OPINION
Elizabeth M. Stryezek appeals a summary judgment granted to The Methodist Hospitals, Inc. (“Methodist”). She raises two issues for our review which we consolidate and restate as whether the trial court properly granted Methodist’s motion for summary judgment. We affirm.
The facts most favorable to Elizabeth follow. In January of 1988, she saw Dr. Bharat Barai, a specialist in chemotherapy, and Dr. Gurbaehan Kapoor, a specialist in radiation oncology, to diagnose and treat her illness. Both doctors had staff privileges at Broadway Methodist Hospital. 1 In addition, Dr. Kapoor was the medical director of the Department of Radiation Oncology at Broadway Methodist Hospital. Elizabeth underwent surgery to remove a tumor. Pathologists at Methodist concluded that the tumor was a thymoma. However, Dr. Barai questioned that diagnosis and requested second opinions from outside lаboratories including: the Division of Pathology at City of Hope National Medical Center; the Department of Pathology at Yale University; the University of Southern California School of Medicine; and, the Armed Forces Institute of Medicine. The outside pathology reports were returned to Methodist’s Department of Pathology department between January 29, 1988 and March 25, ■ 1988. The reports indicated that the tumor was a large-cell lymphoma rather than thymoma.
Based upon the diagnosis of thymoma, Dr. Kapoor prescribed radiation treatments to Elizabeth between February 8, 1988 and February 24, 1988. Elizabeth also received treatments of Cyclophosphamide. On February 25,1988, Dr. Barai notified Dr. Kapoor of the results from the outside pathology reports. Between March 1, 1988 and September 13, 1988, Dr. Barai treated Elizabeth with chemotherapy agents including Adria-mycin and Cyclophosphamide. Upon completion of the chemotherapy treatment, Elizabeth returned to Dr. Kapoor for additional radiation treatments.
On April 7, 1989, Elizabeth suffered a cardiac arrest. On April 30, 1989, Elizabeth underwent surgery to have an Automatic Im *1188 plantable Cardioverter Defibrillator (AICD) permanently implanted in her body.
On February 2, 1993, Elizabeth filed her medical malpractice complaint against Methodist, Dr. Kapoor, and Dr. Barai. On Mаrch 9, 1993, Methodist filed a motion for summary judgment. The trial court granted the motion, but we subsequently reversed the trial court on appeal.
Stryczek v. Methodist Hospitals, Inc.,
Summary judgment is apprоpriate only when there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Ind. Trial Rule 56(C). The moving party has the initial burden of proving these requirements.
Shumate v. Lycan,
Before we address the merits of the summary judgment, we consider Methodist’s argument that Elizabeth improperly designated the affidavit of Nurse Judith Stryczek (“Nurse Stryczek”).
2
Methodist argues that we are “prohibited from looking” at the affidavit because Elizabeth “designated the entire affidavit including all paragraphs.” Appellant’s brief, p. 7. In the previous appeal in this ease, we held that “[pjarties may no longer designate entire portions of the record, such as depositions, but must instead specifically identify relevant portions of pleadings, depositions and other evidentiary material upon which the party relies.”
Stryczek,
“1. Expert witness Affidavit of Judith K. Stryczek, R.N., parаgraphs one (1) through and including nine (9), Exhibit ‘A’, paragraphs one (1) and two (2) showing her qualifications and competency, paragraph three (3) standard of care, paragraph four (4) indicating material reviewed, paragraphs five (5) and seven (7) establishing the deviation of the standard of care, paragraph six (6) establishing causation, paragraph eight (8) damages, paragraph nine (9) confirmation of breach of standаrd of care and causation and damages, attached to Memorandum in Opposition to Motion for Summary Judgment.”
Record, p. 31. This is not a general designation of a document. Rather, this is a designation of specific portions of a document which, as combined, constitutes the entire document. Therefore, Elizabeth did not improperly designate the affidavit of Nurse Stryczek.
On the merits, Elizabeth first contends that the affidavit of Nurse Stryczеk was sufficient to rebut the opinion of the Medical Review Panel and establish the existence of a genuine issue of material fact as to the negligence of the hospital. Methodist responds by arguing that a “nurse is not competent to give medical opinions.” Appellee’s brief, p. 7.
*1189 In her affidavit, Nurse Stryczek stated that she has been a licensed registered nurse for the “State of Indiana and State of Illinois for over 33 years with a Masters in Science and Nursing Degree.” Record, p. 70. She also stated that she was a professor of nursing and had been house supervisor at Methodist for approximately seven years. Her training and experience include cardiovascular nursing, critical care, and “the proper protocol for administering cardio-toxic medications.” Record, p. 70.
