1. Introduction
Deering v. Jehorek arises from a traffic collision involving a heavy commercial vehicle: Jason Deering, operating a 35-ton commercial boom crane truck for Phillips Crane Service, LLC (collectively, “Crane Service”), ran a red light after brake failure and struck a vehicle driven by Kathleen Jehorek, who entered on a green light.
Critically, Crane Service stipulated to breaching the duty of care, narrowing the trial to medical causation and damages. Pretrial and trial management decisions—especially multiple motions in limine, admission of expert testimony using functional magnetic resonance imaging (fMRI) to support a mild traumatic brain injury (MTBI) diagnosis, and the giving of a concurrent-cause jury instruction—became the centerpiece of the appeal after a jury awarded $10,332,285.44 (including prejudgment interest).
The Supreme Court of Nevada affirmed across the board, offering a practice-focused roadmap on (i) relevance after a liability stipulation, (ii) boundaries of “anti-lawsuit” or “attorney-driven” narratives in closing argument, (iii) when medical-lien evidence meaningfully shows bias, (iv) how Nevada’s Hallmark reliability factors apply to fMRI-based opinions, and (v) when concurrent-cause instructions are appropriate.
3. Analysis
3.1 Precedents Cited (and How They Shaped the Decision)
Old Aztec Mine, Inc. v. Brown
The court relied on Old Aztec Mine, Inc. v. Brown to enforce a core appellate principle: a party cannot raise a new theory on appeal that was not presented to the district court. Here, Crane Service attempted to justify Deering’s excluded testimony on a causation theory not argued below; the court held that theory waived.
Practical effect: In limine disputes, counsel must make a clear record of all relevance theories (e.g., causation, credibility, comparative fault, mitigation) or risk forfeiture on appeal.
Las Vegas Metro. Police Dep’t v. Yeghiazarian
Las Vegas Metro. Police Dep’t v. Yeghiazarian supplied the abuse-of-discretion framework for evidentiary exclusions. The affirmance underscores that, once a district court identifies the “facts of consequence” remaining for the jury, appellate courts generally defer to relevance and balancing determinations unless clearly unreasonable.
Whisler v. State
The court used Whisler v. State to reiterate that in limine rulings are reviewed for abuse of discretion and that trial judges have meaningful latitude in policing the line between fair inferences and improper prejudice—especially regarding arguments that can inflame juror attitudes about litigation itself.
Lioce v. Cohen
Lioce v. Cohen is the opinion’s anchor for restricting “anti-lawsuit” rhetoric. The district court, affirmed by the Supreme Court, treated insinuations that the claim was meritless because the plaintiff retained counsel quickly or because the husband threatened to sue as the sort of argument that “instigate[s] jury nullification” by fostering “disdain and distrust for personal injury cases and the civil jury process.”
The court also extended that Lioce logic to “medical build-up” and “attorney-driven care” themes, emphasizing that even if some underlying facts exist (lawyer involvement, referrals), the trial court retains discretion to find the leap to “this case is manufactured” too prejudicial or system-attacking to be fair.
Pizarro-Ortega v. Cervantes-Lopez
Pizarro-Ortega v. Cervantes-Lopez did two kinds of work:
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It framed the boundary between improper system attacks and permissible merits arguments: “send a message” arguments may be allowed when “based on the evidence,” so long as counsel is not asking jurors to “ignore the evidence.”
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It provided the bias-relevance principle for medical liens: lien evidence can be relevant, but its “degree of relevance is limited” when the plaintiff must pay regardless of case outcome—supporting exclusion under NRS 48.035(1) when prejudice outweighs probative value.
Hallmark v. Eldridge
Hallmark v. Eldridge supplied Nevada’s reliability screen for expert testimony (often described as Nevada’s approach to expert gatekeeping). The court affirmed the district court’s use of the Hallmark factors to admit fMRI-based MTBI testimony, treating the RSNA statement as impeachment rather than a dispositive admissibility bar on this record.
D & D Tire, Inc. v. Ouellette
The court relied on D & D Tire, Inc. v. Ouellette for the standard governing jury instructions: district courts have discretion to admit or refuse instructions, and appellate review asks whether the instruction accurately states the law and fits the evidentiary dispute.
Banks v. Sunrise Hosp.
Banks v. Sunrise Hosp. supported the concurrent-cause instruction as a correct statement that proximate cause need not be the only or nearest cause; it is enough that it “concurs with some other cause acting at the same time” to produce injury. The court analogized to Banks, where competing causal narratives made the instruction useful to prevent an erroneous “sole cause” mindset.
Beccard v. Nev. Nat. Bank
The opinion invoked Beccard v. Nev. Nat. Bank to reject an argument that Jehorek misused the concurrent-cause instruction in closing: without a specific, preserved objection, appellate relief is unavailable. This reinforces the opinion’s broader theme: preservation controls outcomes in trial-management appeals.
3.2 Legal Reasoning
(A) Relevance after a liability stipulation: narrowing the “facts of consequence” (NRS 48.015)
The court treated the stipulation to duty and breach as a procedural narrowing device that redefines what is “of consequence” under NRS 48.015. Because the trial issues were medical causation and damages, testimony about Deering’s attempts to avoid the collision was deemed not to make a consequential fact more or less probable.
