Appellants filed this action alleging federal and supplemental Oklahoma state law claims. See 28 U.S.C. §§ 1331, 1367(a). Prior to submitting the case to the jury, the district court granted appellee’s Rule 50 motion as to the federal claim. The jury returned a verdict in appellee’s favor with respect to the supplemental state law claim. The appeal of the district court’s final judgment is now properly before this court. See 28 U.S.C. § 1291. We affirm.
I. INTRODUCTION
A. Facts
On Wednesday, September 23,1998, Martin Shane Phillips, accompanied by his friend and co-worker Mike Lulka, walked into the emergency room of Hillcrest Medical Center (HMC). Phillips complained of severe chest pain and pneumonia-like symptoms. Prior to examining Phillips, HMC staff took background information from Phillips, including whether he was covered under any health insurance plan. Phillips claimed he was covered but could not locate his insurance card. Lulka, who was covered under the same plan from their mutual employer, offered his card to provide HMC administrative staff with the generic information that was equally applicable to the co-workers. HMC staff allegedly indicated on his file that Phillips was not insured.
After initial processing, Phillips was “triaged” by Lugenia Cue, 1 a registered nurse, and then examined by Dr. Carolyn Cobb in the minor care side of the emergency room. After the examination, Phillips was given two prescriptions, dis *795 charged from the emergency room, and referred to an Oklahoma medical clinic for follow-up treatment. Though his symptoms failed to subside, Phillips was seen at work on the two days (Thursday and Friday) following his discharge from HMC. Based upon all accounts, his condition was rapidly deteriorating through Saturday and Sunday.
Late Sunday night or early Monday morning, Fred Phillips, decedent’s father, decided to take Phillips to the emergency room at Tulsa Regional Medical Center (TRMC). They arrived at TRMC, claiming Phillips had been suffering from nausea and vomiting for four to five days. Phillips again gave demographic information and denied, as he had on September 23, the use of illegal drugs. Phillips was initially examined by an emergency room doctor, Dr. Phillip Murta. Dr. Murta believed Phillips was suffering from pneumonia. Dr. Stan Stacy later relieved Dr. Murta and became concerned plaintiffs condition was the result of something more serious than pneumonia. After performing additional tests, Dr. Stacy confirmed Phillips was suffering from bacterial endo-carditis. Phillips’ condition worsened and he was pronounced dead on September 28, 1998. All parties agree the cause of death was acute bacterial endocarditis.
B. Procedural History
Plaintiffs 2 sued Hillcrest Medical Center, Dr. Carolyn Cobb, and Emergency Physicians, Incorporated (later amended to Tulsa Emergency Physicians, Incorporated (TEP)). The suit related only to the evaluation, diagnosis, and treatment provided Phillips on September 23, 1998. Plaintiffs alleged defendants violated the Emergency Medical Treatment and Active Labor Act (EMTALA) and also brought a claim for wrongful death under Oklahoma medical malpractice law for failing to properly treat Phillips.
Prior to trial, the district court dismissed the EMTALA claim against Dr. Cobb and TEP. The remaining claims were presented to a jury. At the close of evidence, the district court sustained HMC’s Rule 50 motion, holding no EMTA-LA claim existed as a matter of law, and sustained appellants’ Rule 50 motion that Dr. Cobb was the agent of HMC. 3 The district court submitted the issue of medical malpractice/wrongful death to the jury and a verdict in favor of HMC was returned. Plaintiffs filed this appeal.
C. Summary of Issues on Appeal
On appeal, appellants raise four issues. Appellants allege the district court erred in (1) granting HMC’s Rule 50 motion as to the EMTALA claim, (2) admitting allegations of Phillips’ drug use, (3) excluding plaintiffs’ expert testimony regarding the cause of bacterial endocarditis, and (4) refusing to allow cross-examination of HMC’s nurse regarding Exhibit 25 and Exhibit 26.
