations of negligence as those stated in the original amendedcomplaint. Plaintiff also attached an attorney's affidavit and a written report from Dr. RalphKelley. Dr. Kelley stated that he had reviewed the records from the Hospital and thetranscripts of the discovery depositions of Dr. Bleyer, Dr. Hickerson, and Smith. Dr. Kelleyopined that the thrombolytic therapy was not provided to plaintiff in compliance withprotocol and that the failure to do so constituted a deviation from the standard of care bySmith and the Hospital.

Defendants filed a motion to strike and dismiss plaintiff's first amended complaint onApril 24, 2000. Defendants requested that the circuit court strike plaintiff's first amendedcomplaint because plaintiff failed to ask for leave of court to file it. Additionally, defendantsrequested that the circuit court dismiss plaintiff's first amended complaint because theattorney's affidavit and written report did not satisfy the requirements of section 2-622(a)(1)of the Code. Defendants again complained that neither the attorney's affidavit nor thephysician's medical report showed that the physician was qualified to render opinionsregarding Smith's actions.

On May 23, 2000, the circuit court entered an order denying defendants' motion tostrike. The court granted defendants' motion to dismiss plaintiff's first amended complaintwith prejudice. The court held, "The medical report and attorney affidavit filed pursuant tosection 2-622 is insufficient in that the medical report fails to set forth the qualifications ofthe affiant as required and enumerated within section 2-622." The court also stated thatpursuant to section 2-622(a)(1) and two Illinois Supreme Court cases (Dolan v. Galluzzo,77 Ill. 2d 279, 396 N.E.2d 13 (1979); Jones v. Young, 154 Ill. 2d 39, 607 N.E.2d 224(1992)), the physician who prepared the medical report was not qualified to testify, provideopinions, or prepare a medical report regarding whether a meritorious cause of action existedagainst a nurse for any alleged negligence in performing nursing procedures. The court alsostated, "[Plaintiff] has had sufficient time within which to file an appropriate attorneyaffidavit and medical report under [section 2-622 of the Code] and has failed to do so." Plaintiff filed a motion to reconsider on June 19, 2000. The circuit court entered an orderon June 20, 2000, denying plaintiff's motion to reconsider. Plaintiff filed a timely notice ofappeal.

The determination as to whether a complaint should be dismissed with or withoutprejudice for the plaintiff's failure to satisfy the requirements of section 2-622(a) is in thesound discretion of the circuit court. Peterson v. Hinsdale Hospital, 233 Ill. App. 3d 327,330, 599 N.E.2d 84, 87 (1992). The circuit court's decision will not be disturbed unless itis clear that it has abused its discretion. Jacobs v. Rush North Shore Medical Center, 284Ill. App. 3d 995, 997, 673 N.E.2d 364, 366 (1996). However, we note that if the circuitcourt's determination of whether the plaintiff has complied with section 2-622(a) involvesthe interpretation of statutory language, that interpretation is subject to de novo review. Bruso v. Alexian Brothers Hospital, 178 Ill. 2d 445, 452, 687 N.E.2d 1014, 1016 (1997).

Initially, we note that defendants claim that if this court finds that plaintiff's firstamended complaint was properly filed, then this court must find that plaintiff effectivelyabandoned and withdrew the amended complaint. See Barnett v. Zion Park District, 171Ill. 2d 378, 384, 665 N.E.2d 808, 811 (1996) (if a plaintiff pleads over rather than stands bythe dismissed complaint, the plaintiff has no right to assign error thereto).

In order to file an amended complaint, the plaintiff must seek and obtain the court'spermission. In re Estate of Zander, 242 Ill. App. 3d 774, 776, 611 N.E.2d 86, 88 (1993). "Amendments filed without leave of court are said to be a nullity which should be stricken." Zander, 242 Ill. App. 3d at 776, 611 N.E.2d at 88.

In the instant case, plaintiff's first amended complaint was filed on April 24, 2000,without leave of court. Accordingly, it was a nullity. Hence, we will not address any ofplaintiff's arguments with respect to the dismissal of the first amended complaint.

Plaintiff claims that the circuit court erred in dismissing plaintiff's amended complaintdue to plaintiff's failure to file a "written report" pursuant to section 2-622(a) of the Code.

Whether plaintiff has complied with section 2-622(a) in filing a deposition transcriptas a "written report" involves the interpretation of statutory language; hence, thatinterpretation is subject to de novo review. See Bruso, 178 Ill. 2d at 452, 687 N.E.2d at1016.

