Court Opinion

ID: 9899277
Source: CourtListenerOpinion
Date Created: 2023-11-16 17:04:26.084489+00
Date Added: 2024-06-11T09:20:17.295188
License: Public Domain

The summaries of the Colorado Court of Appeals published opinions
  constitute no part of the opinion of the division but have been prepared by
  the division for the convenience of the reader. The summaries may not be
    cited or relied upon as they are not the official language of the division.
  Any discrepancy between the language in the summary and in the opinion
           should be resolved in favor of the language in the opinion.

                                                                 SUMMARY
                                                          November 16, 2023

                               2023COA108

No. 22CA1502, Gresser v. Banner Health — Health and Welfare
— Health Care Availability Act — Limitation of Liability —
Award in Excess of Limitation

     A division of the court of appeals considers the scope of a trial

court’s discretion to award past and future economic damages once

the court decides to lift the $1 million statutory cap in a case

governed by the Health Care Availability Act. As a matter of first

impression, the division holds that, after making the necessary

findings to exceed the cap pursuant to section 13-64-302(1)(b),

C.R.S. 2023, a trial court retains its authority to reduce by

remittitur the jury’s award of past and future economic damages in

excess of the cap if the court determines that such award is grossly

and manifestly excessive in light of the evidence before the jury.
     The division concludes that the trial court applied the correct

standard by first conducting a “good cause” and “unfairness”

analysis to lift the cap, and then by awarding damages for past and

future economic damages in the amount the jury found because the

record amply supported that amount and it was not grossly and

manifestly excessive. In light of this determination, and because

the division disagrees with the other contentions of error, the

division affirms the judgment entered in favor of the plaintiffs.
COLORADO COURT OF APPEALS                                        2023COA108

Court of Appeals No. 22CA1502
Weld County District Court No. 19CV30976
Honorable Todd Taylor, Judge

Chance Gresser, individually and as parent, natural guardian, next of friend
and on behalf of his daughter, C.G., and Erin Gresser, individually and as
parent, natural guardian, next of friend and on behalf of her daughter, C.G.,

Plaintiffs-Appellees,

v.

Banner Health, d/b/a North Colorado Medical Center,

Defendant-Appellant.

                            JUDGMENT AFFIRMED

                                  Division VI
                         Opinion by JUDGE LIPINSKY
                        Welling and Gomez, JJ., concur

                        Announced November 16, 2023

Bachus & Schanker, LLC, Darin L. Schanker, J. Howard Thigpen, Melanie
Sulkin, Denver, Colorado; Barrios Kingsdorf & Casteix, LLP, Zachary Wool,
New Orleans, Louisiana; Pendley, Baudin & Coffin, LLP, Jessica Perez,
Plaquemine, Louisiana, for Plaintiffs-Appellees

Hall Booth Smith, P.C., Elizabeth Moran, Greenwood Village, Colorado; Mauro
Lilling Naparty LLP, Richard J. Montes, Woodbury, New York, for Defendant-
Appellant
¶1    The Colorado General Assembly enacted the Health Care

 Availability Act (HCAA) four decades ago to “contain[] the

 significantly increasing costs of malpractice insurance for medical

 care institutions and licensed medical care professionals” and “in

 recognition of the exodus of professionals from health-care practice

 or from certain portions or specialties thereof.” § 13-64-102(1),

 C.R.S. 2023. Among other provisions, the HCAA caps at $1 million

 the tort damages awardable against all defendants for a course of

 care provided to a patient by a health care professional or a health

 care institution. § 13-64-302(1)(b), C.R.S. 2023. The HCAA

 provides limited circumstances in which a trial court may lift the

 cap to award “the present value of additional past and future

 economic damages only.” Id.

¶2    However, once a court makes the appropriate findings and lifts

 the cap, the HCAA does not specify how the court must determine

 the amount of such excess damages. No prior Colorado case has

 addressed this issue. The General Assembly’s silence could mean

 that, upon lifting the cap, the court possesses the discretion to

 reject the jury’s award and independently determine the amount of

 such additional damages. Alternatively, it could mean that, if the

                                   1
 court decides to exceed the cap, it must enter a judgment for

 economic damages in the same amount as the jury’s calculation of

 such damages.

¶3    In this case, defendant, Banner Health, d/b/a North Colorado

 Medical Center, appeals the judgment entered in favor of plaintiffs,

 Chance and Erin Gresser, following a jury trial. The Gressers,

 individually and on behalf of their minor daughter, C.G., asserted a

 medical negligence claim against Banner Health premised on the

 alleged failure of its nursing staff to timely recognize and report to

 C.G.’s treating physicians that C.G. was exhibiting signs of sepsis.

 The jury found in favor of the Gressers, and the court entered

 judgment in their favor in the amount of $39,845,196.83.

¶4    After the jury rendered its verdict, the trial court determined it

 was appropriate to lift the cap. The trial court concluded that its

 application of the cap was “binary”: it was required either to impose

 the $1 million cap or enter a judgment in the amount that the jury

 had calculated for past and future economic damages. It chose the

 latter option and entered the full amount the jury had awarded.

¶5    We disagree with the court’s reading of the HCAA. We hold

 that, after making the necessary findings to exceed the statutory

                                    2
 cap, a trial court may, but is not required to, award additional

 damages in the amount that the jury determined.

¶6    But the court’s discretion is not limitless. To determine the

 scope of that discretion, we look to the case law governing judicial

 review of jury damages awards. Under that case law, a court

 possesses the authority to set aside a jury’s award of damages if the

 award was “grossly and manifestly excessive.” Bohlender v. Oster,

 165 Colo. 164, 168, 439 P.2d 999, 1001 (1968). Although the trial

 court erred by characterizing its available options as “binary,” it

 undertook the correct analysis before adopting the jury’s calculation

 of additional past and future economic damages. Because we also

 reject Banner Health’s other claims of error, we affirm.

                           I.    Background

¶7    C.G. was born at Banner Health. Late on the second day of

 her life, C.G. was transferred to the neonatal intensive care unit

 (NICU), where she received antibiotics to treat a possible infection.

 The following morning, lab results confirmed that C.G. had an E.

 coli infection. By that time, C.G. had developed sepsis. As a result

 of the sepsis, she suffered irreversible neurological injuries,

 including cerebral palsy and cognitive and developmental delays.

                                    3
¶8     The Gressers alleged that nurses employed by Banner Health

  breached their duty of care by failing to timely notify C.G.’s

  physicians that C.G. was exhibiting signs of sepsis, and that such

  failure resulted in delayed treatment and caused C.G.’s injuries.

¶9     The jury found that Banner Health was negligent and that its

  negligence was the proximate cause of C.G.’s injuries. The jury

  awarded the Gressers damages totaling $27,647,274.23, which

  included past and future medical and other health care expenses to

  2075, as well as lost future wages from 2038 to 2070. The court

  entered a total judgment of $39,845,196.83, consisting of the jury’s

  award and pre- and post-filing interest.

                               II.   Analysis

¶ 10   Banner Health contends that the court erred by

  (1) misinterpreting and misapplying the HCAA’s statutory cap for

  past and future economic damages; (2) allowing an expert witness

  to testify outside the scope of his qualifications to establish

  causation; (3) precluding Banner Health’s economist from providing

  opinion testimony regarding the present value of C.G.’s future life

  care plan assuming a life expectancy of fifty-eight; and

  (4) permitting the Gressers’ counsel to insinuate that Banner

                                     4
  Health’s attorneys had colluded with Banner Health’s witnesses to

  fabricate testimony. We agree, in part, with Banner Health’s first

  argument but hold that the court did not err by awarding the

  Gressers past and future economic damages in the amount the jury

  found. We disagree with Banner Health’s second, third, and fourth

  arguments.

                  A.   The Damages Cap in the HCAA

¶ 11   The HCAA places an additional burden on plaintiffs seeking to

  recover more than $1 million from all defendants in any civil action

  for damages in tort brought against a health care professional or a

  health care institution. Even if such plaintiffs prove their damages

  to a jury, section 13-64-302(1)(b) provides that they also must prove

  to the court good cause for an award of past and future economic

  damages in excess of the $1 million cap. The court cannot award

  damages that surpass the cap unless, “upon good cause shown,”

  the court “determines that the present value of past and future

  economic damages would exceed such limitation and that the

  application of such limitation would be unfair.” § 13-64-302(1)(b).

¶ 12   The plaintiff bears the burden of establishing both good cause,

  which means a “legally sufficient reason,” and unfairness, meaning

                                    5
  “marked by injustice, partiality, or deception.” Wallbank v.

  Rothenberg, 140 P.3d 177, 180 (Colo. App. 2006) (first quoting

  Black’s Law Dictionary 235 (8th ed. 2004); and then quoting

  Webster’s Third New International Dictionary 2494 (1986)).

¶ 13   Banner Health contends that the court misinterpreted section

  13-64-302(1)(b) to permit only a binary choice between enforcing

  the statutory cap or awarding the full amount that the jury

  determined. Because the court “felt constrained by a binary

  choice,” Banner Health argues, the court did not properly consider

  the totality of the circumstances in its good cause and unfairness

  analysis. We conclude that the court properly applied the good

  cause and unfairness analysis when deciding to lift the cap and

  that, although we disagree with its characterization of the scope of

  its discretion to determine the amount of additional past and future

  economic damages, it made the necessary findings before entering

  the jury’s award.

