Rish v. Simao ( 2016 )


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  •                                                        132 Nev,, Advance Opinion (1
    IN THE SUPREME COURT OF THE STATE OF NEVADA
    JENNY RISH,                                         No. 58504
    Appellant,
    vs.
    WILLIAM JAY SIMAO AND CHERYL
    FILED
    ANN SIMAO, INDIVIDUALLY AND AS                                  MAR 1 7 2016
    HUSBAND AND WIFE,
    Respondents.                                                               al
    T < F‘IU AVEM
    BCYLEF!.1.            R
    CHIEF DEPLOHCLERK-
    JENNY RISH,                                         No. 59208
    Appellant,
    vs.
    WILLIAM JAY SIMAO AND CHERYL
    ANN SIMAO, INDIVIDUALLY AND AS
    HUSBAND AND WIFE,
    Respondents.
    JENNY RISH,                                         No. 59423
    Appellant,
    vs.
    WILLIAM JAY SIMAO AND CHERYL
    ANN SIMAO, INDIVIDUALLY AND AS
    HUSBAND AND WIFE,
    Respondents.
    Consolidated appeals from a district court judgment in a tort
    action and from post-judgment orders denying a new trial and awarding
    attorney fees. Eighth Judicial District Court, Clark County; Jessie
    Elizabeth Walsh, Judge.
    Reversed, vacated, and remanded.
    Lewis Roca Rothgerber Christie, LLP, and Daniel F. Polsenberg and Joel
    D. Henriod, Las Vegas; Rogers, Mastrangelo, Carvalho & Mitchell, Ltd.,
    and Stephen H. Rogers, Las Vegas,
    for Appellant.
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    David T. Wall, Las Vegas; Eglet Prince and Robert T. Eglet and Robert M.
    Adams, Las Vegas,
    for Respondents.
    BEFORE HARDESTY, DOUGLAS and CHERRY, JJ.
    OPINION
    By the Court, HARDESTY, J.:
    Respondents William Jay Simao and Cheryl Ann Simao
    (Simao) filed a motion in limine to preclude appellant Jenny Rish from
    presenting a low-impact defense in a personal injury case arising out of an
    automobile accident. Simao claimed our holding in Hallmark v. Eldridge,
    
    124 Nev. 492
    , 500-02, 
    189 P.3d 646
    , 651-53 (2008), required the exclusion
    of low-impact evidence because Rish failed to retain a biomechanical
    expert to opine on the nature of the accident. In Hallmark, we held that a
    biomechanical engineer's testimony regarding whether the forces involved
    in a car accident could have caused the plaintiffs injury was without
    sufficient foundation to be admissible under NRS 
    50.275. 124 Nev. at 500
    -
    
    02, 189 P.3d at 651-53
    . Because Hallmark held that a biomechanical
    expert's testimony must have sufficient foundation to be admissible under
    NRS 50.275, not that a biomechanical expert's testimony must underlie all
    evidence of the alleged injury-causing accident, we conclude that the
    district court's order granting the motion in limine was in error as a
    matter of law.
    Following eight alleged violations of the district court's
    pretrial order prohibiting a low-impact defense and violations of two
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    additional pretrial orders, the district court struck Rish's answer as a
    sanction. Because the case-ending sanction order failed to satisfy the
    requirements of BMW v. Roth,       
    127 Nev. 122
    , 126, 
    252 P.3d 649
    , 652
    (2011), we reverse and remand this matter for a new trial.
    FACTS AND PROCEDURAL HISTORY
    Rish and William Simao were involved in a car accident in
    which Rish rear-ended William Simao in stop-and-go traffic. The damage
    to the vehicles was not extensive. While an ambulance was called, both
    Rish and William Simao refused medical treatment at the scene. William
    Simao later alleged that the accident injured his head and neck, causing
    him constant pain and requiring on-going medical treatment and
    procedures. Simao brought suit against Rish to recover damages for
    William's injuries and Cheryl's loss of consortium.
    Before trial, Simao filed a motion in limine asking the district
    court to preclude Rish, her attorneys, her medical expert, Dr. David Fish,
    and her witnesses from testifying, arguing, or insinuating that the
    collision was too insignificant to have caused William Simao's injuries.