Section 2-622(a)(1) provides in relevant part as follows:

"(a) In any action, whether in tort, contract[,] or otherwise, in which theplaintiff seeks damages for injuries or death by reason of medical, hospital, or otherhealing art malpractice, the plaintiff's attorney or the plaintiff, if the plaintiff isproceeding pro se, shall file an affidavit, attached to the original and all copies of thecomplaint, declaring one of the following:

1. That the affiant has consulted and reviewed the facts of the casewith a health professional who the affiant reasonably believes: (i) isknowledgeable in the relevant issues involved in the particular action; (ii)practices or has practiced within the last 6 years or teaches or has taughtwithin the last 6 years in the same area of health care or medicine that is atissue in the particular action; and (iii) is qualified by experience ordemonstrated competence in the subject of the case; that the reviewing healthprofessional has determined in a written report, after a review of the medicalrecord and other relevant material involved in the particular action[,] that thereis a reasonable and meritorious cause for the filing of such action ***. *** A copy of the written report, clearly identifying the plaintiff and the reasonsfor the reviewing health professional's determination that a reasonable andmeritorious cause for the filing of the action exists, must be attached to theaffidavit." (Emphasis added.) 735 ILCS 5/2-622(a)(1) (West 1996).

We note parenthetically that although plaintiff filed his affidavit pursuant to section 2-622(a)(2) of the Code, that section refers to the "written report" required by section 2-622(a)(1). 735 ILCS 5/2-622(a)(1), (a)(2) (West 1996).

When construing a statute, the court strives to ascertain and give effect to the intentand meaning of the legislature, and that effort properly begins with an examination of thestatutory language. Texaco-Cities Service Pipeline Co. v. McGraw, 182 Ill. 2d 262, 270,695 N.E.2d 481, 485 (1998). In the absence of a statutory definition, "the courts will assumethat statutory words have their ordinary and popularly understood meanings." People v.Blair, 52 Ill. 2d 371, 373, 288 N.E.2d 443, 445 (1972).

In the case at hand, plaintiff filed the original complaint on May 25, 1999. Pursuantto section 2-622(a)(2) of the Code, plaintiff attached an affidavit to his complaint. Theaffidavit asserted that the statute of limitations would impair the action and that the requiredconsultation could not be obtained before the running of the statute of limitations. We noteparenthetically that section 2-622(a)(2) refers to the "written report" required by section 2-622(a)(1). Plaintiff then sought leave of court to file an amended complaint with an attachedaffidavit and selected pages from the transcript of plaintiff's treating physician's deposition. The court granted plaintiff leave to file the amended complaint. The court then dismissedplaintiff's amended complaint, finding that the portion of the physician's depositiontranscript that was attached to the amended complaint did not comply with section 2-622(a),which requires the plaintiff to file a "written report."

We note, however, that in Apa v. Rotman, 288 Ill. App. 3d 585, 589, 680 N.E.2d 801,804 (1997), this court stated that the purpose of section 2-622 is to reduce the number offrivolous medical malpractice lawsuits that are filed and to eliminate such actions at an earlystage. "The purpose of the enactment is not to burden the plaintiff with insurmountablehurdles prior to filing [citation][] but to ensure that plaintiff has a meritorious claim." Apa,288 Ill. App. 3d at 589, 680 N.E.2d at 804. The absence of strict compliance is one of formonly and not one of substance, and the technical requirements of the statute should notinterfere with the spirit or purpose of the statute. Apa, 288 Ill. App. 3d at 589, 680 N.E.2dat 804. Additionally, adherence to the technical requirements of the statute should not bemechanically required to deprive a plaintiff of his substantive rights. Hence, section 2-622must be liberally construed in order for cases to be quickly and finally decided according tothe substantive rights of the parties. Apa, 288 Ill. App. 3d at 589, 680 N.E.2d at 804.