              1.      The Court Did Not Abuse Its Discretion
                            in Deciding to Lift the Cap

¶ 14   Banner Health alleges five errors in the court’s application of

  the good cause and unfairness standard in section 13-64-302(1)(b).

                                     6
  “In making findings as to ‘good cause’ and ‘unfairness,’” trial courts

  must consider the “totality of circumstances.” Vitetta v. Corrigan,

  240 P.3d 322, 329 (Colo. App. 2009). We review the court’s

  determination for an abuse of discretion. Wallbank, 140 P.3d at

  179.

¶ 15     First, we disagree with Banner Health’s contention that the

  court “failed to consider and balance any relevant factors in

  determining good cause and unfairness.” Banner Health

  erroneously asserts that the court only considered the sufficiency of

  the evidence to support the jury’s verdict. Rather, as the Gressers

  explain, the court also weighed the type and permanency of C.G.’s

  injuries, her continuous need for intensive and expensive therapies,

  her life expectancy, and that her future medical expenses would

  exceed $1 million even if she were fully covered by Medicaid.

¶ 16     Specifically, in determining that the Gressers had established

  good cause for exceeding the cap, and that enforcing the cap would

  be unfair, the court pointed to the evidence establishing that C.G.

  “suffered severe, permanent neurological injuries, a number of

  which she will never be able to overcome, and those injuries that

  she can learn to overcome will require [her] to be engaged in

                                     7
  intensive, and expensive, therapies for much, if not all, of her life.”

  Further, the court noted that “$1 million would not even

  compensate the Gressers for C.G.’s past medical expenses.”

¶ 17   The court also found that the Gressers presented “substantial,

  and largely unchallenged, evidence” of the cost of the future care

  C.G. would require to “improve her quality of life” and to “avoid the

  risks and complications that her neurological deficits will continue

  to present over her lifetime.” The court said it would be unfair to

  deprive C.G. of such care and opportunities for improvement.

¶ 18   The court determined that it would also be unfair not to

  compensate C.G.’s mother, who would continue to care for C.G. as

  an around-the-clock nurse’s aide and thus be unable to work

  outside the home. Finally, the court found that “there is no doubt

  that [C.G.] will never earn wages,” that the jury’s award of future

  lost wages was within the range to which Banner Health’s expert

  had testified, and that such award did not duplicate the jury’s

  award for future medical expenses.

¶ 19   Although Banner Health takes issue with the lack of

  countervailing factors in the court’s analysis, “a court may exercise

  its discretion to consider factors it deems relevant,” id. at 180-81

                                     8
  (emphasis added); it is not bound to consider all of the factors the

  parties deem relevant.

¶ 20   Second, we reject Banner Health’s contention that the

  Gressers did not meet their burden of proving that C.G.’s past

  medical expenses were $2.5 million. Banner Health does not assert

  that the Gressers provided no evidence to support this figure.

  Rather, although the parties stipulated to the authenticity of the

  bills for C.G.’s medical expenses, Banner Health argues that “the

  $2.5 million awarded reflects a fictitious charged amount as

  opposed to the amount [the Gressers] actually paid.” Specifically, it

  asserts that the Gressers “failed to disclose the amount of any liens

  and what portion of the judgment would be for third-party

  subrogation claims,” and that they were required to do so under the

  statute governing collateral source evidence in medical malpractice

  actions. See § 13-64-402, C.R.S. 2023.

¶ 21   This argument fails. Although that statute requires courts to

  determine “the amount, if any, due the third party payer or provider

  and enter its judgment in accordance with such finding,”

  § 13-64-402(3), the provisions do not apply when the third party

  payer or provider is Medicaid. See § 13-64-402(4). Banner Health

                                    9
  does not allege that any third party payer or provider other than

  Medicaid furnished medical assistance to or on behalf of C.G. And

  it cites no authority indicating that plaintiffs must submit evidence

  of liens or subrogation claims from Medicaid to satisfy their burden

  of proof on damages.

¶ 22   Importantly, the court found that the jury’s award of more

  than $2.5 million for C.G.’s past medical expenses was “amply

  supported by the evidence admitted at trial.” To support its

  argument that the $2.5 million “reflected only the fictitious charged

  amount,” Banner Health points to a single document from

  Children’s Hospital, which states, “This is not a bill. This is an

  itemization of hospital services.” In our view, this is insufficient to

  overturn, on sufficiency of the evidence grounds, the court’s finding.

  See Northstar Project Mgmt., Inc. v. DLR Grp., Inc., 2013 CO 12, ¶ 14,

  295 P.3d 956, 959 (explaining that appellants bear the burden of

  “designating ‘all evidence relevant’ to the finding or conclusion

  challenged on sufficiency of the evidence grounds” (quoting C.A.R.

  10(b)). Banner Health does not allege that the Gressers never

  received those services. And even if Medicaid initially covered the

  cost of those services, the Colorado Department of Health Care

                                     10
  Policy and Financing (the state department) has an automatic lien

  by virtue of section 25.5-4-301(5)(a), C.R.S. 2023, for the amount of

  the medical assistance it furnished to or on behalf of C.G. See

  § 25.5-4-301(5)(a) (“When the state department has furnished

  medical assistance to or on behalf of a recipient pursuant to the

  provisions of this article, and articles 5 and 6 of this title, for which

  a third party is liable, the state department shall have an automatic

  statutory lien for all such medical assistance.”).

¶ 23   Without further explanation or cites to the record indicating

  otherwise, we presume the court properly found that the $2.5

  million damages award was supported by the evidence. See C.A.R.

  28(a)(7)(B) (requiring an appellant’s arguments to contain “citations

  to the . . . parts of the record on which the appellant relies”); Love v.

  Klosky, 2016 COA 131, ¶ 18, 417 P.3d 862, 864 (“We presume that

  the trial court’s findings and conclusions are supported by the

  evidence when the appellant has failed to provide a complete record

  on appeal.”), aff’d on other grounds, 2018 CO 20, 413 P.3d 1267;

  Brighton Sch. Dist. 27J v. Transamerica Premier Ins. Co., 923 P.2d

  328, 335 (Colo. App. 1996) (“[I]t is not the duty of the reviewing

  court to search the record for evidence to support bald assertions.”),

                                     11
  aff’d, 940 P.2d 348 (Colo. 1997). We are not in a position to

  reweigh the evidence, and we do not perceive that the trial court

  abused its discretion in making this finding.

¶ 24   Third, we disagree with Banner Health’s assertion that the

  court erred by failing to consider the implications of a special needs

  trust (SNT) in its assessment of good cause. Although the Gressers

  presented evidence that they intended to create an SNT for C.G., the

  jury awarded zero damages for the “cost to set up and operate a

  trust.” Even assuming the Gressers elect to set up an SNT for C.G.

  at a later date, the SNT would only impact C.G.’s future medical

  expenses, as such trusts are intended to preserve an injured party’s

  eligibility for Medicaid benefits. But Medicaid benefits are an

  “exception to the collateral source statute that ought not inure to

  the benefit of the tortfeasor.” Pressey v. Child.’s Hosp. Colo., 2017

  COA 28, ¶ 14, 488 P.3d 151, 157, overruled on other grounds by

  Rudnicki v. Bianco, 2021 CO 80, 501 P.3d 776. Thus, because the

  court could not reduce the damages award to the Gressers by the

  amount of any Medicaid payments furnished to or on behalf of C.G.,

  the court did not abuse its discretion by declining to consider such

  payments when determining whether the Gressers had satisfied

                                    12
  their burden for exceeding the cap. See id. at ¶ 22, 488 P.3d at

  158. We reject Banner Health’s invitation to depart from Pressey.

¶ 25   Additionally, this case is distinguishable from Scholle v.

  Ehrichs, in which a division of this court determined that the trial

  court erred by finding that the plaintiff owed money to third-party

  payers or providers, and by relying on such erroneous finding in

  deciding to lift the cap. 2022 COA 87M, ¶ 126, 519 P.3d 1093,

  1115 (cert. granted Apr. 10, 2023). Here, by contrast, the court

  found that the Gressers presented ample evidence of past and

  future medical expenses, and Banner Health conceded that C.G.’s

  future medical costs would exceed $1 million even if Medicaid fully

  covered certain of her future expenses.

¶ 26   Fourth, we are not persuaded by Banner Health’s argument

  that the General Assembly intended to limit the good cause

  exception for future earnings to extraordinary circumstances, such

  as where the plaintiff has established “a unique capacity and

  history of extraordinary earnings that have been cut short by the

  injury.” Banner Health supports this contention with comments

  from a single legislator whose comments were not tethered to any

  statutory language. See Hearings on S.B. 143 before the H.

                                    13
  Business Affairs & Labor Comm., 56th Gen. Assembly, 2d Reg.

  Sess. (Mar. 10, 1988) (statement of Rep. Patrick A. Grant). But

  “[t]he remarks of a single legislator, even the sponsor, are not

  controlling in analyzing legislative history.” Chrysler Corp. v.