    Citing to 
    Hallmark, 124 Nev. at 496-97
    , 189 P.3d at 649, Choat v.
    McDorman, 
    86 Nev. 332
    , 335, 
    468 P.2d 354
    , 356 (1970), and Levine v.
    Remolif, 
    80 Nev. 168
    , 171-72, 
    390 P.2d 718
    , 719-20 (1964), Simao asserted
    that any argument or evidence of a low-impact accident should be barred
    because Rish had not retained a biomechanical engineer who could first
    testify that the forces imparted by the collision were too insignificant to
    cause the injury. On this basis, Simao also argued that photographs of the
    vehicles and repair invoices should likewise be excluded as irrelevant
    because, without supporting expert testimony, there was no reliable
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    correlation between the extent of damage and the extent of injury, citing
    Hallmark, NRS 50.275, and Davis v. Maute, 
    770 A.2d 36
    , 40 (Del. 2001).
    Rish opposed the motion, arguing that physicians have always
    been permitted to consider the severity of the accident when formulating
    opinions and to opine on whether the force could have caused the injury.
    She further argued that none of the cases relied upon by Simao prohibit
    the defense from describing the accident as low impact, and that evidence
    of property damage was relevant, admissible, and not substantially
    prejudicial.
    At the motion hearing, the district court found the extent of
    property damage to be relevant but nevertheless granted Simao's motion
    in its entirety because, "pursuant to the Hallmark case," Rish did not have
    "a witness who can lay the proper foundation" for Rish to advance a low-
    impact defense. Finding the result was required by Hallmark, the district
    court granted Simao's requests to prohibit Rish "from Raising a 'Minor' or
    tow Impact' Defense," and to prohibit Dr. Fish and other experts from
    "opin[ing] regarding biomechanics or the nature of the impact of the
    subject crash." The court further prohibited photographs of the parties'
    cars and property damage invoices.
    Before and during the trial, Rish's trial counsel sought
    clarification of the district court's order in limine, voicing concerns that
    the order prevented the defense from offering any testimony showing the
    nature of the accident. The district court, stating that its order was clear,
    declined to clarify the order. During the trial, the court sustained eight
    objections by Simao to Rish's questions and evidence as violating the low-
    impact defense pretrial order.
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    During opening statements, and without objection from
    Simao, Rish's trial counsel described the accident by saying that Rish "was
    stopped behind [William Simao], who moved a few feet in front of her.
    [Rish] applied her brakes, only just not quite hard enough; and the
    accident follow [ed]." Rish's trial counsel also stated that no one in the
    accident claimed loss of consciousness, everyone refused help from the
    paramedics, and Rish drove away from the scene. Rish's trial counsel then
    attempted to play a portion of Rish's videotaped deposition. Simao
    objected. The district court's order indicated that the objection was
    sustained on hearsay grounds and because it contained testimony
    concerning "the nature of the accident."
    Rish's trial counsel cross-examined three of Simao's physician
    experts. During cross-examination of the first doctor, Rish's trial counsel
    asked if he "kn[ew] anything about what happened to Jenny Rish and her
    passengers in this accident." Simao objected on relevancy grounds and
    referenced the low-impact defense pretrial order. The district court
    sustained the objection without comment from Rish.
    Rish's trial counsel asked the second doctor if he "kn[e]w
    anything about the folks in Jenny Rish's car." Simao objected on
    relevancy grounds. A bench conference was held where Rish's trial
    counsel asked if the irrelevancy of his question had been addressed in a
    previous order. Simao briefly referenced the low-impact defense pretrial
    order, and the district court sustained the objection.
    Finally, Rish's trial counsel asked the third doctor: "bdou
    know [William Simao] wasn't transported by ambulance?" After the
    doctor replied in the affirmative, Rish asked: "You know that Jenny
    Rish . . . was lifted from the scene." Simao objected and asked that Rish's
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    trial counsel be admonished for disregarding the low-impact defense
    pretrial order. The objection was sustained, and the jury was told to
    disregard the question. Simao later sought to make a record, outside the
    presence of the jury, as to Rish's trial counsel's violation. The district
    court indicated that it would consider a progressive sanction and
    suggested that Rish's trial counsel reread the order.