Our review of the record shows that Dr. Bleyer's deposition was taken and that no oneobjected to the taking of that deposition. There is no question that after a deposition hasbeen transcribed, the deposition transcript is a written document. Since the issue is reallythe content of the written document and not whether it is in the form of a letter or adeposition transcript, we find that a deposition transcript may be a "written report" withinthe meaning of section 2-622(a) of the Code if the deponent doctor, in sufficient detail, setsforth facts and conclusions that satisfy the requirements of the statutorily required report. The form of the report-i.e., letter, dictated report that is transcribed, or transcribeddeposition-matters little. What does matter is that the "author" of the report must be shownto have the requisite qualifications to express an opinion, and the report must demonstratea reasonable and meritorious claim. If a deposition transcript shows that the plaintiff has ameritorious claim, the technical requirements of the statute should not interfere with thespirit or purpose of the statute. Justice Learned Hand once observed, "[I]t is one of thesurest indexes of a mature and developed jurisprudence not to make a fortress out of thedictionary[] but to remember that statutes always have some purpose or object toaccomplish, whose sympathetic and imaginative discovery is the surest guide to theirmeaning." Cabell v. Markham, 148 F.2d 737, 739 (2nd Cir. 1945), aff'd, 326 U.S. 404, 90L. Ed. 165, 66 S. Ct. 193 (1945).

Defendants argue that even if this court determines that the selected pages of thephysician's deposition transcript are a "written report" pursuant to section 2-622(a) of theCode, plaintiff's amended complaint was properly dismissed because the physician was "notqualified" to prepare the written report pursuant to section 2-622(a)(1). We disagree.

The determination as to whether a complaint should be dismissed with or withoutprejudice for a plaintiff's failure to satisfy the requirements of section 2-622(a) is in thesound discretion of the circuit court. Hinsdale Hospital, 233 Ill. App. 3d at 330, 599 N.E.2dat 87.

Section 2-622 sets forth several provisions regarding the qualifications that a healthprofessional must possess in order to complete the report. This section provides that theattorney must attest that he has consulted and reviewed the facts of the case with a healthcare professional who "(i) is knowledgeable in the relevant issues involved in the particularaction; (ii) practices or has practiced within the last 6 years or teaches or has taught withinthe last 6 years in the same area of health care or medicine that is at issue in the particularaction; and (iii) is qualified by experience or demonstrated competence in the subject of thecase." 735 ILCS 5/2-622(a)(1) (West 1996).

Defendants then cite three cases (Cuthbertson v. Axelrod, 282 Ill. App. 3d 1027, 669N.E.2d 601 (1996); Tucker v. St. James Hospital, 279 Ill. App. 3d 696, 665 N.E.2d 392(1996); Woodard v. Krans, 234 Ill. App. 3d 690, 600 N.E.2d 477 (1992)) to support theirargument that, in order for the complaint to have a proper certificate of merit, the physician'swritten report must also state that these qualifications are met. In their brief, defendantsstate, "Without a statement in the written report from the reviewing health professional thathe meets the qualifications of section 2-622(a)(1), there is no basis for the attorney to state,in his affidavit, that the health professional has such qualifications." Defendants then makethe curious statement, "Because Dr. Bleyer is not a nurse and he does not establish that heis otherwise qualified to testify about nursing procedures, he was not qualified to testifyregarding the nurse's standard of care in administering or monitoring thrombolytic therapy." Defendants request that this court "require the plaintiff to obtain a written report from eithera licensed nurse or a physician who either practices or has practiced or teaches or has taughtnursing or nursing procedures within the last six years, i.e., someone who has knowledgeregarding the appropriate nursing (not physician) standard of care." Defendants claim thatto hold otherwise "would impose a higher standard of care on a nurse."