  Brown, 441 U.S. 281, 311 (1979). Significantly, Banner Health

  does not point to any controlling authority precluding a court from

  considering a permanently disabled child’s future lost wages in

  deciding whether to lift the statutory cap. Similarly, Banner Health

  fails to provide any record cites to support its assertion that C.G.’s

  lost future wages duplicated other damages. The court expressly

  found that the damages awarded to the Gressers were not

  duplicative based on their life care planner’s testimony that, to

  prevent overcompensation, she purposefully excluded from C.G.’s

  life care plan items that C.G. would need regardless of her injuries.

¶ 27    Finally, we reject Banner Health’s contention that the court

  erred by finding good cause to exceed the cap for the purpose of

  awarding prefiling interest to the Gressers. Banner Health asserts

  that prefiling interest is included in the $1 million cap “and cannot

  be lifted.”

                                    14
¶ 28   “[P]refiling, prejudgment interest is part of ‘damages’ capped

  under the HCAA, subject to being uncapped upon a showing of

  good cause and unfairness . . . .” Scholle, ¶ 107, 519 P.3d at 1112;

  see also Rudnicki v. Bianco, 2023 COA 103, ¶ 44, ___ P.3d ___, ___

  (“[P]refiling, prejudgment interest on ‘past and future economic

  damages’ is part of ‘past and future economic damages’ and is

  awardable beyond the $1 million limitation, provided the other

  requirements of the statute are met.” (quoting § 13-64-302(1)(b))).

  Banner Health cites to no authority holding that a separate good

  cause analysis is required to lift the cap for the purpose of awarding

  prefiling interest. Because, as explained above, we discern no

  abuse of discretion in the court’s good cause and unfairness

  analysis, which extends to the court’s award of prefiling interest, it

  properly awarded prefiling interest in excess of the cap.

¶ 29   For these reasons, we conclude that the court did not abuse

  its discretion by finding that the Gressers had shown good cause for

  exceeding the cap and that application of the cap would be unfair.

¶ 30   We next review the court’s interpretation of the HCAA in

  analyzing how it should determine the present value of past and

  future economic damages.

                                    15
       2.    Although the Court Misinterpreted Section 13-64-302(1)(b),
                 Its Misinterpretation Does Not Require Reversal of
                                 Its Damages Award

                           a.   Statutory Interpretation

¶ 31        We review the court’s interpretation of section 13-64-302(1)(b)

  de novo. Wallbank, 140 P.3d at 179. “We construe statutes to give

  effect to the intent of the General Assembly. To determine that

  intent, we look first to the plain language of the statute, reading the

  words and phrases in context and construing them according to

  their common usage.” Morris v. Goodwin, 185 P.3d 777, 779 (Colo.

  2008) (citation omitted). “If, however, the language is ambiguous,

  meaning it is silent or susceptible to more than one reasonable

  interpretation, we may use extrinsic aids of construction, ‘such as

  the consequences of a given construction, the end to be achieved by

  the statute, and the statute’s legislative history.’” People v. Jones,

  2020 CO 45, ¶ 55, 464 P.3d 735, 746 (quoting McCoy v. People,

  2019 CO 44, ¶ 38, 442 P.3d 379, 389).

¶ 32        The relevant provision of the HCAA states as follows:

                 The total amount recoverable for all damages
                 . . . in any civil action for damages in tort
                 brought against . . . a health-care institution
                 . . . shall not exceed one million dollars,
                 present value per patient . . . ; except that, if,

                                         16
             upon good cause shown, the court determines
             that the present value of past and future
             economic damages would exceed such
             limitation and that the application of such
             limitation would be unfair, the court may
             award in excess of the limitation the present
             value of additional past and future economic
             damages only.

  § 13-64-302(1)(b) (emphasis added).

¶ 33   After a court lifts the cap, section 13-64-302(1)(b) is silent as

  to how a court determines the amount of such additional damages

  to award the plaintiffs. No published Colorado case directly

  answers this question. In Wallbank v. Rothenberg, 74 P.3d 413,

  420 (Colo. App. 2003), after holding that the trial court erred by

  lifting the statutory cap without a finding of “good cause,” the

  division directed the court on remand to award the plaintiff lost

  future earnings in the amount the jury had determined. But the

  division did not accept the jury’s calculation of such damages

  reflexively; it expressly held that the evidence was sufficient to

  support the jury’s award. See id. Thus, while the jury’s calculation

  of damages still plays a role in HCAA cases, the existing case law

  does not clarify the weight a court must or should give to the jury’s

                                     17
  damages award or the parameters of the court’s discretion in

  calculating damages in excess of the $1 million cap.

¶ 34   We are not persuaded by the parties’ respective interpretations

  of the HCAA, which “imply words that simply are not there.” People

  v. Diaz, 2015 CO 28, ¶ 15, 347 P.3d 621, 625 (quoting People v.

  Benavidez, 222 P.3d 391, 394 (Colo. App. 2009)). The Gressers

  argue that the trial court correctly concluded it had a binary choice

  under section 13-64-302(1)(b), and that, once it lifts the cap, it is

  bound by the jury’s award of past and future economic damages.

¶ 35   By contrast, Banner Health contends that the court has “great

  flexibility” and discretion in quantifying the amount of additional

  past and future economic damages to award to the plaintiff. For

  example, under Banner Health’s reading of section 13-64-302(1)(b),

  a court may exceed the cap for certain categories of damages while

  declining to exceed the cap for other categories. See Vitetta, 240

  P.3d at 325, 329 (affirming trial court’s decision not to exceed the

  statutory cap for lost earnings where patient’s daily living expenses

  were already included in the award for her future life care and

  medical expenses). Citing dicta in a district court order, Banner

  Health also asserts that a court may conclude that, even if it

                                     18
  determines that imposition of the cap would be unfair, it may find

  that “good cause does not exist to raise the cap all the way” to the

  amount of the jury’s award. See Gallegos v. LeHouillier, No.

  13CV32156, 2020 WL 6694174, at *4 (Colo. Dist. Ct., El Paso Cnty.

  Apr. 22, 2020) (concluding, despite its dicta, that “the cap should

  be raised . . . to permit the full loss determined by the jury to be

  compensated”) (unpublished order).

¶ 36    Rather than engraft such limitations or authorities onto the

  statute, we read section 13-64-302(1)(b) against the backdrop of the

  case law addressing judicial review of jury damages awards

  generally, so long as that case law is consistent with the

  legislature’s intent in enacting the HCAA. See Larrieu v. Best Buy

  Stores, L.P., 2013 CO 38, ¶ 13, 303 P.3d 558, 561 (“When the

  General Assembly legislates in a particular area, we presume it was

  aware of existing case law precedent.”); Williams v. White Mountain

  Constr. Co., 749 P.2d 423, 428 (Colo. 1988) (“In the face of statutory

  silence, questions of interpretation are governed by legislative

  intent.”).

¶ 37    Generally, “[t]he amount of damages to which an injured party

  is entitled is a matter within the sole province of the jury.” Ochoa v.

                                     19
  Vered, 212 P.3d 963, 972 (Colo. App. 2009). Nonetheless, the

  reasonableness of a jury’s award is “always subject to judicial

  scrutiny in the post-trial and appellate stages of a case.” Averyt v.

  Wal-Mart Stores, Inc., 265 P.3d 456, 462 (Colo. 2011). Thus, even

  in cases subject to the cap, “the trial court . . . retains its authority

  to reduce by remittitur an award it determines to be excessive in

  light of the evidence before the jury.” Garhart v.

  Columbia/Healthone, L.L.C., 95 P.3d 571, 582 (Colo. 2004). Under

  that authority, a court may set aside the verdict if it is “grossly and

  manifestly excessive.” Ochoa, 212 P.3d at 973. But the court may

  not disturb the amount “unless it is completely without support in

  the record.” Id.

¶ 38   Nothing in the HCAA suggests that the General Assembly

  intended to alter this interplay between the jury verdict and the

  court’s review of that verdict when calculating the amount of

  additional past and future economic damages to award after it lifts

  the cap. The General Assembly enacted the HCAA based on its

  understanding that the cap would “contain[] the significantly

  increasing costs of malpractice insurance.” § 13-64-102(1).

  Section 13-64-302(1)(b) adds the extra step of the “good cause” and

                                      20
  “unfairness” analysis before the court can lift the cap. But the

  HCAA does not lessen a court’s discretion, once the court lifts the

  cap, by enforcing a binary “cap or jury verdict” choice contrary to

  the courts’ longstanding remittitur authority. Neither does the

  HCAA bestow greater discretion on a court by allowing it to

  undertake its own independent calculations of additional past and

  future economic damages unmoored from the jury’s determination

  of such damages.