II. ANALYSIS
A. EMTALA
Appellants argued at trial that HMC treated Phillips differently than similarly situated patients because he was alleged to be uninsured and that HMC’s established procedures were not followed. The district court ruled no evidence of differential treatment was presented and, at most, the complained of conduct amounted to negligence. See Vol. II, pp. 844-45. At the invitation of the district court, 4 appellants *796 are now pressing similar argument before this court.
1. Standard of Review
This court reviews the grant of judgment as a matter of law
de novo,
sitting in the same position as the trial court.
See Tyler v. Re/Max Mountain States, Inc.,
2. Legal Framework
Congress enacted EMTALA in 1986 to address the problem of “dumping” patients in need of medical care but without health insurance.
See Abercrombie v. Osteopathic Hosp. Founders Ass’n,
Under EMTALA, a participating hospital
5
has two primary obligations.
See Ingram v. Muskogee Reg’l Med. Ctr.,
Pursuant to section 1395dd(a), HMC was required to conduct an “appropriate medical screening examination ... to determine whether or not an emergency medical condition ... exists.” 42 U.S.C. § 1395dd(a).
6
This court has stated that
*797
whether a given hospital has performed an “appropriate medical screening examination,” as defined by EMTALA, varies with the unique capabilities of the specific hospital.
See Repp,
The underlying principle behind section 1395dd(a) is to ensure all patients, regardless of their perceived ability or inability to pay for medical care, are given consistent attention. EMTALA’s requirement of an “appropriate screening examination” undeniably requires HMC to “apply uniform screening procedures to all individuals coming to the emergency room.”
Vickers v. Nash Gen. Hosp. Inc.,
3. Appellants’ Claims
Appellants argued to the district court, as they have here, that evidence of a bias towards those who are uninsured is sufficient to state an EMTALA claim. They point to the testimony of Mike Lulka regarding the initial intake procedures HMC undertook and attempt to extrapolate an intolerance towards those perceived to be uninsured.
8
They
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also look for support in Christina Daczew-itz’s testimony that she saw, some time after Phillips’ death, a notation of “no insurance” on Phillips’ medical records at HMC. Appellants’ repeated attempts to introduce evidence regarding HMC’s motives are irrelevant to whether Phillips was treated in a manner consistent with HMC’s existing procedures. This circuit, like many others, does not require any particular motive for EMTALA liability to attach.
See Repp,
Moving to the crux of their EMTALA claim, appellants attempted to identify certain HMC policies they claim were not followed. During the Rule 50 colloquy, the district court asked appellants to point to the evidence adduced in support of the EMTALA claim.
See
Vol. II, p. 827. As they have before this court, appellants pointed to Exhibit 47 (Vol.IV) and an unidentified discharge policy, claiming various aspects of these policies were not followed. The district court repeatedly implored appellants’ counsel to describe the evidence showing that HMC failed to screen and evaluate Phillips’ condition. In the interest of brevity, it is sufficient to say appellants’ counsel reluctantly conceded HMC, either through Nurse Cue and/or Dr. Cobb, did in fact make a determination as to Phillips’ condition with respect to each and every allegation of failure to abide by existing policy requirements.
See
Vol. II, p 829, In. 19-20;
Id.
at p. 830, In. 11 — p. 831, In. 4;
Id.
at p. 831, In. 5-p. 832, In. 4;
Id.
at p. 843, In. 11 — p. 844, In. 12. Based upon these admissions and in reliance upon
Repp
and
Tank v. Chronister,
Appellants’ argument brings into focus the uneasy intersection between EMTALA and state law medical negligence claims. They argue HMC staff failed to appropriately identify and/or appreciate the gravity of Phillips’ condition. In other words, while they concede HMC technically complied with their pre-existing standards, the practical effect was an inadequate examination. EMTALA was not, however, designed for such a claim. Though it created a new cause of action, we have consistently recognized EMTALA’s provisions have only a limited reach and purpose. See
Ingram,
EMTALA does not set a federal standard of care or replace pre-existing state medical negligence laws.