    During Simao's cross-examination of Dr. Fish, Dr. Fish
    attempted to distinguish a case where he had causally related a patient's
    injury to her accident by stating, "Well, in this very significant accident,
    yes." Simao moved to strike most of the doctor's response, and the court
    instructed the jury to disregard all but the word "yes." On redirect of Dr.
    Fish, Rish's trial counsel asked how he reached the opinion that the
    accident did not cause William Simao's injuries. Dr. Fish stated that it
    was "based on multiple factors. It's based on the actual—looking at the
    images of the MRI. . It's looking at the notes that were taken of the
    events that happened and it's knowing about the accident itself." Simao
    objected and moved to strike, and the district court told the jury to
    disregard Dr. Fish's last phrase. Another exchange followed outside the
    presence of the jury, and Simao asked the court to give a presumption
    instruction to the jury as a sanction. The court ultimately instructed the
    jury that "there is an irrebuttable presumption that the motor vehicle
    accident of April 15, 2005 was sufficient to cause the type of injuries
    sustained by the Plaintiff. Whether it proximately caused those injuries
    remains a question for the jury to determine."
    Finally, during cross-examination of William Simao, Rish's
    trial counsel asked if the traffic was stop-and-go. Simao asked for a bench
    conference, and the district court precluded the question because it
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    improperly suggested that the impact was minor Rish's trial counsel then
    asked William Simao whether the paramedics had transported anyone
    from Rish's car. Simao objected, asked for a bench conference, and moved
    to strike Rish's answer. The district court granted the motion, entered a
    default judgment against Rish, and dismissed the jury.
    Thereafter, the district court held a prove-up hearing, at
    which it limited each party to a short argument regarding damages and
    awarded William Simao $194,390.96 for past medical expenses;
    $1,378,209 for past pain, suffering, and loss of enjoyment of life; and
    $1,140,552 for future pain, suffering, and loss of enjoyment of life. It also
    awarded $681,286 to Cheryl Simao for loss of consortium and attorney fees
    in the amount of $1,078,125. In all, the awards against Rish totaled
    nearly $4.5 million.' This appeal followed.
    DISCUSSION
    On appeal, Rish primarily challenges the validity of the
    district court's final sanction of striking her answer and entering a default
    judgment against her. The threshold question is whether the pretrial
    order precluding the testimony and evidence of a low-impact defense was
    erroneous as a matter of law. We hold that it was. We also hold that the
    district court erred by striking Rish's answer, and we reverse the district
    court's judgment and order a new trial.
    'Because we are reversing this matter for a new trial, we do not
    address the procedure used by the district court to determine damages
    pursuant to Foster v. Dingwall, 
    126 Nev. 56
    , 68, 
    227 P.3d 1042
    , 1050
    (2010) ("[T]he nonoffending party[ has an] obligation to present sufficient
    evidence to establish a prima facie case, which includes substantial
    evidence that the damages sought are consistent with the claims for which
    the nonoffending party seeks compensation.").
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    The district court erred in extending Hallmark to preclude all argument of
    a low-impact defense
    Trial courts have broad discretion in determining whether to
    admit evidence and may exclude relevant evidence that is substantially
    more unfairly prejudicial than probative. NRS 48.035(1); S. Pac. Transp.
    Co. v. Fitzgerald, 
    94 Nev. 241
    , 243, 
    577 P.2d 1234
    , 1235 (1978). When the
    district court abuses its discretion in determining whether to admit or
    exclude evidence, this court will overturn the district court's
    determination. Land Res. Dev. v. Kaiser Aetna, 
    100 Nev. 29
    , 34, 
    676 P.2d 235
    , 238 (1984).
    During the proceedings below, Simao argued that Hallmark
    precludes all testimony, evidence, argument, and insinuation of a low-
    impact defense unless the party offering it first provides a foundation for
    this defense through expert testimony from a qualified biomechanical
    engineer. The district court agreed and imputed the reasoning from
    Hallmark to bar any evidence of a minor or low-impact defense.