Her affidavit offered conclusions as to the defеndants’ care of Elizabeth in light of the standards of care for diagnosing patients, the administration of cardio-toxic medications, and the requirements to inform patients of the risks and alternative procedures associated with their treatment. Specifically, Nurse Stryczek concluded that the defendants’ deviation from the applicable standards of care resulted in the following: the misdiagnosis of Elizabeth’s condition; the failurе to perform tests “to determine the condition of her heart after completion of the chemotherapy with radiation and the cardio-toxic agent Adria-mycin”; the failure of the physicians to advise Elizabeth of the risks associated with the drugs and radiation administered and the alternative treatments, procedures or protocols which were available; the administration of an improper dosage of Adriamyein and, the failure to “timely communicate the proper diagnosis received from some outside agencies prior to embarking on a course of radiation treatment.” Record, p. 72. Nurse Stryczek concluded that these deviations resulted in Elizabeth’s cardiac damage.
We have previously held that “[i]n an action for [medical] malpractice, whether the defendant used suitable professional skill must generally be рroven by expert testimony, that is, other physicians, surgeons, or orthodontists, as the ease may be.”
Stackhouse v. Scanlon,
Physicians receive unlimited licenses as to the entire medical field; registered nurses receive licenses which limit the services they may perform. See Ind.Code §§ 25-23-1-1.1 and' 25-22.5-1-1.1. Specifically, physicians are authorized to engage in the “diagnosis, treatment, correction, or prevention of any disease..:.” I.C'. § 25-22.5-1-1.1. Under this statute, diagnosis is defined as the examination of “a patient, parts of a patient’s body, substances taken or removed from a patient’s body, or materials produced by a patient’s body to determine the source or nature of a disease or other physical or mental condition_” I.C. § 25-22.5-l-l.l(c). Physicians are also authorized to engage in “the suggestion, recommendation or prescription or administration of any form of treatment, without limitation_” I.C. § 25-22.5-1-1.1(a)(1)(B). In contrast, registered nurses are limited to make nursing diagnosés. These diagnoses must be amenable to a nursing regimen, defined as “preventive, restorative, maintenance, and promotion activities which include meeting or assisting with self-care needs, counseling and teaching.” I.C. § 25-23-1-1.1(d). In addition, registered nurses are limited to treatments which are amenable to a nursing regimen. Thus, there is a significant difference in the scope of their respective diagnostic and treatment authority.
Therefore, we conclude that Nurse Stryc-zek is not qualified to offer expert testimony on the standards of care for physicians.
See Stackhouse,
Of the remaining conclusions contained in Nurse Stryczek’s affidavit, she could possibly offer testimony on the administration of cardio-toxic medications, if the testimony was limited to the standard of care for administering the medications by nurses. However, based upon our review of her affidavit and the designated evidence, Nurse Stryczek’s testimony would have focused upon whether the physicians failed to prescribe the prоper dosage of Adriamycin rather than whether the medications were administered improperly by the nurses involved. 3 Nurse Stryczek is not qualified to provide such expert testimony. Further, she is not qualified to testify as to whether this alleged deviation caused Elizabeth’s cardiac damage.
Finally, Nurse Stryczek testified in her affidavit that the hospital failed to “timely communicate the proper diagnosis received from some outside agencies prior to embarking on a course of radiation treatment.”- In her brief, Elizabeth relies on
Keene v. Methodist Hospital,
Elizabeth contends Methodist has once again failed to provide a procedure to ensure proper communication. 4 Specifically, she argues that the hospital failed to ensure the proper communication of outside pathology reports. However, Elizabeth misconstrues Keene. In Keene, it was the conclusory opinion of the radiologist based upon the X-rays that failed to be communicated to the proper persons. As Elizabeth indicated in her brief, the Keene court held that:
“[i]n Fowler v. Norways Sanitorium (1942),112 Ind.App. 347 ,42 N.E.2d 415 , the Court recognized the distinction between administrative acts and medical acts. Under the test used in that ease, the reading оf an X-ray would be a medical act requiring the professional opinion of a licensed radiologist. However, the decision on how to communicate that opinion is not a medical act that would cause the person so acting to be guilty of the offense of practicing medicine without a license.”
Id.
In the instant case, the pathologists waited for all of the outside laboratory reports before completing the revised pathology diagnosis. Upon hearing from the fourth outside laboratory on February 24, 1988, the pathologists issued their revised pathology diagnosis.
5
Dr. Barai’s office notified Dr.
*1191
Kapoor of the revised diagnosis the next day. The act of reviewing the reports and arriving at the revised diagnosis is a medical act.