A review of Dr. Bleyer's deposition transcript shows that he meets the qualificationsthat are required by section 2-622(a)(1) of the Code to enable him to render an opinionregarding Smith's actions. A review of Dr. Bleyer's deposition transcript shows that he isa board-certified cardiologist. Dr. Bleyer stated that he was working in the emergency roomon May 28, 1997. He stated that he provided care to plaintiff on that date and that he beganthrombolytic therapy. Dr. Bleyer stated that plaintiff was having an "acute anterior wallmyocardial infarction, a heart attack." He explained, "It's been shown in numerous studiesthat the administration of thrombolytics in this type of myocardial infarction improvessurvival, decreases left ventricular dysfunction, and is the standard of care for this kind oftreatment when the patient presents in the appropriate time frame that would allow theadministration of the drug." Dr. Bleyer stated that the appropriate time frame is "definitelyin the first six hours." He explained that a mortality benefit has clearly been shown with theadministration of thrombolytics in the first six hours. He further stated: "From six to twelvehours, there are some studies that do indicate that the administration of thrombolytics wouldimprove survival, but that is not as clear as in the first six hours. And *** there *** [are]studies that [indicate that the administration of thrombolytics] from 12 to 24 hours [improvessurvival,] especially if the patient has had a stuttering course where maybe he has had somechest pain and it's gone." The deposition testimony emphasized that time is of the essenceand that it is recommended that thrombolytics are given as soon as possible to increase thechance of survival and decrease damage. On redirect, Dr. Bleyer explained that the causeof heart attack is mild, moderate, or severe atherosclerosis, usually in the arteries. Theatherosclerosis or plaque will rupture or become unstable and will open its inner contentsinto the bloodstream. This activates the clotting mechanism, and a clot or thrombus willdevelop. The thrombus is made of clotting factors, platelets, and it occludes the artery,sometimes totally, sometimes partially. Dr. Bleyer stated that, usually, if there is totalocclusion, there is an infarction. With partial occlusion, an unstable angina or non-Q-waveinfarction results. Dr. Bleyer explained that, in general, a total occlusion leads to a Q-wavemyocardial infarction. He stated that the thrombolytic therapy will stimulate the breakdownof the clot, which opens the blood vessels so the blood can return to the area of the heart thatis normally supplied by the blood vessel. He emphasized that time is of the essence in theadministration of the thrombolytic therapy. Dr. Bleyer opined that plaintiff had a myocardialinfarction and that he sustained anterior wall damage as a result. When he was asked hisopinion, within a reasonable degree of medical certainty, whether the chance of injury toplaintiff increased due to Smith's delay in administering the thrombolytic therapy, he statesas follows: "[I]t is clear that time is important for adequate thrombolysis. Whether the delayof 15 to 18 minutes was the sole, the only, or the contributing factor to the residual damagethat is left with the patient I cannot tell you." Dr. Bleyer did state, however, that the chanceof damage is increased with any type of delay of thrombolytics. Dr. Bleyer claimed that heis a "very particular physician" and that he "let it be known" that he was very unhappy withSmith's delay of thrombolytics in plaintiff's case. He agreed that it was Smith's job to infuseplaintiff. He also agreed that Smith was supposed to be monitoring plaintiff to ensure thathe was, in fact, being infused. Dr. Bleyer admitted that he was aware that plaintiff had notbeen infused for an indeterminate period of time and that Smith had deviated from thestandard of care on the part of a nurse. Although Dr. Bleyer admitted that a nurse shouldnot be watching the pump "every minute," he stated that if she had looked at the pump, shewould have known that plaintiff was not being infused.

Defendants cite Jones, 154 Ill. 2d 39, 607 N.E.2d 224, Dolan, 77 Ill. 2d 279, 396N.E.2d 13, and Wingo v. Rockford Memorial Hospital, 292 Ill. App. 3d 896, 686 N.E.2d 722(1997), to support their position that Dr. Bleyer was not in the same area of health care ormedicine as Smith. These cases are distinguishable from the instant case because they relateto whether a professional is qualified to testify and provide opinions at trial, whereas in theinstant case we are being asked to determine whether a cardiologist is qualified pursuant tosection 2-622(a) of the Code to make a written report regarding the actions of a nurseadministering thrombolytic therapy, a cardiac infusion process that is used to reduce the riskof residual damage during a heart attack. The qualifications required to testify at a trial aredifferent than those required by section 2-622(a). The type of testimony that will be reliedon at a trial has no bearing on the requirements of section 2-622. See Lyon v. HasbroIndustries, Inc., 156 Ill. App. 3d 649, 655, 509 N.E.2d 702, 707 (1987) (the plaintiff mustcomply with section 2-622 even if the plaintiff can prove his or her case at a trial withoutan expert).

Dolan is also distinguishable from the instant case because it dealt with a podiatrist. Podiatrists are specifically mentioned in section 2-622(a), and specific exceptions apply incases involving podiatrists.

