Retractable Technologies, Inc. v. Becton Di , 919 F.3d 869 ( 2019 )


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  •      Case: 17-40960   Document: 00514888678     Page: 1   Date Filed: 03/26/2019
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT   United States Court of Appeals
    Fifth Circuit
    FILED
    March 26, 2019
    No. 17-40960
    Lyle W. Cayce
    Clerk
    RETRACTABLE TECHNOLOGIES, INCORPORATED; THOMAS J. SHAW,
    Plaintiffs - Appellants
    v.
    BECTON DICKINSON & COMPANY,
    Defendant - Appellee
    Appeals from the United States District Court
    for the Eastern District of Texas
    Before HIGGINBOTHAM, SMITH, and GRAVES, Circuit Judges.
    PATRICK E. HIGGINBOTHAM, Circuit Judge:
    A jury found that Becton Dickinson & Co. falsely advertised its products
    for years. The district court determined that neither disgorgement of profits
    nor further injunctive relief would be equitable under the circumstances. It did
    not abuse its discretion. We affirm.
    I
    This case involves a narrow subset of medical syringes: retractable
    syringes, a type of “safety syringe” designed to reduce risk of accidental
    needlesticks. Retractable syringes compete both with other varieties of safety
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    syringes and with “conventional” syringes. 1 Although retractable syringes
    provide significant protection against accidents, their fixed needles prevent use
    for some hospital and clinical purposes. 2
    Retractable Technologies, Inc. and Becton Dickinson & Co. compete in
    the U.S. safety syringe market alongside two other major safety syringe
    manufacturers. 3 RTI primarily manufactures retractable syringes and
    dominates the retractable syringe sub-market; while BD produces retractable
    syringes, it also produces several conventional and non-retractable safety
    products that account for the bulk of its revenue. 4 This appeal is the latest
    stage of ongoing litigation between the two.
    A
    BD made two false claims in its marketing materials. First, it advertised
    itself as having the “world’s sharpest needle,” reflecting that needle sharpness
    is seen as a proxy for patient comfort, and persisted in doing so after its
    internal tests indicated otherwise. 5 Second, it promoted its retractable
    syringes as having seven times less “waste space” than RTI’s product, meaning
    that the syringes would waste less medicine per use. 6 While BD’s testing
    supported this claim at first, internal tests from 2003 onward demonstrated
    that RTI’s syringes were less wasteful than claimed. 7
    RTI and its founder, Thomas J. Shaw, sued BD for antitrust violations
    and false advertising under the Lanham Act, pointing to these false claims and
    1 Retractable Techs., Inc. v. Becton Dickinson & Co. (RTI I), 
    842 F.3d 883
    , 889 (5th
    Cir. 2016).
    2 
    Id. 3 Id.
    As of 2010, BD had a 49% share of the safety syringe market, Covidien Ltd. had
    a 30% share, Smiths Medical had a 10% share, and RTI had a 6% share. 
    Id. 4 Id.
           5 
    Id. at 893.
           6 
    Id. at 893–94.
           7 
    Id. 2 Case:
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    other allegedly unfair and anticompetitive business practices. 8 A jury sided
    with RTI on one of its antitrust claims and all of its Lanham Act false
    advertising claims. It found that RTI was due more than $113.5 million in
    antitrust damages. 9 RTI elected to not seek an award of damages for the
    Lanham Act claim from the jury. 10
    The district court statutorily trebled the antitrust damages and granted
    attorney’s fees, resulting in a total award of approximately $352 million. RTI
    additionally requested disgorgement of BD’s profits and injunctive relief. The
    district court concluded that equity favored disgorgement, but that any
    relevant profits were subsumed by the trebled antitrust damages award. It also
    crafted a six-part injunction requiring BD to cease certain advertising claims
    for several years, post a notice on its website, notify various entities of the false
    claims, and implement a training program for employees and distributors. 11
    On BD’s motion to stay the injunction pending appeal, the district court stayed
    only the portion of the injunction that would require BD to notify its “end
    users”—that is, the “hospitals, clinics, and other healthcare providers that do
    not resell the syringes in the ordinary course of business.” 12
    8  RTI initially filed state tort claims in addition to its Lanham Act and antitrust
    claims, but dismissed them after the close of evidence at trial. 
    Id. at 890.
    RTI also sued BD
    for patent infringement, which was tried separately. On appeal, the Federal Circuit upheld
    one of the patent claims on which RTI had prevailed at trial. See Retractable Techs., Inc. v.
    Becton, Dickinson & Co., 
    653 F.3d 1296
    (Fed. Cir. 2011).
    9 RTI 
    I, 842 F.3d at 890
    .
    10 
    Id. 11 The
    injunction extended up to five years for certain portions and up to three years
    for other portions.
    12 The district court’s rationale for staying this portion of the injunction was that
    intermediary distributors were the most likely to perpetuate BD’s false statements and
    further harm RTI, whereas forcing BD to admit wrongdoing to end users posed a greater risk
    of irreparable harm to BD.