See, e.g., Repp v. Anadarko Mun. Hosp.,
B. Drug Use
In addition to the EMTALA claim, appellants alleged Dr. Cobb and HMC violated the standard of care in the treatment of Phillips. As an affirmative defense, Dr. Cobb and HMC responded Phillips was at fault, invoking Oklahoma’s comparative negligence defense, for failing to notify them of his prior drug use. HMC claimed this failure to provide relevant medical information contributed to any negligent care it may have provided.
Prior to trial, appellants moved to exclude any and all evidence of Phillips’ alleged drug use. The district court denied this request and allowed testimony that Phillips had used “street drugs” and failed to inform Dr. Cobb of this information when he sought treatment at HMC. The court ruled the evidence was admissible to support HMC’s defense of comparative negligence. On appeal, appellants argue that the evidence was irrelevant and unduly prejudicial.
1. Standard of Review
Though appellants moved,
in limine,
to exclude evidence of drug testimony, they failed to renew their objection at trial. HMC admits this has sufficiently preserved the issue for appellate review.
See United States v. Mejia-Alarcon,
2. Relevance
In Oklahoma, evidence of a patient’s failure to provide an accurate medical history is relevant to the defense of contributory negligence in a medical malpractice claim.
See
Okla.Stat. tit. 23, §§ 13, 14;
Graham v. Keuchel,
3. Unfair Prejudice
Even assuming Phillips’ failure to inform HMC of his prior drug use was relevant, appellants claim the district court erred because evidence of Phillips’ drug use was unfairly prejudicial. Pursuant to Rule 403, the district court must determine whether the admission of relevant evidence would cause unfair prejudice.
See
Fed. R.Evid. 403. Due to the district court’s superior position to gauge the testimony’s prejudicial impact in light of the evidence presented throughout trial and the jurors’ perception of the case as a whole, we give the district court’s determination a large degree of deference.
See, e.g., Joseph v. Terminix Int’l Co.,
Under Rule 403, relevant evidence may be excluded “if its probative value is substantially outweighed by the danger of unfair prejudice.” Fed.R.Evid. 403. According to the literal language of the rule, ordinary prejudice alone is insufficient to exclude relevant evidence. The prejudice must be unfair, such that we may conclude the jurors made them decision based not upon the evidence presented but upon their confusion, passion, or emotion.
See, e.g., Stump v. Gates,
Based upon a review of the proceedings appellants have identified as most egregious, we are unable to conclude any unfair prejudice occurred. The testimony from HMC and Dr. Cobb’s expert simply noted the obvious — drug use is an important indicator of a patient’s physical condition and is crucial to determining whether to undertake additional testing.
See
Vol. II, p. 945.
11
While plaintiffs would have preferred evidence of Phillips’ drug use not be presented to the jury, simple prejudice alone is insufficient to warrant exclusion.
See Peters,
C. Causation Testimony
Appellants next contend the district court erroneously excluded testimony of *801 their expert, Dr. Benjamin E. Zola. Dr. Zola apparently would have testified that Phillips’ alleged drug use did not cause bacterial endocarditis. The district court, however, ruled that evidence of what caused plaintiffs fatal condition was not at issue. See Vol. II, p. 755-56. The court stated the issue was whether Dr. Cobb negligently treated Phillips on September 23, 1998 and whether Phillips contributed, by withholding pertinent health information, to the alleged negligent care. See id. As such, what actually caused bacterial endocarditis was irrelevant to whether Dr. Cobb’s treatment fell below the recognized standard of care.