¶ 39   We find support for this interpretation in Pisano v. Manning,

  2022 COA 22, ¶¶ 23-24, 510 P.3d 572, 576, in which a division of

  this court interpreted section 13-21-102.5(3)(a), C.R.S. 2023, which

  contains an analogous damages cap to that found in section

  13-64-302(1)(b). Section 13-21-102.5(3)(a) and (c) provide that

  damages for noneconomic loss or injury awarded in civil actions

  (other than medical malpractice actions) are capped at $250,000,

  adjusted for inflation every two years, “unless the court finds

  justification by clear and convincing evidence therefor.” Id. The

  division determined that the additional requirement of “clear and

  convincing evidence” applies to the court’s justification for

  exceeding the cap, and not to the fact of damages. Pisano, ¶ 24,

                                    21
  510 P.3d at 576. In other words, section 13-21-102.5(3)(a) does not

  alter the standard of proof in applicable cases. Id. at ¶ 25, 510 P.3d

  at 577. In the same way, we conclude that the “good cause” and

  “unfairness” analysis required under section 13-64-302(1)(b)

  applies only to a trial court’s decision to exceed the cap and not to

  the calculation of additional damages.

                      b.    The Court’s Application

¶ 40   Although the court erred by believing it had only a binary

  choice in awarding additional damages to the Gressers, it

  conducted the correct analysis in quantifying the amount of such

  damages. The court first conducted the good cause analysis, as

  described in Part II.A.1 above, and made findings regarding the

  unfairness of imposing the cap by considering the reasonableness

  of the jury’s award for each category of damages — past medical

  expenses, future medical expenses, and future lost wages.

¶ 41   After finding good cause to lift the cap, the court then

  acknowledged it could disregard the jury award if the amount of

  damages was unsupported by the evidence or indicated that the

  jury was improperly motivated by passion or prejudice. Following

  its review of the record, however, the court found that “substantial

                                    22
  evidence supports the jury’s award of economic damages” and that

  the award was “not grossly and manifestly excessive.”

¶ 42   Thus, the court correctly concluded that it would be improper

  to adjust the amount of damages that the jury had awarded.

  Accordingly, as the court expressly stated, it entered its judgment

  “consistent with the jury’s verdict . . . in conjunction with the

  court’s findings.” This approach is consistent with the case law

  governing judicial review of jury awards.

¶ 43   We disagree with Banner Health’s assertion that the court

  improperly engrafted the “grossly and manifestly excessive”

  standard for a C.R.C.P. 59 remittitur onto its “good cause” and

  “unfairness” analysis for lifting the HCAA cap. In HCAA cases, a

  court may exercise its remittitur authority by analyzing the present

  value of past and future economic damages on a “case-by-case”

  basis, Garhart, 95 P.3d at 582, but only after it has found that the

  plaintiff established the good cause and unfairness necessary to lift

  the cap. As we explain above, the court properly kept these

  analyses separate — it first found good cause to lift the cap, and

  then it determined the award was not “grossly and manifestly

  excessive.” Id. Based on the latter determination, the court

                                     23
  declined to set aside the damages award as quantified in the

  verdict.

¶ 44   In sum, while we disagree with the court that it was faced with

  a binary choice, once it decided the cap should be lifted, it did not

  err by awarding the Gressers the same amount of past and future

  economic damages that the jury had calculated.

             B.   Dr. Rimawi’s Expert Opinions on Causation

¶ 45   Over Banner Health’s objection, the Gressers called Ramzy

  Rimawi, M.D., to testify on causation. At trial, Dr. Rimawi opined

  that administration of antibiotics to C.G. at specific times during

  her second day in the hospital would have “prevented the

  permanent neurological harm” she later suffered. Banner Health

  contends that the court should have precluded Dr. Rimawi from

  testifying on causation because he “was not qualified to opine on

  whether a reasonable pediatric specialist would have ordered

  antibiotics.” Relatedly, Banner Health argues that the court should

  have entered judgment notwithstanding the verdict in its favor

  because Dr. Rimawi was the Gressers’ only causation expert and,

  without his testimony, they could not prove their negligence claim.

                                    24
  Because we disagree with Banner Health’s first argument, its

  second argument necessarily fails.

               1.    Relevant Law and Standard of Review

¶ 46    Trial courts provide an important gatekeeping function in

  determining whether a jury should hear particular expert

  testimony. See Bocian v. Owners Ins. Co., 2020 COA 98, ¶ 45, 482

  P.3d 502, 513. Colorado Rule of Evidence 702 governs a trial

  court’s determination as to the admissibility of expert testimony.

  People v. Shreck, 22 P.3d 68, 70 (Colo. 2001). “If scientific,

  technical, or other specialized knowledge will assist the trier of fact

  to understand the evidence or to determine a fact in issue, a

  witness qualified as an expert by knowledge, skill, experience,

  training, or education, may testify thereto in the form of an opinion

  or otherwise.” CRE 702. This inquiry focuses on “(1) the reliability

  of the scientific principles, (2) the qualifications of the witness, and

  (3) the usefulness of the testimony to the jury.” Shreck, 22 P.3d at

  70.

¶ 47    “A witness may be qualified by virtue of any one of the five

  factors” specified in CRE 702. Huntoon v. TCI Cablevision of Colo.

  Inc., 969 P.2d 681, 690 (Colo. 1998). “Under this liberal rule, a

                                     25
  court may admit expert testimony if the witness can offer

  ‘appreciable’ assistance on a subject beyond the understanding of

  an ‘untrained layman.’” People in Interest of Strodtman, 293 P.3d

  123, 129-30 (Colo. App. 2011) (quoting People v. Williams, 790 P.2d

  796, 798 (Colo. 1990)).

¶ 48   “Trial courts are vested with broad discretion to determine the

  admissibility of expert testimony. Therefore, we will not overturn a

  trial court’s decision absent an abuse of discretion.” Est. of Ford v.

  Eicher, 250 P.3d 262, 266 (Colo. 2011) (citation omitted). In

  addition, we review de novo a trial court’s denial of a motion for

  judgment notwithstanding the verdict. Smith v. Surgery Ctr. at Lone

  Tree, LLC, 2020 COA 145M, ¶ 8, 484 P.3d 745, 749.

        2.    The Court Did Not Abuse its Discretion by Finding
                   that Dr. Rimawi Was Qualified to Offer
                           Opinions on Causation

¶ 49   We agree with the court that Dr. Rimawi possessed the

  requisite knowledge, skill, experience, training, and education in

  the areas of infectious diseases, sepsis, treatment of sepsis, and

  management of sepsis regarding patients of all ages to provide

  expert testimony on causation. Dr. Rimawi testified that he is

  board certified in internal medicine, infectious diseases, and critical

                                    26
  care medicine. He explained that he studies how infections happen,

  how to treat them, and the consequences of not treating them.

  While working as an emergency room physician, Dr. Rimawi gained

  experience in suspecting and treating sepsis in newborns through

  his daily treatment of infected infants.

¶ 50   At the time of trial, Dr. Rimawi worked at Emory University

  Hospital, which he characterized as “probably one of the top in the

  world for critical care medicine.” At Emory, he cared for adults in

  the intensive care unit (ICU) and served on committees that

  developed treatment protocols for patients of all ages, including

  those in the NICU. For example, Dr. Rimawi chaired Emory’s

  resuscitation committee, which reviewed incidents in which

  protocols, such as those for treating sepsis, were not followed. And

  he was a member of the antibiotic stewardship committee, which

  set forth standards for the administration of antibiotics.

¶ 51   Additionally, Dr. Rimawi was involved in developing Emory’s

  “surviving sepsis guidelines,” which provide guidance on

  management of sepsis and a screening tool to assist practitioners in

  determining whether a patient has developed sepsis. Further,

  Dr. Rimawi taught how to suspect and spot sepsis to medical

                                    27
  students, nurse practitioners, family practice doctors, pediatricians,

  and obstetrical-gynecological doctors. All of these professionals

  treat infants and need to know how to recognize sepsis in

  newborns.

¶ 52   Based on Dr. Rimawi’s credentials and experience, we hold

  that the court did not abuse its discretion by determining that

  Dr. Rimawi was “sufficiently qualified to offer opinions related to

  treating sepsis in neonates” and that he could testify as to “how

  [Banner Health’s] nursing staff’s alleged delay in treatment may

  have caused [C.G.’s] injuries.” Similarly, the court did not abuse its

  discretion by permitting him to testify “as to what a reasonable

  physician would have done” with regard to treating C.G. “had

  certain information been provided.” All these opinions related to

  causation.

¶ 53   Although Banner Health attacks Dr. Rimawi’s lack of specific

  experience in and knowledge of treating newborns in a well baby

  hospital unit, such gaps in his background do not alter our

  determination that Dr. Rimawi was qualified to offer “appreciable”

  assistance on “a subject beyond the understanding of an ‘untrained

  layman’” — sepsis treatment and management of patients of any

                                    28
  age. Strodtman, 293 P.3d at 130 (quoting Williams, 790 P.2d at

  798).