    We held in Hallmark that the district court abused its
    discretion in allowing an expert witness, who was both a physician and
    mechanical engineer, to testify that an accident was too low impact to
    have caused the plaintiffs 
    injuries. 124 Nev. at 502
    , 189 P.3d at 652.
    Although we determined that the witness was qualified to testify as an
    expert, we concluded that the expert did not have an adequate factual or
    scientific basis for his opinions regarding the nature of the accident after
    he acknowledged that he failed to review critical information when he
    formed his opinion. 
    Id. at 497,
    504, 189 P.3d at 649
    , 654. Rather, the
    expert's opinion was based more on supposition than science and did not
    qualify as admissible expert testimony under NRS 50.275 because
    biomechanics was not a recognized field of expertise, the testimony had
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    OPLT5-710
    not been and could not be tested, and the expert's theories and methods
    had not been subjected to peer review. Id. at 500-
    02, 189 P.3d at 651-53
    .
    While noting that biomechanical testimony was not necessarily precluded
    in every case, we determined that the expert's testimony in that case was
    without a sufficient foundation to be admitted. 
    Id. at 504,
    189 P.3d at 654.
    Thus, Hallmark focused specifically on the admissibility of expert
    testimony.
    Nothing in Hallmark mandates that supporting testimony
    from a certified biomechanical engineer or other expert must be offered
    before a defendant will be allowed to present a low-impact defense. 2
    Rather, Hallmark stands for the well-established proposition that expert
    testimony, biomechanical or otherwise, must have a sufficient foundation
    before it may be admitted into evidence. 
    Id. at 503-04,
    189 P.3d at 653-54;
    see also Daubert v. Merrell Dow Pharm., Inc., 
    509 U.S. 579
    , 590 (1993);
    City of Pomona v. SQM N. Am. Corp., 
    750 F.3d 1036
    , 1043 (9th Cir.), cert.
    denied U .S. , 135 S. Ct. 870(2014); Howard Entm't, Inc. v. Kudrow,
    
    146 Cal. Rptr. 3d 154
    , 170 (Ct. App. 2012). In the absence of a specific
    issue concerning the speed or the nature of the impact, mandating
    2 Inarguing below that a low-impact defense requires supporting
    testimony from a qualified biomechanical engineer, Simao also cited to
    Choat v. McDorman, 
    86 Nev. 332
    , 335, 
    468 P.2d 354
    , 356 (1970), and
    Levine v. Remolif, 
    80 Nev. 168
    , 171-72, 
    390 P.2d 718
    , 719-20 (1964).
    Neither of those cases creates such a rule. Rather, in both of those cases,
    we held that an expert may not testify to the specific speed of the vehicles
    at the time of a collision absent a sufficient foundation for that
    determination. 
    Choat, 86 Nev. at 335
    , 468 P.2d at 356; 
    Levine, 80 Nev. at 171-72
    , 390 P.2d at 719-20. Moreover, as neither case addressed whether
    medical doctors may opine on injury causation, they are inapplicable to
    the issue before this court.
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    supporting expert testimony as a prerequisite to advancing a general low-
    impact defense would effectively and impermissibly deprive juries of
    hearing any testimony regarding the nature and circumstances of the
    accident and any resulting injuries unless an expert first describes the
    accident to the jury. 3 See Banks v. Sunrise Hosp., 
    120 Nev. 822
    , 838, 
    102 P.3d 52
    , 63 (2004) (noting that it is for the jury to determine the credibility
    of and the weight to be given to testimony where evidence presented on a
    material point may be conflicting or facts could support differing
    inferences). Nothing in Hallmark mandates such a requirement, and we
    have previously determined that causation issues, including the
    circumstances and severity of an accident and whether it proximately
    caused the alleged injuries, are factual issues that are proper for a jury to
    weigh and determine. See Nehls v. Leonard, 
    97 Nev. 325
    , 328, 
    630 P.2d 258
    , 260 (1981) (holding that whether a collision proximately caused
    respondent's injuries were factual issues for the jury to resolve); Fox v.
