The Section 2-622 Health Professional Report in an Illinois Birth Injury Case

The birth of a child is one of the most closely documented events in modern medicine, with nurses, monitors, physicians and laboratory systems all recording what happened minute by minute. That said, when a delivery goes wrong, most families have never seen that record — and very few know that Illinois law requires a qualified health professional to read it before a lawsuit can even begin.

Under 735 ILCS 5/2-622, a complaint alleging medical negligence must be accompanied by an attorney affidavit and a written report from a reviewing health professional. This article explains what that reviewer reads in the labor and delivery record, what the report must state and what it does not decide.

We understand that the weeks after a difficult birth are often consumed by NICU visits, specialist appointments and uncertainty about the future. Keep in mind that the 2-622 process is a gatekeeping step built into Illinois procedure, and understanding it can make the path forward feel less opaque.

The Illinois General Assembly enacted Section 2-622 of the Code of Civil Procedure to screen out medical negligence claims that lack a professional basis. In practice, this means the attorney for the family must consult with a qualified health professional before filing, and that professional must put a written opinion on paper.

The core requirement has two parts that travel together. First, the plaintiff's attorney signs an affidavit stating that they consulted and reviewed the facts of the case with a health professional they reasonably believe is knowledgeable in the relevant issues.

Second, that health professional prepares a written report, which is attached to the affidavit and filed with the complaint. The report must state that, after a review of the medical records and other relevant material, the reviewer has determined there is a reasonable and meritorious cause for filing the action.

Illinois courts have described 2-622 as a pleading requirement rather than a substantive element of the claim. As a result, courts have generally construed it liberally, with the goal of filtering out frivolous filings without defeating claims that have a real professional basis — confirm how that case law applies to a specific complaint with counsel.

This step sits alongside the other early decisions covered in our guide to bringing a birth injury claim in Illinois, including the limitations and repose rules. Those timing rules differ for the child's claim, the parents' own claims and the repose period, so the answer always depends on the facts.

The statute does not allow just any clinician to sign the report. Instead, 735 ILCS 5/2-622 describes a reviewer the attorney reasonably believes is knowledgeable in the relevant issues involved in the particular action.

The statute also ties the reviewer to recent, relevant work. Generally, the reviewer must practice, or have practiced within the last six years, or teach, or have taught within the last six years, in the same area of health care or medicine that is at issue in the case, and must be qualified by experience or demonstrated competence in the subject of the case.

In a birth injury matter, that standard shapes who is asked to review the chart. Depending on the facts, the relevant reviewers may include:

• Obstetricians and maternal-fetal medicine specialists. These physicians can address prenatal risk assessment, labor management, the decision to proceed to an operative or cesarean delivery and the timing of that decision.
• Labor and delivery nursing experts. A nursing reviewer can speak to fetal monitor surveillance, escalation to the physician, oxytocin titration and documentation practices on the unit.
• Neonatologists. These physicians can evaluate resuscitation at delivery, NICU care and whether cooling therapy or other interventions were considered in time.
• Anesthesiologists. Where epidural, spinal or general anesthesia is at issue, an anesthesia reviewer can address the timing and management of the anesthetic.

Where a physician is named as a defendant, Illinois law and case law generally expect the report to come from a physician. Moreover, because a single birth often involves several disciplines, a case may need more than one reviewer to address each defendant's role — counsel decides how to structure that review.

Note that the reviewer is a screening consultant at this stage. The same person may or may not later serve as a testifying expert, and that decision usually comes much further down the road.

A meaningful 2-622 review depends on a complete record. A reviewer working from a partial chart may miss the very entries that explain what happened, which is why records collection usually comes before the consultation itself.

The documents a reviewer typically examines in a birth injury case include but are not limited to:

• The prenatal chart. Prenatal visits record risk factors such as gestational diabetes, hypertension, fetal growth concerns or a prior cesarean, which frame what the delivery team should have anticipated.
• The labor and delivery nursing notes. These notes show cervical checks, contraction patterns, maternal vital signs and, critically, when nurses notified the physician about concerning findings.
• The complete fetal heart rate tracing. The reviewer reads the strip itself, not just the summary notes, looking at baseline, variability, accelerations and decelerations, as discussed in our article on fetal monitoring failures.
• Medication administration records. Oxytocin start times, rate increases and pauses are compared against contraction frequency, a topic we cover in Pitocin and tachysystole records.
• The delivery or operative note. This note documents the mode of delivery, any instruments used, complications such as shoulder dystocia and the timing of the decision to deliver.
• Cord blood gas results. Umbilical artery and vein values can help characterize the baby's condition at birth, which we explain in our guide to cord blood gases.
• Apgar scores and resuscitation records. These entries show how the newborn responded in the first minutes of life, as described in our article on Apgar score timing.
• The placental pathology report. When the placenta is sent to pathology, the findings may point toward or away from particular explanations, covered in our guide to the placental pathology report.
• The NICU chart and imaging. Neonatal MRI results, EEG findings and NICU progress notes help the reviewer understand the nature and timing of the injury.

