Nephrology Experts May Rely on Principles Taught in Residency to Render Opinions Regarding Standard of Care

Court: Court of Appeals of Mississippi
Jurisdiction: Federal
Case Name: Kronfol v. Johnson
Citation: 2019 Miss. App. LEXIS 183


The petitioner brought a medical malpractice suit against the appellant for injuries that she suffered when a catheter in her dialysis port became infected. The petitioner suffered kidney failure and was under the appellant’s care for her kidney and dialysis needs. She suffered sepsis with tachycardia secondary to an infected temporary catheter in her internal jugular vein during hemodialysis.

The petitioner retained nephrology expert witness who testified that the appellant breached the standard of care by allowing the petitioner’s temporary catheter to be in for more than one week. The expert further claimed that this negligence led to the petitioner’s infection from Methicillin-resistant Staphylococcus aureus (MRSA) and later sepsis.

The appellant moved under Mississippi Rule of Evidence 702 and Daubert to strike the nephrology expert’s opinions. The appellant relied on the National Kidney Foundation’s 2006 Updates to Clinical Practice Guidelines and Recommendations. The trial court ultimately denied the appellant’s motion to strike.

The appellant appealed on the grounds that the trial court erred in failing to grant his Daubert challenge to the nephrology expert’s reliance upon “guidelines,” which were not the standard of care, were outdated, and were not scientifically valid, and that the Expert had failed to mention national standards of duty of care that nephrologists should adhere to.

The Nephrology Expert

The plaintiff’s nephrology expert was affiliated with several hospitals in the Birmingham, Alabama area. He received his medical degree from the University of Toledo College of Medicine, and at the time of the case, he had been in practice for almost 20 years.


The court set down the boundaries of its perusal by saying it “should find error in the trial court’s decision to exclude expert testimony only if the decision was arbitrary or clearly erroneous.” (citing Patterson v. Tibbs, 60 So. 3d 742, 748 (Miss. 2011)). The court also noted that an expert witness must be qualified to render an opinion and that expert witnesses “should be given wide latitude when offering opinions within their expertise,” (citing Patterson) At the same time, the court noted that expert testimony admitted at trial must be based on scientific methods and procedures, not on unsupported speculation or subjective belief, citing McKee v. Bowers Window & Door Co., 64 So. 3d 926, 932 (¶18) (Miss. 2011).

When reviewing the trial court’s decision to deny the appellant’s Daubert challenge of the expert’s opinion for arbitrariness, the court discussed the expert’s testimony that he had depended on not only the guidelines for his opinion but also his training and experience as a nephrologist. The expert explained that the guidelines are taught in residency programs to determine the proper standard of care. The court found that the expert’s testimony was relevant because he grounded his opinions and testimony in the medical records, the methods and scientific principles taught in residency programs, and methods and principles instructed upon by medical texts.


The court held that the trial court had not erred by acting arbitrarily in denying the appellant’s Daubert challenge to the testimony proffered by the petitioner’s nephrology expert witness.

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