1. Standard of Review
Ordinarily, this court would review the exclusion of expert testimony under the standards set forth in
Daubert v. Merrell Dow Pharmaceuticals, Incorporated,
2. Causation of Disease
Appellants made a proffer that Dr. Zola would testify that, based upon a reasonable degree of medical certainty, Phillips’ drug use did not cause bacterial endocarditis. See Vol. II, p. 753-55. This testimony was necessary, appellants argue, to rebut arguments or evidence that HMC or Dr. Cobb might present to the effect Phillips caused his own death. The district court stated that the cause of Phillips’ bacterial endocarditis was irrelevant to the negligence claim at issue and that Phillips’ use of drugs was relevant only to the extent that he failed to inform Dr. Cobb of a pertinent medical condition. See id. at 755. While counsel for HMC and Dr. Cobb were free to argue Phillips withheld pertinent information, the district court rule that “if [counsel for HMC or Dr. Cobb] start even for a moment suggesting that the cause of death was drug use, then there will be serious old testament stuff.” Id.
Because appellant has failed to indicate any events contrary to this ruling actually occurred, we are assured all arguments fell well within this ruling. Without evidence alleging Phillips caused his own death, appellants’ sole justification for Dr. Zola’s testimony vanishes. Accordingly, we hold the district court’s decision fell well within his wide discretion. Furthermore, while it may have been appropriate to offer a limiting instruction to the jury, there is no indication appellants requested one. Given appellants’ failure, we can not say plain error occurred.
See Gilbert v. Cosco Inc.,
D. Cross-examination
In their fourth and final point, appellants allege evidence of disparate treatment (applicable only to the EMTALA claim) would have been shown if the district court had allowed them to cross-examine HMC’s triage nurse, Lugenia Cue, with Exhibits 25 and 26. These exhibits were summaries, prepared by HMC’s counsel at the request of appellants, indicating the number of patients admitted to *802 the emergency room (Exhibit 25) and the minor care area of HMC (Exhibit 26) on September 28, 1998. See Vol. IV, Exs. 25 and 26. The information contained in these exhibits showed the time the unnamed patients were admitted and released, a one to two word description of their symptoms, and which side of the hospital they were sent to after initial “triaging.” Upon consulting the record, it appears appellants sought to submit these two documents to the jury as definitive proof of differential treatment by HMC. See Vol. I, p. 370-77. The district court ruled this method was unduly confusing to the jurors but invited appellants to question Cue as to Phillips’ condition and whether, as a general matter, more patients with those symptoms were triaged to the emergency room on that day or otherwise. See id. at pp. 375-78. Appellants then asked Cue whether she typically sent more people with chest pain to the minor side or to the emergency side, but when she responded she could make no categorical statement, the issue was pressed no further. See id. at 378.
1. Standard of Review
As an initial matter, the parties disagree as to what standard of review this court should use to analyze appellants’ claim of error. HMC contends no offer of proof was made as to the content of these exhibits and therefore this court may review only for plain error. As we have stated before, “[ejrror may not be based on a ruling excluding evidence unless ‘the substance of the evidence was made known to the court by offer [of proof] or was apparent from the context within which questions were asked.’ ”
Inselman v. S & J Operating Co.,
In order to satisfy Rule 103(a)(2), we have held that “ ‘merely telling the court the content of ... proposed testimony’ is not an offer of proof.”
Polys v. Trans-Colorado Airlines, Inc.,
Based upon a review of the record, appellants have sufficiently preserved this issue for appeal. Specifically, the exhibits were identified, their contents and origins discussed, and argument as to their admissibility was made.
See
Vol. I, pp. 369-76. We hold this more than sufficiently met the demands of
Polys.
As such, appellants’ allegation of error will be reviewed under the less stringent abuse of discretion standard.
See Polys,
2. Exclusion of Testimony
The district court’s rationale for excluding the exhibits is that they were rough summaries made by HMC’s counsel, were utterly ambiguous, and, without more information, would be “fundamentally misleading.” Vol. I., p. 374. Though not ex
*803
pressed, it appears the court relied upon Rule 40B and determined the evidence, in the form of exhibits 25 and 26, would have painted a distorted picture. In order to allow the alleged differential treatment evidence to be presented to the jury, however, the district court provided a sufficiently effective alternative method.