This reasoning reflects a disciplined view of relevance: evidence can be emotionally or narratively important (e.g., to show the driver “tried”), yet still be legally irrelevant once liability is not in dispute.
(B) Closing-argument guardrails: distinguishing merits advocacy from civil-system disparagement
The court affirmed the trial court’s line-drawing under Lioce v. Cohen: arguments that invite jurors to devalue a claim because the plaintiff hired a lawyer quickly, or because someone at the scene threatened suit, can shift the jury’s focus from evidence to resentment about litigation culture. The same concern applies to loosely supported claims that treatment was “attorney-driven.”
Importantly, the court did not hold that evidence of counsel involvement is always inadmissible or unusable. Instead, it deferred to the district court’s assessment that the record here (quick retention, a threat to sue, two instances of attorney input on care) was not substantial enough to justify the argumentative jump to “this case is manufactured,” especially given the prejudice risk.
(C) Medical-liens evidence: limited probative value where patient remains responsible (NRS 48.035(1))
The court acknowledged the general theory: liens may show provider bias (e.g., a financial stake aligned with the plaintiff’s recovery). But it emphasized, consistent with Pizarro-Ortega, that the probative value shrinks when the plaintiff must pay regardless of outcome—reducing the inference that a provider’s testimony is contingent on the verdict.
With diminished probative value, the district court’s NRS 48.035(1) determination—that unfair prejudice substantially outweighed probative value—fell well within permissible discretion.
(D) fMRI MTBI expert testimony: reliability is contextual under Hallmark
Crane Service’s principal attack was general acceptance, bolstered by an RSNA statement cautioning against “routine clinical use” of fMRI to diagnose individual TBI patients. The Supreme Court affirmed the district court’s approach: general acceptance is a factor, “not always determinative,” and a professional statement like RSNA’s can serve as strong impeachment without mandating exclusion where other reliability indicators are satisfied.
The district court found the opinion (1) within a recognized field, (2) testable and tested, (3) published and peer reviewed, and (5) grounded in particularized facts. The Supreme Court also highlighted the plaintiff’s documentation of thousands of supporting articles and prior acceptance in multiple courts, reinforcing that the methodology was not so speculative as to be inadmissible per se.
Key nuance: The opinion does not announce that “fMRI is always admissible for MTBI.” It affirms a discretionary, factor-based gatekeeping decision on the record presented.
(E) Concurrent-cause instruction: avoiding a “sole cause” misunderstanding
With medical causation contested, the instruction served a clarifying function: jurors may find proximate cause even when other causes are operating “at the same time.” The court deemed the instruction an accurate statement of Nevada law and a reasonable fit under Banks v. Sunrise Hosp..
3.3 Impact
1) Litigation conduct and “anti-lawsuit” themes
The decision strengthens Nevada trial courts’ authority to cabin arguments that leverage common cultural skepticism about personal-injury litigation (e.g., “they lawyered up immediately,” “they threatened to sue,” “the treatment was run by lawyers”) when the evidentiary foundation is thin and the rhetorical aim is to discredit the civil system rather than test medical causation.
2) Medical liens as bias evidence: more context, less reflex
The ruling reinforces a contextual approach: lien evidence is not automatically admitted to show bias. When the plaintiff is personally obligated for the bills regardless of outcome, courts may view lien evidence as carrying limited probative value and significant prejudice risk—particularly if it invites jurors to discount care as “litigation medicine” without strong supporting proof.
3) Expert-gatekeeping for advanced diagnostics
For emerging or contested medical technologies (like fMRI applications to MTBI), the opinion signals that Nevada courts will apply Hallmark pragmatically: professional-society cautionary statements may sharpen cross-examination and competing expert testimony, but they do not necessarily defeat admissibility if the methodology is testable, peer-reviewed, applied to particularized facts, and otherwise reliable.
4) Trial structuring after stipulations
Once a defendant stipulates to liability elements, evidence that primarily explains “how” the accident happened may be excluded as irrelevant if it does not bear on the remaining issues. This can materially change trial storytelling and witness presentation, pushing parties to tailor proof to medical causation and damages.
5) Preservation as an outcome driver
The opinion is also a cautionary tale: waiver and lack of specific objection (Old Aztec Mine, Inc. v. Brown; Beccard v. Nev. Nat. Bank) can foreclose appellate review even where a party believes the jury was misled.
5. Conclusion
Deering v. Jehorek affirms a substantial verdict while clarifying several trial-practice pressure points in Nevada tort litigation. The court (1) endorsed strict issue-narrowing after liability stipulations when applying relevance rules, (2) reinforced Lioce v. Cohen-based limits on “attorney-driven care” and similar anti-lawsuit themes absent a strong evidentiary basis, (3) treated medical-lien evidence as only modestly probative of bias when the plaintiff remains personally liable for the bills, (4) upheld admission of fMRI-based MTBI testimony under the Hallmark reliability framework, and (5) approved concurrent-cause instructions when medical causation is genuinely disputed.
The decision’s broader significance lies less in any single evidentiary holding than in its combined message: Nevada appellate review is highly deferential to trial-court discretion in managing evidence and argument, and outcomes on appeal often turn on careful preservation, disciplined relevance analysis, and the ability to ground trial themes in substantial record support rather than litigation stereotypes.