    Cusick, 
    91 Nev. 218
    , 221, 
    533 P.2d 466
    , 468 (1975) (concluding that it is
    "for the jury to weigh the evidence and assess the credibility" of the
    witnesses); Barreth v. Reno Bus Lines, Inc., 
    77 Nev. 196
    , 198, 
    360 P.2d 1037
    , 1038 (1961) (the jury decides questions of proximate cause). The
    district court therefore abused its discretion in prohibiting Rish from
    presenting or eliciting any evidence and testimony regarding the nature
    and circumstances of the accident, as well as the injuries suffered by Rish
    and her passengers. See AA Primo Builders, LLC v. Washington,         
    126 Nev. 3
    Generally,  once a plaintiff presents testimony regarding the nature
    of the impact in a vehicle collision case, the defense may present evidence
    to rebut the plaintiff's assertions. See Provence v. Cunningham, 
    95 Nev. 4
    ,
    7-8, 
    588 P.2d 1020
    , 1021-22 (1979).
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    578, 589, 
    245 P.3d 1190
    , 1197 (2010) ("While review for abuse of discretion
    is ordinarily deferential, deference is not owed to legal error."); see also
    Cooter & Gell v. Hartmarx Corp., 
    496 U.S. 384
    , 405 (1990) ("A district
    court would necessarily abuse its discretion if it based its ruling on an
    erroneous view of the law or on a clearly erroneous assessment of the
    evidence."), superseded by rule on other grounds, Fed. R. Civ. P. 11.
    As to whether a medical doctor may relate the nature and
    severity of the impact to the injuries, we note that courts in other
    jurisdictions have allowed such testimony. See, e.g., Mattek v. White, 
    695 So. 2d 942
    , 943 (Fla. Dist. Ct. App. 1997) (holding that defendant's expert
    in accident reconstruction and biomechanical engineering, who was not a
    medical doctor, was not qualified to opine on the extent of plaintiffs
    injury); Santos v. Nicolos,    
    879 N.Y.S.2d 701
    , 704 (Sup. Ct. 2009)
    (explaining that biomechanical engineer was not qualified to testify about
    the causal relationship between an accident and the injuries of the
    plaintiff because he was not a medical doctor); Streight v. Conroy, 
    566 P.2d 1198
    , 1200 (Or. 1977) (refusing to assign error where the trial court
    allowed expert medical witnesses to testify as to whether the impact could
    have caused plaintiffs wife's back problems after viewing photographs of
    the accident because the jury could review the evidence and "give such
    weight to the experts' testimony as they saw fit"); Wilson v. Rivers, 
    593 S.E.2d 603
    , 605 (S.C. 2004) (stating that medical doctor "was qualified to
    render an opinion on the forces created by an impact and on the general
    effects on the human body caused by such forces and,. . . an opinion
    regarding the cause of respondent's particular medical problems"); John v.
    Im, 
    559 S.E.2d 694
    , 697 (Va. 2002) ("[S]ince [the expert] was not a medical
    doctor, he was not qualified to state an expert medical opinion regarding
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    the cause of [the] injury."). And in Hallmark, this court suggested that
    had the defense expert, who was also a medical doctor, physically
    examined the plaintiff or reviewed her medical history, the defense may
    have been able to lay a proper foundation to allow the expert to testify as
    to causation. 124 Nev. at 
    504, 189 P.3d at 654
    .
    Based on this analysis, we conclude that a medical doctor may
    offer an opinion regarding causation so long as there is a sufficient
    foundation for the conclusion. We do not intend by this opinion to suggest
    that low-impact collisions cannot result in serious injuries. Low-impact
    collisions can cause serious, as well as minor, injuries, but, as noted above,
    the nature of the impact is a factor for the trier of fact to consider in
    determining the causation of the injuries that form the basis of the claim.