12
While the district court excluded arguably relevant evidence, it was not an abuse of discretion, especially considering the viable and effective alternatives discussed and agreed to by counsel.
See Deters v. Equifax Credit Information Servs. Inc.,
III. CONCLUSION
After a thorough review and analysis of all issues fairly presented, we AFFIRM.
Notes
. When patients arrive at HMC, hospital personnel perform a "triage.” Triage is a procedure, first used by military hospitals, to perform an initial assessment of a patient’s symptoms in order to direct the patient to the area of care commensurate with his condition. See American Heritage Dictionary 1908 (3d ed. 1992).
. Plaintiffs include Phillips’ surviving daughter (Crystal Star Phillips), his Estate (the Estate of Martin Shane Phillips), his father (Fred Phillips, Jr.), and the mother of his daughter (Minnie Christina Daczewitz).
. As such, Dr. Cobb is no longer a party to this case.
.The court stated to appellants’ counsel "you certainly can amplify [your argument] many pages over in Denver, but you’ve certainly got a record here.” Vol. II, p. 852, Ins. 3-4.
. The parties agree HMC is a participating hospital and is therefore covered by EMTA-LA's requirements. See 42 U.S.C. § 1395dd(e)(2).
. 42 U.S.C. section 1395dd(a) reads as follows:
Medical screening requirement
In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treat *797 ment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.
. When a procedure has not been established by a participating hospital, the inquiry is somewhat different.
See, e.g., Power v. Arlington Hosp. Ass’n,
. Interestingly, however, Lulka further stated the fact that Phillips did not have on his person the insurance card was not a problem and did not appear to affect the care of Phillips.
. They did and the jury returned a verdict in favor of HMC and Dr. Cobb.
. Appellants have attempted to avoid this result by claiming their negligence claim was based upon Dr. Cobb's failure to "test,” not "diagnose,” Phillips. It is unclear to this court what, if any, significance this alleged distinction would make to the relevance of Phillips' withholding pertinent medical information from his treating physicians. Because appellants have failed to support this distinction with any authority, legal or otherwise, we need not consider it.
See, e.g., Pelfresne v. Village of Williams Bay,
. Specifically, the identified portion of the record reads:
Q: All right. Before we move on, I want to go back to bacterial endocarditis and just ask you for diagnostic purposes is it important for you, the clinician, to know whether or not the patient is using street drugs?
A: I think it is. And much as I indicated earlier in terms of the historic or the setting, the use of street drugs raises your suspicion for infectious processes with particular regard to the heart and much like if you have a history of abnormal heart valves or previous heart surgery.
Vol. II, p. 945, Ins. 8-16. In addition, counsel for Dr. Cobb, in opening statement, claimed drug use was relevant to the case because, "for diagnostic purposes the clinician needs to know that because it’s well known that [the use oí] street drugs is a well known predisposing factor for various infections including bacterial endocarditis, and they need to know that.” Vol. I, p. 56, Ins. 8-13.
. The colloquy between appellants counsel and the district court went as follows:
Court: Right. So the question — I mean, you can ask her why it is that she chose, in the face of chest pain, to send him to minor care. And you can even ask her if in more circumstances than not, chest pain goes to the emergency room. But your goal here is to talk about what she saw and heard and what decision she made and why she made them, and whether or not those decisions in the normal course were different than what she normally does.
Counsel: Is Your Honor saying I can ask her typically do more people go to the emergency side with chest pain?
Court: Does she send more people to the emergency side.
Counsel: Yes sir.
Court: And what was it about this patient that caused her not to do that.
Court: [ ] The point is, is that with that the one word entry doesn't tell us anything about whether or not somebody should go to the minor care side or ER side; right?
Counsel: Well, I mean, I think that’s something that the witness would certainly be able to explain. But I understand. With my objection noted, Your Honor, I understand the court’s ruling.
Court: No. I understand your objection. All Right.
Vol. I, pp. 375-76.