¶ 54      First, while Banner Health characterizes Dr. Rimawi as “an

  adult infectious disease physician,” it fails to point to any material

  difference between the training of pediatric physicians to suspect,

  manage, or treat sepsis and that of physicians who primarily treat

  adults. On the contrary, Dr. Rimawi testified that one does not

  need to be a pediatric infectious disease doctor to spot the signs of

  sepsis in a newborn. The “primary consideration” in determining

  Dr. Rimawi’s qualifications for recognizing and treating sepsis in

  newborns is his “actual ‘knowledge, skill, experience, training or

  education’, rather than [his] particular title.” Melville v. Southward,

  791 P.2d 383, 387 (Colo. 1990) (quoting CRE 702).

¶ 55      Second, Banner Health asserts that Dr. Rimawi was “not

  familiar with the normal respiratory rate, voiding patterns, or

  feeding patterns for neonates,” or with the pain scoring system for

  such patients. But the record shows that he obtained that

  information through research. Banner Health does not explain why

  Dr. Rimawi would need to know such data points without reference

  to medical authorities to determine when C.G. developed sepsis.

                                     29
¶ 56   Third, although Dr. Rimawi lacked specific experience in a

  postpartum unit and was not credentialed to treat patients under

  the age of eighteen at the time of trial, he had treated infants with

  sepsis, and he was involved in developing protocols and screening

  tools for sepsis treatment of patients of all ages. See Huntoon, 969

  P.2d at 690 (“There is no requirement that a witness hold a specific

  degree, training certificate, accreditation, or membership in a

  professional organization, in order to testify on a particular issue.”).

¶ 57   Finally, Banner Health takes issue with Dr. Rimawi’s lack of

  publications on neonatal infection. However, Dr. Rimawi testified

  that he participated in peer review of manuscripts submitted to

  journals and served on the editorial boards of various publications,

  including the Journal of Neonatal Biology. Moreover, he is a prolific

  author on subjects relating to infectious diseases generally and

  sepsis specifically.

¶ 58   Thus, while such alleged gaps might impact the “weight and

  credibility” a jury may afford Dr. Rimawi’s testimony, they did not

  preclude him from providing opinion testimony in this case. See

  Strodtman, 293 P.3d at 130. The trial court did not abuse its

  discretion by determining that Dr. Rimawi was qualified to offer

                                     30
  opinion testimony, even though his resume lacked the credentials

  that Banner Health deemed necessary for an expert offering an

  opinion on an infant’s sepsis infection.

¶ 59   In addition, because Dr. Rimawi was qualified to offer an

  opinion on causation, the court properly denied Banner Health’s

  motion for judgment notwithstanding the verdict premised on

  Dr. Rimawi’s alleged lack of sufficient knowledge and experience.

¶ 60   We next consider whether the court properly limited

  Dr. Rimawi’s opinion testimony to his areas of expertise.

  3.    Dr. Rimawi Did Not Testify Outside the Scope of His Expertise

¶ 61   Banner Health further argues that the trial court erred by

  permitting Dr. Rimawi to provide opinions that fell outside the

  scope of the subject areas for which the court qualified him as an

  expert.

¶ 62   In circumscribing the scope of Dr. Rimawi’s testimony, the

  court specified that he could not “testify as to the appropriate

  standard of care,” which the parties agree was the standard of care

  for nurses. The court explained that, while Dr. Rimawi could not

  testify “as to what a nurse should or should not have done,” he

                                    31
  would be “permitted to testify as to what a reasonable physician

  would have done had certain information been provided.”

¶ 63   Accordingly, the court qualified Dr. Rimawi to offer opinions

  regarding important links in the causal chain: he could opine that

  delayed reporting of C.G.’s symptoms caused a delay in the

  administration of antibiotics, which caused C.G.’s sepsis to

  progress, which caused C.G.’s injuries.

¶ 64   The majority of Dr. Rimawi’s testimony involved a general

  description of sepsis. He connected this testimony to his opinion on

  causation, explaining that a patient with suspected sepsis should

  be started on antibiotics within three hours. He said “those three

  hours are really critical” because of the exponential growth rate of

  bacteria. Such testimony was within the scope of the areas for

  which the trial court had qualified Dr. Rimawi as an expert on

  sepsis.

¶ 65   Applying his expertise to the facts of C.G.’s case, Dr. Rimawi

  testified that C.G. was “very far along” the stages of sepsis by

  8:30 p.m. on the second day of her hospitalization, when she was

  tachycardic and grunting. He opined that starting the antibiotics at

  6 p.m. that day would have prevented C.G.’s permanent

                                    32
  neurological injuries. Dr. Rimawi explained that starting them

  when C.G. was admitted to the NICU after 11 p.m. was “too late”

  because certain of her organs, such as her brain, were already

  dying by that time. Dr. Rimawi concluded that “earlier antibiotics

  would have had an effect, more likely than not, that . . . would have

  prevented [C.G.’s] complications.” This causation testimony fell

  within Dr. Rimawi’s designation as an expert in sepsis and its

  treatment and management, and the testimony did not, as Banner

  Health contends, improperly constitute an opinion on the standard

  of care for nurses.

¶ 66   Dr. Rimawi also testified that a reasonable physician would

  have begun treating C.G. with antibiotics upon learning from

  Banner Health’s nursing staff that C.G. was showing signs of

  sepsis. This opinion testimony fell within the permissible scope of

  Dr. Rimawi’s endorsement as an expert. While it tangentially

  related to a physician’s standard of care, it was not a standard of

  care opinion. Rather, it focused on the significance of the length of

  time that elapsed between when C.G. first showed signs of sepsis

  and when she was first administered antibiotics. This testimony

  thus related to a chain in the element of causation and supported

                                    33
  the Gressers’ theory that C.G. would not have suffered neurological

  injuries had Banner Health’s nurses timely reported the symptoms

  of sepsis to C.G.’s physicians.

¶ 67    For these reasons, we hold that Dr. Rimawi did not testify

  outside the scope of those subject areas in which the court had

  qualified him as an expert.

       C.   The Court’s Exclusion of Opinion Testimony Regarding
             the Present Value of C.G.’s Life Care Plan Based on
                       a Life Expectancy of Fifty-Eight

¶ 68    At trial, counsel for Banner Health asked their expert

  economist, Dr. Eric Joshua Drabkin, to opine on the present value

  of C.G.’s life care plan based on a life expectancy of fifty-eight years.

  The court sustained the Gressers’ objection to such testimony on

  the ground that Banner Health had not previously disclosed this

  present value figure to the Gressers. Banner Health argues the

  court erred by doing so. We disagree.

                           1.   Additional Facts

¶ 69    Before trial, the Gressers and Banner Health exchanged expert

  reports on issues relating to the amount of the Gressers’ damages.

  The Gressers engaged John Lawrence Merritt, M.D., to opine on

  C.G.’s anticipated life expectancy. In his report, Dr. Merritt stated

                                     34
  that the “natural life expectancy” is eighty-one years for a girl in the

  United States with the same race and ethnicity as C.G. He noted

  that “[a] reduced life expectancy is most closely correlated with

  ability for self-mobility and ability to feed oneself,” but he opined

  that C.G. “has shown steady progress in areas of motor skills, and

  it is to a reasonable degree of medical probability that with

  continued intensive rehabilitation training [C.G.] will achieve these

  mobility and swallowing goals in the coming years.” He concluded

  that “[h]er life expectancy therefore should not be significantly

  affected by her injuries, with provision of optimal medical and

  supportive care.”

¶ 70   In addition, the Gressers disclosed expert reports concerning

  C.G.’s future medical and other health care costs and the present

  value of those costs.

¶ 71   Banner Health designated Dr. Drabkin, an economist, to

  provide his own calculation of the present value of C.G.’s life care

  plan based on three different life expectancies — seventeen, twenty-

  one, and “normal life expectancy” of 77.29 years — and on the

  expert opinions calculating the amount of C.G.’s future care costs.

  Dr. Drabkin calculated that the present value of C.G.’s life care

                                     35
  plan, assuming a “normal life expectancy,” was $22,712,545.

  Changing the life expectancy figure materially impacted the present

  value calculation because it affected the length of time C.G. would

  require care.

¶ 72   At trial, Dr. Merritt reiterated his opinion that C.G.’s injuries

  would not shorten her life. On cross-examination, counsel for

  Banner Health challenged this opinion by asking whether scientific

  literature “suggest[s] — and I believe you testified during your

  deposition — that 83 percent of cerebral palsy patients have a life

  expectancy of less than 58 years.” Banner Health suggested during

  the examination that such statement appears in papers published

  by Drs. Jordan Brooks, Robert Shavelle, David Strauss, and others

  (the Shavelle papers).

¶ 73   After Dr. Merritt said he did not recall “testifying to that”

  during his deposition, counsel for Banner Health attempted to

  impeach him with his deposition testimony, asking whether during

  the deposition, she had asked, “You were aware of the Strauss and

  Shavelle literature that reflects that 80 percent have a life

  expectancy less than 58 years. Do you see that?” Dr. Merritt

  responded during his cross-examination at trial that he was “aware

                                     36
  of that statement in the literature.” But he did not testify that he

  agreed with the statement.

¶ 74   The court allowed the jurors to submit questions to the

  experts. In response to juror questions, Dr. Merritt said that C.G.’s

  life expectancy would be reduced by fifteen percent if she were

  unable to self-feed and by another fifteen percent if her ability to

  self-ambulate did not improve. No party objected to these

  questions.