    3
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    B
    While BD began to comply with the portions of the injunction that were
    not stayed, it appealed the jury’s finding of antitrust liability and the district
    court’s remedies determination. 13 We concluded that RTI’s antitrust claim was
    legally insufficient and reversed that portion of the judgment—so at a
    minimum, RTI was no longer entitled to trebled antitrust damages and
    attorney’s fees. 14 Having determined that the injunction was predicated at
    least in part on BD’s antitrust liability, we also vacated the injunction and
    remanded to the district court to determine whether the Lanham Act violations
    standing alone justified continued equitable relief. 15
    As for disgorgement of BD’s profits, we specifically approved of some of
    the district court’s findings: “at least some portion of BD’s profits were
    attributable to the false advertising,” BD intended to confuse or deceive
    consumers, and RTI did not unreasonably delay in seeking relief. 16 Beyond
    that, recognizing that the district court had subsumed the disgorgement into
    the trebled antitrust damages, we remanded “for a thorough reweighing of the
    remaining factors and the entirety of the record to determine whether and how
    much profit BD should disgorge to compensate for the Lanham Act
    violations.” 17 “In particular,” we observed, “when assessing [whether BD
    diverted sales from RTI], the district court should bear in mind that
    speculative and attenuated evidence of diversion of sales will not suffice.” 18
    13  RTI 
    I, 842 F.3d at 893
    , 901. BD also appealed its Lanham Act liability, asserting
    res judicata and laches. 
    Id. at 898–900.
    It did not contest the underlying finding of false
    advertising liability.
    14 
    Id. at 898.
            15 
    Id. at 902.
            16 
    Id. at 901
    (emphasis added).
    17 
    Id. 18 Id.
    (citing Seatrax, Inc. v. Sonbeck Int’l, Inc., 
    200 F.3d 358
    , 372 & n.8 (5th Cir.
    2000)).
    4
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    On remand, the district court conducted a one-day bench trial and
    evaluated an otherwise closed record. It ultimately declined to disgorge BD’s
    profits or reinstate any portion of the vacated injunction. RTI appeals.
    II
    We review a district court’s decision to grant or withhold disgorgement
    or injunctive relief under the Lanham Act for abuse of discretion. 19 Exercise of
    its discretion must not have been based on an “erroneous view of the law” or a
    “clearly erroneous assessment of the evidence.” 20 The district court otherwise
    has “[g]reat latitude” 21 to “determine the nature of the infringing conduct and
    its adverse effects, if any, on the plaintiff,” and to fashion relief accordingly. 22
    III
    We will begin with the district court’s denial of further injunctive relief.
    A district court’s discretion to grant injunctive relief is both broad and
    constrained by well-settled principles. When we remanded the issue to the
    district court, while recognizing that a further need for injunctive relief was
    “theoretically possible,” we emphasized that “[a] plaintiff seeking injunctive
    relief must show a real and immediate threat of future or continuing injury
    apart from any past injury,” and that any injunction should be “no broader
    than reasonably necessary to prevent the deception.” 23
    19 See, e.g., Quick Techs., Inc. v. Sage Grp., PLC, 
    313 F.3d 338
    , 347 (5th Cir. 2002).
    20 Aransas Project v. Shaw, 
    775 F.3d 641
    , 648 (5th Cir. 2014) (per curiam). RTI argues
    that because the district judge on remand did not preside over the original trial, the court’s
    factual conclusions on remand should be subject to higher scrutiny. Here, where the remand
    court conducted a one-day bench trial and could review extensive documentary evidence
    presented in the initial trial, we will review its factual determinations for clear error. Cf.
    Anderson v. City of Bessemer City, 
    470 U.S. 564
    , 574 (1985) (confirming that clear error
    review accounts for the trial court’s expertise in determining facts, so even factual findings
    that do not rest on in-person testimony must be reviewed for clear error).
    21 Martin’s Herend Imports, Inc. v. Diamond & Gem Trading USA Co., 
    112 F.3d 1296
    ,
    1304 (5th Cir. 1997).
    22 
    Seatrax, 200 F.3d at 369
    .
    23 RTI 
    I, 842 F.3d at 902
    (quoting Aransas 
    Project, 775 F.3d at 663
    , and Better Bus.
    Bureau of Metro. Hous., Inc. v. Med. Dirs., Inc., 
    681 F.2d 397
    , 405 (5th Cir. 1982)).
    5
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    The district court hewed to these reminders on remand. It observed that
    although it had stayed the requirement that BD notify its end users of the false
    advertising, BD took multiple steps to comply with the remainder of the
    injunction for the two-year period 24 before we reversed BD’s false advertising
    liability on appeal. BD notified “over 750 distributors, over 10,000 employees,
    and all the major Group Purchasing Organizations, stating that its needle
    sharpness and waste space claims were inaccurate.” Further, “BD removed the
    false advertising from its marketing materials . . . and posted a notice on its
    website.” It also implemented a training program for employees and
    distributors. The district court concluded that these steps had been sufficient
    to remedy any injury or threat of injury RTI had suffered from the false
    advertising.