    In this case, Dr. Fish examined William Simao's medical records, the MRI
    images, and photographs of the damage to the parties' vehicles, and
    therefore had a sufficient basis to offer an opinion on whether the accident
    caused William Simao's injuries. 4
    4 The district court also excluded from evidence all photographs of
    the vehicles and invoices for the repair work on the basis that such
    evidence was substantially prejudicial and that Hallmark required
    supporting testimony from a biomechanical engineer in order to be
    admissible. During arguments, Fish withdrew any objection to the district
    court's ruling, and therefore, we do not decide whether the district court
    erred in either applying Hallmark to bar the admission of the photographs
    and invoices. However, we note that other jurisdictions generally admit
    such evidence because, even in the absence of supporting expert
    testimony, there is a common-sense correlation between the nature of the
    impact and the severity of the injuries, and a plaintiff may overcome any
    prejudicial effect by offering contradicting testimony, cross-examining the
    witnesses, and utilizing other mechanisms to prove his or her case. See
    Johnson v. McRee, 
    152 P.2d 526
    , 527-28 (Cal. Ct. App. 1944); Martin v.
    Miqueu, 
    98 P.2d 816
    , 818 (Cal. Ct. App. 194W; Hayes v. Sutton, 190 A.2d
    continued on next page...
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    The district court erred in striking the answer
    We now turn to the validity of the sanction, which we review
    under a somewhat heightened standard of review. See Foster v. Dingwall,
    
    126 Nev. 56
    , 65, 
    227 P.3d 1042
    , 1048 (2010) ("[A] somewhat heightened
    standard of review applies where the sanction strikes the pleadings,
    resulting in dismissal with prejudice."). A party is required to follow court
    orders, even erroneous ones, until overturned or terminated.        Walker v.
    City of Birmingham, 
    388 U.S. 307
    , 320-21 (1967) (holding that order
    violating civil rights should have nevertheless been followed until
    overturned); see also Howat v. Kansas, 
    258 U.S. 181
    , 190 (1922) ("It is for
    the court of first instance to determine the question of the validity of the
    law, and until its decision is reversed for error by orderly review, either by
    itself or by a higher court, its orders based on its decision are to be
    respected, and disobedience of them is contempt of its lawful authority, to
    be punished."). Even if the order is later overruled, a sanction predicated
    on violations of that order may remain in force.     See Beauregard, Inc. v.
    Sword Services LLC, 
    107 F.3d 351
    , 354 (5th Cir. 1997).
    Here, the district court imposed a case-ending sanction by
    striking Rish's answer, entering a default, and conducting a prove-up
    hearing. Following argument on Simao's motion to strike Rish's answer,
    the district court entered a written order analyzing the factors in Young v.
    ...continued
    655, 656 (D.C. 1963); Cancio v. White, 
    697 N.E.2d 749
    , 756 (Ill. App. Ct.
    1998); Mason v. Lynch, 
    878 A.2d 588
    , 601 (Md. 2005); Brenman v.
    Demello, 
    921 A.2d 1110
    , 1118 (N.J. 2007); Gambrell v. Zengel, 
    265 A.2d 823
    , 824-25 (N.J. Super. Ct. App. Div. 1970); Accetta v. Provencal, 
    962 A.2d 56
    , 61-62 (R.I. 2009); Murray v. Mossman, 
    329 P.2d 1089
    , 1091
    (Wash. 1958).
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    Johnny Ribeiro Building, Inc., 
    106 Nev. 88
    , 93, 
    787 P.2d 777
    , 780 (1990),
    and finding that Rish's trial counsel's conduct violated the low-impact
    defense pretrial order. The order concluded that counsel engaged in
    misconduct by violating the low-impact defense pretrial order on eight
    occasions during trial: one incident involved a videotaped deposition that
    Rish's trial counsel attempted to play during opening statements, four
    incidents involved questions Rish's trial counsel posed to William Simao
    and his experts concerning what happened to Rish and her passengers
    following the accident, one incident involved Rish's trial counsel asking
    William Simao if there was stop-and-go traffic prior to the accident, and
    two incidents involved Dr. Fish's answers during cross-examination and
    redirect.°
    °The district court's oral order imposing case-ending sanctions was
    "primarily" based on Rish's trial counsel's violations of the low-impact
    defense pretrial order, but its written order also makes reference to three
    additional violations of two separate pretrial orders. The parties did not
    raise, and we do not analyze, the question of whether these two additional
    pretrial orders and their corresponding violations violate BMW, 
    127 Nev. 122
    , 126, 
    252 P.3d 649
    , 652 (2011). Based on our disposition, we resolve
    them briefly here.