¶ 75   After Dr. Merritt answered the juror’s questions, the court

  allowed the attorneys to ask follow-up questions. In response to a

  question from counsel for the Gressers, Dr. Merritt said that C.G.’s

  life care plan provided for “early intervention to keep [C.G.] healthy

  so that she can reach her full life expectancy,” and he noted that

  she had been making “remarkable progress on feeding and

  ambulation,” much more so than he “would have thought after the

  first exam.”

¶ 76   During recross-examination, Dr. Merritt agreed that, if C.G.

  was unable to feed herself and unable to self-ambulate, her life

  expectancy would be reduced by a total of thirty percent, which was

  roughly “24 off the 78 additional years,” or slightly below fifty-eight.

                                     37
  But, as noted above, Dr. Merritt indicated at other times during his

  examination that he disagreed with the assumptions underlying the

  question — that C.G. would never feed herself or self-ambulate.

  Thus, he never adopted the opinion that C.G. would only live to age

  fifty-eight.

¶ 77    During Dr. Drabkin’s direct examination later in the trial,

  counsel for Banner Health elicited his calculations of the present

  value of C.G.’s future care costs based on a life expectancy of

  twenty-two ($4,300,577) and of eighty-one ($22,873,393).

¶ 78    Counsel for Banner Health then asked Dr. Drabkin whether he

  had calculated the present value of C.G.’s future care costs using a

  life expectancy “approximately for the mid-50s,” based on

  Dr. Merritt’s testimony regarding a potential thirty percent

  reduction in C.G.’s life expectancy. The Gressers’ counsel objected.

  The court sustained the objection on the ground that Dr. Drabkin

  had not previously disclosed this opinion.

¶ 79    At the conclusion of trial, the jury found that C.G. would incur

  future “medical and other health care expenses” until 2075, when

  she would turn fifty-eight. It determined that the amount of

  damages in this category was $23,930,000 — a figure higher than

                                    38
  Dr. Drabkin’s present value calculation that assumed a full life

  expectancy.

                2.   Standard of Review and Applicable Law

¶ 80   “We review a trial court’s decision on evidentiary issues for an

  abuse of discretion, and a trial court does not abuse its discretion

  unless its ruling is manifestly arbitrary, unreasonable, or unfair.”

  Murray v. Just In Case Bus. Lighthouse, LLC, 2016 CO 47M, ¶ 32,

  374 P.3d 443, 453.

¶ 81   Under C.R.C.P. 26(a)(2)(B)(I), a party must disclose specified

  information for each of its retained experts, including “a complete

  statement of all opinions to be expressed and the basis and reasons

  therefor.” C.R.C.P. 26(a)(2)(B)(I)(a). The purpose of the mandatory

  disclosure rule is to “ensure that discovery information is provided

  early and is updated in a timely manner, thus promoting accuracy,

  encouraging settlements, and avoiding surprises at trial.” D.R.

  Horton, Inc.-Denver v. Bischof & Coffman Constr., LLC, 217 P.3d

  1262, 1267-68 (Colo. App. 2009) (emphasis added).

¶ 82   C.R.C.P. 37(c)(1) provides:

            A party that without substantial justification
            fails to disclose information required by
            C.R.C.P. 26(a) . . . shall not be permitted to

                                     39
             present any evidence not so disclosed at trial
             . . . , unless such failure has not caused and
             will not cause significant harm, or such
             preclusion is disproportionate to that harm.

¶ 83   “[U]nder C.R.C.P. 37(c), a trial court has a duty to sanction a

  party for failure to comply with certain discovery deadlines by

  precluding evidence or witnesses, unless the party’s failure to

  comply is either substantially justified or harmless.” Todd v. Bear

  Valley Vill. Apartments, 980 P.2d 973, 975 (Colo. 1999); see also

  Cath. Health Initiatives Colo. v. Earl Swensson Assocs., Inc., 2017

  CO 94, ¶ 15, 403 P.3d 185, 188 (noting that, subsequent to the

  2015 amendments to C.R.C.P. 37, the “harm and proportionality

  analysis under [C.R.C.P.] 37(c)(1) remains the proper framework for

  determining sanctions for discovery violations”). “The burden is on

  the non-disclosing party to establish that its failure to disclose was

  either substantially justified or harmless.” Todd, 980 P.2d at 978.

¶ 84   The failure to disclose does not result in automatic preclusion

  of evidence at trial. “Rule 37(c)(1)’s framework is flexible, not

  absolute, and the trial court has the discretion to fashion an

  appropriate sanction proportionate to any harm caused.” Cath.

  Health Initiatives Colo., ¶ 11, 403 P.3d at 188.

                                     40
       3.     The Court Did Not Abuse Its Discretion by Precluding
            Dr. Drabkin from Testifying Regarding the Present Value of
            C.G.’s Life Care Costs Assuming a Life Expectancy of Fifty-
                                       Eight

¶ 85   For two reasons, we hold that the court did not abuse its

  discretion by precluding Dr. Drabkin from offering his previously

  undisclosed opinion regarding the present value of C.G.’s life care

  plan assuming she would live to fifty-eight.

¶ 86   First, Dr. Merritt never testified that he believed C.G. would

  only live to fifty-eight. Although Dr. Merritt agreed at trial that

  C.G.’s life expectancy could drop to fifty-eight if she never learned to

  feed herself or self-ambulate, he rejected the application of these

  assumptions to C.G. Dr. Merritt said it was “more likely than not”

  that “with continued optimal care,” C.G. could have “a full life

  expectancy.” He said that C.G. was “making significant progress”

  with walking and predicted that, “if she continues to make these

  kind of gains over the next few years,” she “will be ambulating

  sufficiently in order to get the exercise that prevents the deleterious

  effect of immobility.” Dr. Merritt also said “it’s much more likely

  than not that she will be able to achieve . . . the ability to feed

  herself” and that the factors of feeding and “the ability to mobilize”

                                     41
  will not “weigh in on reducing her life expectancy.” Thus,

  Dr. Merritt consistently stated that, in his view, C.G. would have a

  full life expectancy.

¶ 87   Because Dr. Merritt did not accept the assumptions

  underlying a conclusion that C.G. would only live to fifty-eight, the

  court did not abuse its discretion by precluding Dr. Drabkin from

  providing the jury with a new, previously undisclosed present value

  calculation premised on the assumption that Dr. Merritt had

  adopted the fifty-eight-year life expectancy figure.

¶ 88   Second, even if Dr. Merritt’s testimony following the juror’s

  questions amounted to a new opinion regarding C.G.’s life

  expectancy, such opinion would not have come as a surprise to

  Banner Health. During Dr. Merritt’s deposition, as during trial,

  Banner Health attempted to discredit Dr. Merritt’s full-life-

  expectancy opinion by asking him to acknowledge that the Shavelle

  papers, on which he relied in developing his opinion, suggested that

  “80 percent of cerebral palsy patients have a life expectancy of less

  than 58 years.” Thus, Banner Health was aware of the fifty-eight-

  year figure during Dr. Merritt’s deposition and it could not claim

  surprise regarding the figure being discussed at trial. If Banner

                                    42
  Health intended to press Dr. Merritt on the fifty-eight-year life

  expectancy at trial — as it had during his deposition — it should

  have disclosed Dr. Drabkin’s calculation of the present value of

  C.G.’s life care plan based on that figure in the event its strategy

  succeeded and Dr. Merritt agreed that C.G.’s life expectancy could

  be fifty-eight years under certain circumstances.

¶ 89   We next consider whether, under the applicable test, Banner

  Health’s failure to disclose Dr. Rabkin’s new present value

  calculation before trial was justified. In Todd, our supreme court

  set forth a nonexhaustive list of factors for determining whether a

  party’s failure to make a pretrial disclosure was “substantially

  justified or harmless”:

       (1)   the importance of the witness’s testimony;

       (2)   the party’s explanation for its failure to comply with the

             required disclosure;

       (3)   the potential prejudice or surprise to the party against

             whom the testimony is offered that would arise from

             allowing the testimony;

       (4)   the availability of a continuance to cure such prejudice;

                                    43
       (5)   the extent to which introducing such testimony would

             disrupt the trial; and

       (6)   the non-disclosing party’s bad faith or willfulness.

  Todd, 980 P.2d at 978. Considering these factors, we conclude that

  the court did not abuse its discretion by barring Dr. Drabkin from

  offering at trial his previously undisclosed present value calculation

  of C.G.’s life care plan premised on a life expectancy of fifty-eight.

¶ 90   First, we agree with Banner Health that the testimony was

  important. After hearing a life expectancy figure of fifty-eight

  bandied about in the courtroom, even if Dr. Merritt did not agree

  with that figure, the jury could — and did — conclude that C.G.

  would likely live to fifty-eight. Thus, it would have been helpful for

  the jury to have Dr. Drabkin’s calculation of the present value of

  C.G.’s life care plan premised on a fifty-eight-year life expectancy.

¶ 91   Second, we disagree with Banner Health’s contention that it

  could not have disclosed before trial Dr. Drabkin’s calculation of the

  present value of C.G.’s life care plan to age fifty-eight because

  Dr. Merritt’s testimony following the juror’s questions came as a

  surprise. As we explain above, such testimony should not have

  come as a surprise to Banner Health because it was familiar with

                                      44
  the Shavelle papers throughout the case. Indeed, since the

  discovery phase of the case, Banner Health had pressed Dr. Merritt

  to agree that the Shavelle papers suggested a life expectancy for

  C.G. of “less than 58 years.”