See Keene,
Under this analysis, Elizabeth’s argument is better understood as that the final revised diagnosis could have been completed prior to receiving all four reports. However, because the reports were the basis upon which the revised pathology diagnosis was made, and arriving at the revised diagnosis is a medical act, the question of whether the final revised diagnosis could have been completed prior to receiving all four reports is a medical issue which requires аn expert opinion. For the same reasons above, Nurse Stryezek is not qualified to provide such expert testimony. Further, she is not qualified to testify as to whether this alleged' deviation resulted in Elizabeth’s cardiac damage. Consequently, because there is nothing left in the affidavit for which she was qualified to testify, Nurse Stryczek’s opinion testimony by way of affidavit is inadmissable. Therefore, we conclude, as apparently did the trial court, that Nurse Stryczek’s affidavit presented nothing that could generate a genuine issue of material fact as to Methodist’s alleged negligence. 6
Elizabeth also contends that there are genuine issues of material fact with regard to Methodist’s alleged negligent acts which do not require expert testimony. In her brief, Elizabeth alleges “negligent hiring, inadequate staffing, and failure to provide policies for communicating corrective diagnoses from outside agencies to the proper parties.” Appellant’s brief, pp. 24-25. However, her complaint does not specifically allege these claims. Even assuming that her complaint contains these amorphous claims, she has provided no factual allegations to support them. In Hansford v. Maplewood Station Bus. Park, we held that:
“[u]nder Indiana’s “notice” pleading system instituted in 1970, a pleading need not adopt a specific legal theory of recovery to be adhered throughout the case; a pleading must, however, plead the operative facts so as to place the defendant on notice as to the evidence to be presented at trial....”
*1192
Hansford v. Maplewood Station Bus. Park,
In sum, the claims which Elizabeth has sufficiently alleged require medical opinion to rebut the opinion of the medical review panel concluding that Methodist did not breach any standard of care. However, aside from Nurse Stryezek’s affidavit, which cannot be used, Elizabeth has designated no evidentia-ry material to rebut the opinion of the medical review panel. Consequently, Elizabeth has not presented any genuine issues of material fact with regard to any allegations of Methodist’s negligence. Therefore, the trial court did not err in granting summary judgment to Methodist.
For the foregoing reasons, we affirm the judgment of the trial court.
Affirmed.
Notes
. While Dr. Kapoor provided treatments and maintained an office at Broadway Methodist, the record does not indicate the precise location of Dr. Barai's office. According to his deposition. Dr. Kapoor maintained his own corporation, G.S. Kapoor, M.D., Inc., which had an independent contractual agreement with the Division of Radiology, the "mother corporation." Rеcord, p. 109. The Division of Radiology maintained a contractual agreement with Broadway Methodist Hospital. Finally, Broadway Methodist Hospital was a part of The Methodist Hospitals, Inc. Essentially, anyone who was to receive radiation oncology treatments at Methodist would do so through Dr. Kapoor’s group.
. According to the Appellee’s brief, Nurse Judith Stryczek is the mother of Elizabeth Stryczek.
. It may well be that the physicians themselves administered the chemotherapy and radiation treatments. However, we believe "prescribe” more accurately reflects the focus of Elizabeth’s argument.
. Although Elizabeth does not explicitly present this argument in her complaint, there are enough allegations in the complaint to consider it implicitly presented. In addition, she designated the issue to the trial court in her memorandum in opposition to defendant hospital’s second motion for summary judgment. Finally, she has designated evidentiary material to support her argument, though we conclude the evidence to be inadmissible.
.There is some conflicting evidentiary material as to when the diagnosis was made and when the last report was received. First, Dr. Kapoor testified in his deposition that the final revised diagnosis was based upon the results from three outside laboratories including: City of Hоpe, University of Southern California ("USC”), and Cornell University. The record does not contain a report from Cornell but does contain a report from Yale University. Second, the outside laboratory reports are dated January 29, 1988 (City of Hope), February 17, 1988 (Yale University), *1191 February 24 (University of Southern California), and March 25, 1988 (Armed Forces Institute). However, the report from the Armed Forces Institute indicates that the letter confirmed a phone сonversation that occurred on February 19, 1988. Both parties state that four reports were received prior to communicating the final revised diagnosis to Dr. Kapoor on February 25, 1988. The designated material supports this conclusion when one considers the phone conversation of February 19, 1988. Therefore, this is the conclusion we reach. Regardless, it would not alter the outcome of this appeal.
. We acknowledge the parties' arguments on what is required in an affidavit opposing the opinion of a medical review panel. We also acknowledge the conflicting opinions on this point of law.
See Oelling v. Rao,