    First, during opening statement, Rish's trial counsel referred to an
    unrelated motorcycle accident involving William Simao, which was barred
    by a pretrial order. Second, Rish's trial counsel stated during opening
    statement that doctors were going to testify and that some of them appear
    regularly in court, and later Rish's trial counsel asked Dr. McNulty on
    cross-examination whether he had testified around 100 times. Simao
    objected to this question, and the district court sustained the objection.
    These violations were allegedly barred by a pretrial order excluding any
    attempt to present an "attorney driven' or a 'medical-buildup' case."
    Neither of these alleged medical-build up violations appear to
    actually fall within the pretrial order. In fact, the opening statement and
    continued on next page...
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    In BMW v. Roth, 
    127 Nev. 122
    , 126, 
    252 P.3d 649
    , 652 (2011),
    we held "[for violation of an order in limine to constitute attorney
    misconduct requiring a new trial, the order must be specific, the violation
    must be clear, and unfair prejudice must be shown." Although the
    sanction requested in BMW differs from the sanction requested here,
    BMW's analysis is applicable because it addresses the larger issue of
    attorney misconduct.   See also 
    Foster, 126 Nev. at 66
    , 227 P.3d at 1049
    (discussing whether "the court's decision to strike defendants' pleadings
    and enter default was just, related to the claims at issue in the violated
    discovery order, and supported by a careful written analysis of the
    pertinent factors").
    ...continued
    cross-examination question are relevant to credibility. See Delaware v.
    Van Arsdall, 
    475 U.S. 673
    , 678-79 (1986) ("[T]he exposure of a witness
    motivation in testifying is a proper and important function of the
    constitutionally protected right of cross-examination." (internal quotation
    marks omitted)); Robinson v. G.G.C., Inc., 
    107 Nev. 135
    , 143, 
    808 P.2d 522
    , 527 (1991) ("Expert witness testimony is, in some respects, akin to a
    business arrangement between the witness, the hiring attorney and the
    client. The trier of fact has the right to take business associations into
    account when determining the credibility of witnesses and the weight to
    give their testimony."). Additionally, they do not implicate "medical build-
    up." "Medical buildup" concerns a party "seekfing] necessary but costly
    medical treatment, that they would otherwise forego" in order to generate
    a larger award. Nora Freeman Engstrom, Sunlight and Settlement Mills,
    86 N.Y.U. L. Rev. 805, 834 (2011); see also Bruce A. Hagen, Karen K.
    Koehler & Michael D. Freeman, 2 Litigating Minor Impact Soft Tissue
    Cases § 36:12 (2015) (explaining that a motion seeking to preclude a
    defendant from referring to a case as a "medical buildup" or "attorney-
    driven" case "seeks to preclude any evidence or statement implying that
    medical treatment was sought as a result of litigation—or at the
    suggestion of Plaintiffs attorneys").
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    Specificity of the order
    The low-impact defense pretrial order "preclude [d] [Rishl from
    Raising a 'Minor' or tow Impact' Defense," but it gives no further
    guidance except to specifically preclude Dr. Fish and other witnesses from
    testifying, arguing, or insinuating that the collision was too insignificant
    to have caused William Simao's injuries. Rish's trial counsel expressed his
    confusion with the order on numerous occasions, but the district court
    refused to clarify what it would and would not allow.
    A low-impact defense is defined as "describ[ing] [an] incident
    as 'low impact' in order "to liken the incident to common, everyday
    experiences." Roxanne Barton Conlin & Gregory S. Cusimano, Litigating
    Tort Cases § 53:22 (2014). The district court appears to broadly construe
    the term low-impact defense to include the facts before, during, and after
    the accident.