The issue in the case at hand was addressed in Shanks v. Memorial Hospital, 170 Ill.App. 3d 736, 525 N.E.2d 177 (1988). In Shanks, the plaintiff filed a medical malpracticeaction against a hospital's nursing staff. At issue in Shanks was whether the plaintiff'sconsultation with a registered nurse fulfilled the requirements of section 2-622(a)(1). TheShanks court pointed out, "If the defendant is 'a physician licensed to treat human ailmentswithout the use of drugs or medicines and without operative surgery, a dentist, a podiatrist,or a psychologist,' the health care professional must be one licensed in the same professionas the defendant." Shanks, 170 Ill. App. 3d at 739, 525 N.E.2d at 179 (quoting Ill. Rev. Stat.1985, ch. 110, par. 2-622(a)(1)). The Shanks court stated, "For all other defendants,however, the health care professional must be a 'physician licensed to practice medicine inall its branches.' " Shanks, 170 Ill. App. 3d at 739, 525 N.E.2d at 179-80 (quoting Ill. Rev.Stat. 1985, ch. 110, par. 2-622(a)(1)). The Shanks court determined that since the defendant(the hospital) fell into the category of "all other defendants," the plaintiff was required toconsult a physician licensed to practice medicine in all its branches. The Shanks court thenstated that the plaintiff's consultation with a registered nurse did not comply with therequirements of section 2-622(a)(1). Shanks, 170 Ill. App. 3d at 739, 525 N.E.2d at 180.

The Shanks decision states that section 2-622(a)(1) of the Code defines the type ofhealth care professional to be consulted, based on the type of defendant sued. Hospitals andnurses fall under the second category of "all other defendants." That portion of the statutestates that for all other defendants, the health care professional must be a physician licensedto practice medicine in all its branches. Hence, if a plaintiff is suing a hospital or a nurse,he must still attach a report from a physician, according to the statute. In Lyon, 156 Ill. App.3d at 655, 509 N.E.2d at 707, the court held that a plaintiff must comply with section 2-622even if the plaintiff could prove his case at a trial without an expert.

We agree with the Shanks court and conclude that defendants' argument is one thatwould be more appropriately addressed to the legislature. The legislature has determinedwhich health care professionals can submit the required report under the statute, and we willnot substitute our judgment for that of the legislature when the statute is clear. See Shanks,170 Ill. App. 3d at 740, 525 N.E.2d at 180.

Hence, after reviewing the aforementioned deposition transcripts, we conclude thatDr. Bleyer is knowledgeable in the relevant issues involved in the particular action. Additionally, his deposition established that he is a board-certified cardiologist and that hewas practicing in that capacity when plaintiff presented himself at the Hospital. Hence, atthe time of the alleged malpractice, Dr. Bleyer was practicing within the same area of healthcare or medicine (cardiology) that is at issue in this particular action. Finally, the depositiontestimony shows that Dr. Bleyer is qualified by experience or demonstrated competence incardiology. We find that Dr. Bleyer's deposition establishes that he was qualified pursuantto section 2-622(a) to complete the written report required by that section.

The attorney's affidavit that was attached to plaintiff's original amended complaintstated as follows:

"1. That I have reviewed the facts of the aforementioned case with Dr. Bleyer,one of the treating physicians in this cause of action, by taking his deposition, wherea portion of the medical records pertaining to [plaintiff] were carefully reviewed asthey pertained to the treatment provided by [the Hospital] and Sandra Smith, R.N.[;]

2. Based on his knowledge of the treatment, Dr. Bleyer, who isknowledgeable in the relevant issues involved in this action and who has practicedand is practicing in the same area of medicine and is qualified to offer opinions in thisarea[,] concluded, as stated in his deposition, which constitutes a written report, therelevant excerpts of which are attached hereto, that [plaintiff] was provided negligentcare at [the Hospital] by Sandra Smith, R.N.;

3. That said nurse did not properly monitor the patient after the infusion ofthrombolytic agents had been ordered;

4. That those conclusions reached by Dr. Bleyer indicate a reasonable causefor filing a meritorious cause of action against those defendants."

After reviewing Dr. Bleyer's deposition testimony, we find that the attorney'saffidavit, which was based on the deposition, establishes that Dr. Bleyer was qualified tocomplete the required written report.

Defendants argue the following: "Even assuming this court would hold, in a case offirst impression[,] that a medical deposition can be considered to be a written report undersection 2-622[] and assuming a doctor can testify to a nursing standard of care, the trialcourt's decision should be affirmed because there was no evidence that the defendant [sic]breached any standard of care." We disagree.

Dr. Bleyer's testimony established that Smith had deviated from the standard of carefor a nurse because she did not monitor plaintiff properly while he was being infused.