¶ 92   Third, the Gressers faced potential prejudice or surprise if the

  court allowed Dr. Drabkin to provide a new present value

  calculation at trial. Even if, as Banner Health asserts, Dr. Drabkin

  used “the exact same methodology from his reports and deposition,”

  with the only difference being the life expectancy factor, the

  Gressers likely would have had no opportunity to review or question

  that calculation absent a continuance of the trial.

¶ 93   Fourth, it is generally burdensome to place a jury trial on

  hold. See People v. Smith, 275 P.3d 715, 722 (Colo. App. 2011) (The

  burden of “assembling the witnesses, lawyers, and jurors at the

  same place at the same time . . . counsels against continuances

  except for compelling reasons.” (quoting Morris v. Slappy, 461 U.S.

  1, 11 (1983))). Dr. Drabkin sought to provide his new opinion on

  the sixth day of a jury trial. In any event, the Gressers did not

  request a continuance and Banner Health did not propose one.

  Rather, the court simply disallowed Dr. Drabkin’s testimony

                                    45
  regarding the new calculation because it was “undisclosed

  testimony.”

¶ 94    Fifth, the record does not reflect the extent to which the

  introduction of the challenged evidence would have disrupted the

  trial, if at all. We cannot speculate whether, had the court

  permitted Dr. Drabkin to provide his new, undisclosed opinion, the

  Gressers would have sought a continuance for the purpose of,

  among other reasons, obtaining a competing calculation of the

  present value of C.G.’s life care plan premised on a life expectancy

  of fifty-eight.

¶ 95    Sixth, the record does not establish whether Banner Health’s

  attempt to present Dr. Drabkin’s new present value calculation

  midtrial reflected, or did not reflect, bad faith or willfulness.

¶ 96    In sum, although the first Todd factor weighs in favor of

  admission of Dr. Drabkin’s new opinion, factors two, three, and four

  weigh in favor of preclusion. Factors five and six are neutral.

  Accordingly, we hold that the court’s ruling on the admissibility of

  Dr. Drabkin’s new opinion was not “manifestly arbitrary,

  unreasonable, or unfair,” Murray, ¶ 32, 374 P.3d at 453, and

  therefore was not an abuse of discretion.

                                     46
                    D. Counsel’s Suggestions that
                  Banner Health and Its Witnesses Colluded
                          to Fabricate Testimony

¶ 97    The trial in this case was hard-fought and included

  contentious cross-examinations and arguments. Banner Health

  asserts that the court erred by permitting the Gressers’ counsel to

  “insinuate — through pervasive questioning and arguments — that

  Banner Health’s attorneys and their client-witnesses colluded to

  fabricate testimony.” Banner Health contends that the court should

  have provided the jury with a curative instruction addressing the

  impropriety of the Gressers’ counsel’s suggestions of collusion or,

  alternatively, should have taken the case away from the jury and

  entered a judgment in favor of Banner Health because the

  insinuations of the Gressers’ counsel deprived Banner Health of a

  fair trial.

¶ 98    We perceive no error.

                          1.    Additional Facts

¶ 99    Counsel for the Gressers questioned several of Banner

  Health’s employees about their meetings with Banner Health’s

  attorneys to prepare for the employees’ depositions and trial.

  Specifically, during the examinations of Banner Health’s nurses and

                                    47
  doctors, counsel for the Gressers elicited admissions that Banner

  Health’s counsel represented each of them individually, as well as

  testimony regarding the length of their meetings with counsel to

  prepare for their depositions and trial, the persons present at those

  meetings, and the materials the attorneys asked the witnesses to

  review. The court overruled Banner Health’s initial objections to

  this line of questioning, determining that the information was

  relevant to reveal the witnesses’ potential bias, and noting that the

  questioning did not implicate the attorney-client privilege.

¶ 100   However, as counsel for the Gressers persisted with this line of

  questioning, the court sustained several of Banner Health’s

  objections. For example, after nurse Alayna Blevins confirmed that

  at least five other hospital employees were present during one of her

  meetings with the attorneys, the court sustained an objection to the

  question from the Gressers’ counsel whether she was “familiar with

  the phrase ‘get your stories straight’” on the grounds that it was

  argumentative. The court also agreed it was improperly

  argumentative for the Gressers’ counsel to ask nurse Rachel Ortiz

  Ververs, “And here we are, four years later, after the meeting with

  the [hospital] lawyers and a lawsuit has been filed, ma’am; and you

                                    48
  and Nurse Quinones have a completely different story from what

  Dr. [Abigail] Myers [one of C.G.’s treating physicians] wrote down,

  don’t you?”

¶ 101   Banner Health also asserts that the Gressers’ counsel asked

  improperly argumentative questions during the examination of

  Dr. Myers. For example, counsel for the Gressers asked Dr. Myers

  whether she was aware that Banner Health’s attorneys had

  designated her as an expert and had disclosed her anticipated

  opinion testimony to counsel for the Gressers nine months before

  the attorneys had first contacted her about serving as an expert.

  Counsel for the Gressers also elicited testimony from Dr. Myers that

  Banner Health’s lawyers had asked her to review transcripts of the

  depositions of other hospital employees and the defense’s expert

  reports, but not transcripts of the depositions of the Gressers or the

  reports of their experts. Banner Health objected when the Gressers’

  counsel then asked whether “that sounds an awful lot like

  cherrypicking information” and whether being “only given one side

  of the story” could “slant [her] opinion and understanding” of the

  facts.

                                    49
¶ 102   During a bench conference to discuss Banner Health’s

  objections to this questioning, the court expressed concern that it

  suggested “the lawyers have done something improper, unethical.”

  While the court determined that the information Dr. Myers “was

  provided or not provided is relevant,” it instructed counsel for the

  Gressers to “move on from this line of questioning.”

¶ 103   After the Gressers rested their case-in-chief, Banner Health

  renewed its objection to “the continual questioning of the witnesses

  on the number of times, the length of time, and information that

  they obtained from the meetings with [Banner Health’s] lawyers —

  consistently referred to as the Banner lawyers.” Banner Health

  argued the attorney-client privilege made it impossible to “cross-

  examine or direct the witnesses on what they did or what they

  talked about, [or] how long the meetings were” for the purpose of

  neutralizing the insinuations inherent in counsel for the Gressers’

  questions.

¶ 104   Accordingly, Banner Health asked the court to provide the jury

  with a curative instruction that “such conduct by the [Banner

  Health] lawyers . . . is not improper and therefore the

  attorney[-]client privilege protects such things and it cannot be held

                                    50
  against [Banner Health and its employees].” Banner Health

  requested a mistrial as an alternative remedy, arguing that, without

  a curative instruction, there would be no way to “correct the

  opinions of this jury” that Banner Health’s lawyers had “done

  something unethical.”

¶ 105   The court denied Banner Health’s requests for a curative

  instruction and for a mistrial. It determined that none of the

  questions sought the disclosure of privileged information,

  questioning regarding the witnesses’ preparation for their

  depositions and trial was “fair game” and “relevant” for weighing

  their credibility, and a curative instruction would invade the jury’s

  role in weighing the evidence. Although the court expressed

  concern “from a systemic level” about how the insinuations from

  both sides would cause “cynicism . . . to trickle down and affect the

  jurors’ perceptions of the system of justice,” it concluded that the

  Gressers’ counsel had not “crossed a line that would warrant” the

  relief that Banner Health sought.

¶ 106   Later in the trial, the Gressers’ counsel challenged a physician

  witness who testified that, unlike other doctors, he chose not to

  refer to “apnea” in his notes even though C.G. had stopped

                                    51
  breathing. The Gressers’ counsel retorted, “That testimony is not

  good for Team Banner, is it, those notes in the records? Those

  aren’t good for Team Banner?” The court sustained Banner

  Health’s objection that the question was argumentative and advised

  the jury that it should disregard the “improper” and “inappropriate”

  term “Team Banner.” The court told the jury, “It’s important you

  make your decisions here based on the facts in the case and not on

  any characterizations of one side or the other in the case.”

¶ 107   During closing argument, the Gressers’ counsel asked the

  jurors to consider whether the Banner Health employees who

  testified were not credible because they were “to[e]ing the company

  line.” But Banner Health’s counsel did not object to this statement.

¶ 108   After the jury returned its verdict in favor of the Gressers,

  Banner Health moved for a new trial on the grounds that the

  Gressers’ counsel’s “constant and pervasive implication that

  defense counsel engaged in wrongdoing and manipulated witness

  testimony denied [Banner Health] of the right to a fair trial.” The

  court denied the motion.

                                     52
                2.   Standard of Review and Relevant Law

¶ 109   Trial courts have broad discretion to set the scope and limits

  of cross-examination for bias, Bonser v. Shainholtz, 3 P.3d 422, 424

  (Colo. 2000); determine “the form and the style of jury instructions,”

  Antolovich v. Brown Grp. Retail, Inc., 183 P.3d 582, 601 (Colo. App.