    However, Rish, without objection, was permitted to describe
    the accident in her opening statement, stating that "she was stopped
    behind [William Simad who moved a few feet in front of her. . . ; [Rish]
    applied her brakes, only just not quite hard enough; and the accident
    followled]." Thereafter, Simao objected to questions concerning the nature
    of the accident, including questions posed by Rish's trial counsel
    concerning traffic conditions and what Rish did following the accident.
    These objections were all sustained. This inconsistent application of the
    low-impact defense pretrial order leads to our conclusion that the order
    prohibiting the low-impact defense lacks specificity.
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    Clarity of the violations
    Two of the violations of the low-impact defense pretrial order
    were statements made by Dr. Fish. Dr. Fish's implied comment that the
    accident was not significant was made during Simao's cross-examination,
    and his statement that William Simao's injuries were based, in part, on
    knowledge of the accident was made during redirect. Nothing in the
    record or the district court's order shows that Fish's trial counsel
    prompted or caused Dr. Fish to testify in violation of the low-impact
    defense pretrial order.
    The other instances of attorney misconduct regard the same
    basic questions posed by Rish's trial counsel: whether the witness knew
    what happened to Fish as a result of the accident and whether there was
    stop-and-go traffic before the accident. While these instances might be
    construed to violate the low-impact defense pretrial order, none of them
    describe the accident itself. We conclude that there is no clear violation,
    let alone misconduct, of the low-impact defense pretrial order caused by
    these questions.
    Unfair prejudice
    Even if we were to find clear misconduct, there was no unfair
    prejudice to Simao. The district court found that "no lesser sanction had
    been successful in precluding future violations." But, the district court's
    order fails to explain why. Under this prong, the district court is required
    to find that a violation is so extreme that it cannot be eliminated through
    an objection and admonition. Lioce v. Cohen, 
    124 Nev. 1
    , 17, 
    174 P.3d 970
    ,
    6 We note that the district court never described how the alleged
    instances of misconduct violated the pretrial orders.
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    981 (2008). The district court failed to meet this requirement because it
    did not articulate why the various admonitions and, ultimately, the
    irrebuttable presumption instruction were inadequate to address the
    alleged misconduct.
    Even if an irrebuttable presumption instruction was justified,
    the instruction itself was confusing. The jury was first instructed that the
    accident in this case was sufficient to cause William Simao's injuries.
    However, the jury was then instructed that it was to determine whether
    the accident proximately caused William's injuries. But given the first
    part of the instruction, it is unclear how Rish could show or the jury would
    decide whether the accident caused William's injuries. Also, the district
    court did not explain the difference between causation and proximate
    causation, so the jury would not have been able to effectively understand
    or utilize the instruction. Further, regardless of its confusion, the
    instruction was more than sufficient to remedy any misconduct that
    occurred up to that point in the trial.
    While it is true that two more alleged violations of the low-
    impact defenseS pretrial order occurred before the district court struck
    Rish's answer, the district court struck both questions posed by Rish's trial
    counsel and William Simao did not answer either. The district court did
    not explain how these two alleged violations raised the aggregate
    misconduct to a level warranting the ultimate case-ending sanction.
    Because we• conclude that any misconduct by Rish's trial
    counsel did not rise to the level requiring the case-ending sanctions
    imposed by the district court under 
    BMW, 127 Nev. at 126
    , 252 P.3d at
    652, we vacate the order striking Rish's answer.
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    Accordingly, for the reasons set forth above, we reverse the
    district court's judgment and post-judgment order denying a new tria1, 7
    and we remand this matter to the district court for a new trial consistent
    with this opinion. 8
    xer.AtA.-\         J.
    Hardesty
    We concur:
    J.
    7 We  decline to assign this case to a different judge because the
    district court's rulings do not suggest bias. See Millen v. Eighth Judicial
    Dist. Court, 
    122 Nev. 1245
    , 1254-55, 
    148 P.3d 694
    , 701 (2006)
    ("[D]isqualification for personal bias requires an extreme showing of bias
    that would permit manipulation of the court and significantly impede the
    judicial process and the administration of justice." (internal quotation
    marks and alteration omitted)).
    8 In   light of this opinion, the attorney fees order is also vacated.
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