Defendants claim that there was no showing that there was a reasonable andmeritorious cause for the filing of the action pursuant to section 2-622(a). We agree withdefendants that section 2-622 provides that an attorney's affidavit, which is required to befiled, must contain statements regarding the health professional's qualifications to renderopinions in the case. Section 2-622 also requires that the attorney's affidavit must state that"the reviewing health professional has determined in a written report, after a review of themedical record and other relevant material involved in the particular action[,] that there isa reasonable and meritorious cause for the filing of such action." 735 ILCS 5/2-622(a)(1)(West 1996). That section also states, "A copy of the written report, clearly identifying theplaintiff and the reasons for the reviewing health professional's determination that areasonable and meritorious cause for the filing of the action exists, must be attached to theaffidavit." 735 ILCS 5/2-622(a)(1) (West 1996).

In the instant case, the attorney's affidavit states, "[The] conclusions reached by Dr.Bleyer indicate a reasonable cause for filing a meritorious cause of action against thosedefendants." When Dr. Bleyer was asked in his deposition his opinion, within a reasonabledegree of medical certainty, whether the chance of injury to plaintiff increased due to Smith'sdelay in administering the thrombolytic therapy, he stated as follows: "[I]t is clear that timeis important for adequate thrombolysis. Whether the delay of 15 to 18 minutes was the sole,the only, or the contributing factor to the residual damage that is left with the patient Icannot tell you." (Emphasis added.) Dr. Bleyer did state, however, that the chance ofdamage is increased with any type of delay of thrombolytics. Dr. Bleyer claimed that he isa "very particular physician" and that he "let it be known" that he was very unhappy withSmith's delay of thrombolytics in plaintiff's case. Dr. Bleyer agreed that it was Smith's jobto infuse plaintiff. He also agreed that Smith was supposed to be monitoring plaintiff toensure that he was, in fact, being infused. Dr. Bleyer admitted that he was aware thatplaintiff had not been infused for an indeterminate period of time and that Smith haddeviated from the standard of care on the part of a nurse. Although Dr. Bleyer admitted thata nurse should not be watching the pump "every minute," he stated that if she had looked atthe pump, she would have known that plaintiff was not being infused. Dr. Bleyer alsoadmitted that during the time period that thrombolytic therapy was delayed, plaintiff washaving chest pains. Dr. Bleyer stated that since plaintiff was having chest pain during thisperiod of time, he assumed "that there was still anoxia to the myocardium."

Hence, a review of Dr. Bleyer's testimony shows that he emphasized that any type ofdelay in administering thrombolytic therapy increases the chance for damage and that Smithhad clearly deviated from the standard of care on the part of a nurse. Dr. Bleyer also statedthat he could not opine whether the delay was either the sole cause of or merely acontributing factor in a patient's residual damage. Dr. Bleyer's testimony established thatwhile it is difficult to know precisely how much damage any patient would sustain with adelay of thrombolytics, delay is not desirable because it increases the chance of damage tothe patient. Hence, Dr. Bleyer's testimony shows that plaintiff has a meritorious cause ofaction. See Hagood v. O'Conner, 165 Ill. App. 3d 367, 373, 519 N.E.2d 66, 70 (1988) (ahealth professional is not required to include the phrase "reasonable and meritorious causefor filing the action" within the written report, although there must be sufficient facts andconclusions set forth in the report to support the finding).

Defendants claim that Dr. Bleyer had to state his opinion, to a medical degree ofcertainty, that Smith had deviated from the nursing standard of care in failing to monitor theinfusion. Defendants cite Collins v. Straka, 164 Ill. App. 3d 355, 517 N.E.2d 1147 (1987),to support their argument that medical opinions must be based upon a reasonable degree ofmedical certainty to be received or relied on by a jury.

Initially, we note that the deposition testimony in the instant case was being used asa "written report" pursuant to section 2-622 of the Code. Dr. Bleyer's testimony was notbeing received or relied on by a jury. Additionally, Illinois courts liberally construe aphysician's certificate of merit in favor of the malpractice plaintiff, recognizing the statuteas a tool to reduce frivolous lawsuits by requiring a minimum amount of merit, not alikelihood of success. Sherrod v. Lingle, 223 F.3d 605, 613 (7th Cir. 2000).

Based on the foregoing analysis, we conclude that the circuit court abused itsdiscretion in determining that plaintiff failed to satisfy the requirements of section 2-622 ofthe Code.

For all of these reasons, we reverse the circuit court's April 4, 2000, order dismissingplaintiff's amended complaint because Dr. Bleyer's deposition transcript was not a "writtenreport" pursuant to section 2-622 of the Code. We remand this case to the circuit court forfurther proceedings consistent with this opinion.

Reversed; cause remanded.

WELCH and RARICK, JJ., concur.