  2007); and evaluate “the prejudicial impact of misconduct by

  opposing counsel and of any irregularities at trial,” Acierno v.

  Garyfallou, 2016 COA 91, ¶ 28, 409 P.3d 464, 469 (citation

  omitted). Accordingly, we review for an abuse of discretion the

  court’s denial of Banner Health’s request for a curative instruction,

  a mistrial, and a new trial in response to the aggressive questioning

  of counsel for the Gressers.

¶ 110   “[A] witness’s credibility is for the fact-finder to decide, subject

  to the trial court’s discretion” regarding whether “violations of the

  ethical rules implicate the fairness of the proceedings.” Murray,

  ¶ 21, 374 P.3d at 451. When assessing witnesses’ credibility and

  thus the weight to give their testimony, the jury may consider

  factors such as the consistency of the witnesses’ testimony, whether

  other witnesses contradicted them, and the witnesses’ manner and

  demeanor on the witness stand. Prudential Ins. Co. of Am. v. Cline,

                                      53
  98 Colo. 275, 284, 57 P.2d 1205, 1209 (1936), overruled on other

  grounds by Lockwood v. Travelers Ins. Co., 179 Colo. 103, 498 P.2d

  947 (1972). “Cross-examination for bias is liberally permitted

  because bias is always relevant as discrediting the witness and

  affecting the weight of his or her testimony.” Evans v. Colo.

  Permanente Med. Grp., P.C., 902 P.2d 867, 874 (Colo. App. 1995),

  aff’d in part and rev’d in part on other grounds, 926 P.2d 1218 (Colo.

  1996).

¶ 111   At the same time, attorneys have a duty to confine their

  arguments to the jury within proper grounds. United States v.

  Young, 470 U.S. 1, 8 (1985). An attorney seeking to attack a

  witness’s credibility should avoid challenging the witness’s moral

  character. See People v. Couch, 179 Colo. 324, 329, 500 P.2d 967,

  969 (1972). Moreover, “[a] trial is not a referendum on the conduct

  of the attorneys, and disparagement of opposing counsel is

  improper.” People v. Garcia, 2012 COA 79, ¶ 13, 296 P.3d 285,

  288. Thus, attorneys “must not be permitted to make unfounded

  and inflammatory attacks on the opposing advocate.” Young, 470

  U.S. at 9.

                                   54
   3.   The Court Did Not Err by Refusing to Grant Banner Health’s
        Requests for a Curative Instruction, a Mistrial, or a New Trial

¶ 112   The Gressers’ counsel walked a fine line during their

  aggressive questioning of Banner Health’s witnesses. It was not

  improper for counsel to explore whether Banner Health’s witnesses

  had coordinated their testimony at joint trial preparation sessions

  with Banner Health’s lawyers, whether those lawyers had scripted

  the opinions of one of Banner Health’s experts, whether the expert’s

  opinions were not based on all relevant facts, and whether a

  witness had withheld material information in his notes regarding

  C.G.’s symptoms. But accusations of lawyer or witness conduct

  such as “getting stories straight” and “cherrypicking” information,

  even if potentially proper in closing argument, have no place during

  the examination of witnesses absent evidence of misconduct not

  present here. A witness’s meeting with a lawyer to prepare for trial

  does not, without more, establish collusion or other unethical

  conduct. All the more, absent unusual circumstances not present

  here, few reasonable lawyers would allow a client to testify without

  any preparation.

                                    55
¶ 113   Against this backdrop, the court did not abuse its discretion in

  evaluating the risk of prejudice to Banner Health resulting from the

  challenged questioning and selecting an appropriate remedy in

  response to the Gressers’ counsel’s insinuation of collusion between

  Banner Health’s witnesses and lawyers.

¶ 114   First, the court correctly determined that the questioning

  regarding the time the witnesses spent with counsel, the materials

  the witnesses reviewed with the lawyers, and the presence of others

  at the trial preparation sessions did not implicate the attorney-

  client privilege. See Guy v. Whitsitt, 2020 COA 93, ¶ 21, 469 P.3d

  546, 551. Because those facts may influence a witness’ testimony,

  that questioning was relevant to the witnesses’ credibility. The

  questioning did not improperly probe into communications between

  Banner Health’s attorneys and the witnesses. Although Banner

  Health is correct that it was unable to respond to the questioning

  by counsel for the Gressers by eliciting testimony as to the

  substance of those communications because the communications

  were privileged, Banner Health’s tactical disadvantage does not

  mean that the questioning was improper. Thus, the court did not

  abuse its discretion by allowing the Gressers’ counsel to ask the

                                    56
  Banner Health employees about their meetings with Banner

  Health’s counsel.

¶ 115   Second, the court correctly sustained Banner Health’s

  objections to the argumentative questions that more directly

  alluded to collusion. The court’s rulings were effective; they cut off

  further questioning attacking the character of the witnesses or

  counsel for Banner Health. Similarly, the court’s instruction to the

  jury to disregard the reference to “Team Banner” precluded the

  Gressers’ counsel from repeating the phrase and advised the jury to

  decide the case based on the facts and not on characterizations of

  the parties. Absent evidence to the contrary, we presume that the

  jury followed the court’s instructions. See Qwest Servs. Corp. v.

  Blood, 252 P.3d 1071, 1088 (Colo. 2011). These actions sufficiently

  remedied any risk of prejudice to Banner Health resulting from the

  problematic questioning. See Smith v. Kinningham, 2013 COA 103,

  ¶ 34, 328 P.3d 258, 265.

¶ 116   Third, it was not manifestly arbitrary, unreasonable, or unfair

  for the court to decline to give a curative instruction that Banner

  Health lawyers’ conduct in preparing the witnesses was “not

  improper” and that the jury should not hold against Banner Health

                                    57
  the “accusations that something was done unethically.” The court

  explained that it was not the court’s “call as to whether or not the

  way the witnesses were prepared leads to the possibility that either

  they were coached, or . . . that they had an opportunity to get their

  testimony straight.” Further, the court reasoned that Banner

  Health’s lawyers had been able to effectively counter any implied

  accusations of impropriety. Because the trial court did not abuse

  its discretion by declining to provide a mid-trial curative

  instruction, the court likewise did not abuse its discretion by

  denying Banner Health’s request for the “most drastic” remedy of a

  mistrial. Id. (quoting Bloom v. People, 185 P.3d 797, 807 (Colo.

  2008)).

¶ 117    Fourth, we do not consider Banner Health’s specific challenge

  to the statements in the Gressers’ counsel’s closing argument

  because Banner Health did not contemporaneously object to those

  statements. “[T]his is not one of the exceptionally rare civil cases

  that warrants reversal based on an unpreserved claim of error.”

  Pinnacol Assurance v. Laughlin, 2023 COA 9, ¶ 22, 528 P.3d 912,

  916.

                                    58
¶ 118      Finally, because the court did not abuse its discretion in

  addressing each of the challenged questions, we affirm its denial of

  Banner Health’s motion for a new trial premised on those questions.

  The court was in the best position to evaluate whether the conduct

  of the Gressers’ counsel prevented Banner Health from having a fair

  trial. See Acierno, ¶¶ 27-28, 409 P.3d at 469. It was not manifestly

  arbitrary, unreasonable, or unfair to conclude that the Gressers’

  counsel’s questioning did not warrant the drastic remedy of a new

  trial.

¶ 119      We reject Banner Health’s invitation to grant a new trial based

  on the out-of-state cases cited in its opening brief. We have

  reviewed those cases and are not persuaded that they support

  Banner Health’s position that the relief it seeks is warranted

  because they are either distinguishable or inapposite. See United

  States v. Holmes, 413 F.3d 770, 775 (8th Cir. 2005) (reversing and

  remanding for new trial in criminal case where the prosecutor told

  the jury “[defense counsel] wants to distract you” and “[defense

  counsel] needs to make sure that they get their stories straight”);

  Sizemore v. Fletcher, 921 F.2d 667, 669-71 (6th Cir. 1990)

  (affirming grant of habeas relief where the prosecutor denigrated the

                                       59
  defendant’s right to counsel by arguing that the defendant had

  hired seven attorneys to “get [the] story straight” and “take[] care of

  everything”); State v. Underwood, 418 P.3d 658, 666 (Haw. 2018)

  (vacating conviction where the prosecutor told jury that the “defense

  attorney tried to get [the witness] to make up some story”); People v.

  Witted, 398 N.E.2d 68, 78 (Ill. App. Ct. 1979) (ordering new trial in

  criminal case where the prosecutor told the jury that defense

  counsel would have witnesses “say whatever he wants” and

  admonished the jury not to let defense counsel “hide behind

  technicalities in the law”); Ky. Guardianship Adm’rs, LLC v. Baptist

  Healthcare Sys., Inc., 635 S.W.3d 14, 28 (Ky. 2021) (The trial court

  did not err by precluding counsel from asking an adverse witness,

  “[H]ow many times have you rehearsed your testimony?”).

                             III.   Disposition

¶ 120   The judgment is affirmed.

        JUDGE WELLING and JUDGE GOMEZ concur.

                                     60