The reviewer is not simply reading these pages in isolation. Instead, they reconstruct a timeline, matching what the monitor showed at a given moment against what the nursing notes say, what orders were entered and when the delivery actually occurred.

For instance, in a case involving a delayed emergency C-section, the reviewer may compare the time a concerning tracing first appeared, the time the physician was called, the time the decision to deliver was documented and the time of incision. Gaps between those entries are often where the standard-of-care analysis begins.

Access and audit-trail data can matter as well. Electronic health record systems log when entries were created and edited, and a reviewer may want to know whether a late entry reflects real-time care or after-the-fact charting.

All of these records tell a story only when they are read together. This is why the integrity of the full record — not just the discharge summary — sits at the center of the 2-622 review.

The report itself has specific content requirements under 735 ILCS 5/2-622. It must clearly identify the plaintiff and the reasons for the reviewing health professional's determination that a reasonable and meritorious cause for filing exists.

In practice, Illinois courts have looked for reports that do more than recite a conclusion. A sufficient report generally explains what the standard of care required, how the reviewer believes the defendant deviated from it and why that deviation supports a meritorious claim — counsel should confirm current appellate guidance on report sufficiency.

The statute also calls for a separate certificate and written report for each defendant. Accordingly, a case that names an obstetrician, a labor nurse's employer and a hospital may require the report to address each one specifically, rather than lumping the care team together.

It is equally important to understand what the report does not do. The 2-622 report is a threshold document, and it does not establish medical causation, prove negligence or predict an outcome.

Causation in a birth injury case — for example, whether a period of oxygen deprivation led to hypoxic-ischemic encephalopathy — is something the case must prove later through records, discovery and expert testimony. Our guide to HIE and oxygen deprivation explains the clinical questions those experts typically address.

In other words, the report answers a narrow question: does a qualified professional, having read the record, believe there is a reasonable and meritorious basis to proceed? Everything else in the case is built on top of that foundation.

The statute recognizes that a complete review is not always possible before the complaint must be filed. For that reason, Section 2-622 provides limited alternatives to attaching the report at the outset.

One alternative applies when the attorney was unable to obtain a consultation before the potential expiration of the limitations period. In that situation, the attorney may file an affidavit saying so, and the statute then allows a set period after filing — generally 90 days — to file the required certificate and report.

A second alternative addresses records requests. Where a request for records under the Illinois records-access provisions has not been answered within the statutory period, the statute allows the certificate to follow within a set period after the records are received — confirm the exact timing and conditions with counsel.

Be aware that these alternatives are exceptions, not substitutes for a timely review. If the report is missing or deficient, the defendant may move to dismiss, and while courts have often allowed amendment, that outcome is not guaranteed.

Timing rules around the underlying claim are separate from the 2-622 mechanics. The limitations and repose provisions that govern a birth injury case differ for the child, the parents and the repose period, so the safest course is to review the specifics on our Illinois claims page and confirm with counsel.

The quality of a 2-622 review depends on the quality of the record the reviewer receives. Evidence, not the family, is what carries time pressure here — fetal monitor strips, audit trails and pathology specimens can be harder to obtain as time passes.

There are practical steps that can help an attorney build a complete record for review. Some examples include:

• Requesting the complete chart. Ask for the full labor and delivery record, including the fetal monitor strip in its native or complete format, rather than a summary or abstract.
• Requesting both the mother's and the baby's records. The mother's chart and the newborn's chart are usually kept separately, and the reviewer typically needs both.
• Asking about the placenta. If the placenta was sent to pathology, the report and any retained slides may be important to the review.
• Keeping a personal timeline. Notes about when symptoms appeared, who was in the room and what was said can help counsel know which entries to look for.
• Saving NICU discharge paperwork and follow-up records. Later neurology, developmental and imaging records help the reviewer understand the full picture of the injury.

Of course, no family is expected to know how to read a fetal heart rate tracing or a cord gas panel. That is precisely why Illinois built the 2-622 step into the process — so that a qualified professional does that reading before a case is filed.

If your family has questions about what happened during a delivery, our team can explain how the Section 2-622 review works and what records are typically needed. Free consultation. No fee unless we recover.

This article is for informational purposes and does not constitute legal advice. Consult a qualified attorney in your jurisdiction about your specific situation.