    RTI argues that this analysis was flawed because it failed to account for
    notification to end users, the portion of the original injunction that never went
    into effect because the district court stayed it pending appeal; that because end
    users play a significant role in medical decisions to purchase syringes, BD’s
    false advertising cannot be fully remedied without requiring end user
    notification. While aware that this portion of the original injunction never took
    effect, the district court concluded that RTI had not demonstrated a real and
    immediate threat of future or continuing injury that would warrant further
    injunctive relief. RTI has presented no reason to conclude that the district
    court clearly erred in this determination or that it abused its discretion by
    denying further injunctive relief.
    24 The district court required BD to begin complying with the injunction on February
    14, 2015, and our opinion issued on December 2, 2016.
    6
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    IV
    The heart of the parties’ dispute is whether the district court erred in
    denying disgorgement of BD’s profits. Section 35 of the Lanham Act allows
    monetary recovery for certain Lanham Act violations in the form of actual
    damages, disgorgement, and costs. 25 A plaintiff’s entitlement to disgorged
    profits is assessed based on the equities of the case and does not automatically
    follow from liability. 26
    Our caselaw establishes two distinct considerations in assessing whether
    disgorgement is appropriate. The first is whether disgorgement is equitable
    under the six factors set forth in Pebble Beach Co. v. Tour 18 I Ltd.:
    (1) whether the defendant had the intent to confuse or
    deceive, (2) whether sales have been diverted, (3) the
    adequacy of other remedies, (4) any unreasonable
    delay by the plaintiff in asserting his rights, (5) the
    public interest in making the misconduct unprofitable,
    and (6) whether it is a case of palming off. 27
    The Pebble Beach factors are non-mandatory and non-exclusive: the district
    court is free to consider other facts in assessing whether disgorgement of
    profits would be equitable, just as it may exercise discretion in weighing the
    individual factors. 28
    25 15 U.S.C. § 1117(a) (2018). The statute further clarifies that “[i]n assessing profits
    the plaintiff shall be required to prove defendant’s sales only; defendant must prove all
    elements of cost or deduction claimed.” 
    Id. 26 See,
    e.g., Am. Rice, Inc. v. Producers Rice Mill, Inc., 
    518 F.3d 321
    , 338 (5th Cir.
    2008); 
    Seatrax, 200 F.3d at 369
    .
    27 Pebble Beach Co. v. Tour 18 I Ltd., 
    155 F.3d 526
    , 554 (5th Cir. 1998), abrogated on
    other grounds by TrafFix Devices, Inc. v. Mktg. Displays, Inc., 
    532 U.S. 23
    (2001). While these
    factors were formulated in the trademark infringement context, they also apply to false
    advertising. See, e.g., RTI 
    I, 842 F.3d at 900
    –01.
    28 See, e.g., Quick 
    Techs., 313 F.3d at 348
    –49.
    7
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    The second consideration is whether the defendant’s profits are
    attributable to the Lanham Act violation. 29 In short, “where a plaintiff who has
    brought a Lanham Act claim for false advertising has failed to present evidence
    that the defendant benefited from the alleged false advertising, the plaintiff
    will not be permitted to recover any of the defendant’s profits,” even where the
    Pebble Beach test favors disgorgement. 30
    On remand, the district court correctly recognized that we had affirmed
    certain portions of its disgorgement analysis, making that analysis the law of
    the case. We agreed with the district court’s conclusion that “at least some
    portion of BD’s profits were attributable to the false advertising.” 31 As for the
    Pebble Beach factors, we specifically affirmed its findings that the “intent to
    confuse or deceive” and “unreasonable delay” Pebble Beach factors favored
    disgorgement. 32 Following our instructions to engage in “a thorough re-
    weighing of the remaining factors and the entirety of the record to determine
    whether and how much profit BD should disgorge to compensate for the
    Lanham Act violations,” 33 the district court reevaluated the remaining Pebble
    Beach factors. It found that although BD had intended to confuse or deceive,
    RTI had not unreasonably delayed in asserting its rights, and the public
    interest favored disgorgement, the equities weighed against disgorgement
    because RTI had not shown diversion of sales or palming off and injunctive
    relief was an adequate remedy. RTI challenges the district court’s assessment
    of several of the individual Pebble Beach factors, as well as its ultimate
    balancing of the factors.
    29See, e.g., 
    id. at 350;
    Tex. Pig Stands, Inc. v. Hard Rock Cafe Int’l, Inc. (Texas Pig
    Stands II), 
    966 F.2d 956
    , 957 (1992), on denial of reh’g.
    30 Logan v. Burgers Ozark Country Cured Hams Inc., 
    263 F.3d 447
    , 464 (5th Cir. 2001).
    31 See RTI 
    I, 842 F.3d at 901
    .
    32 See 
    id. 33 Id.
    8
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    A
    RTI contests the district court’s conclusion on remand that the “diversion
    of sales” factor did not favor disgorgement. The district court initially found
    that this factor favored disgorgement, but only slightly. As we have explained,
    the district court found that at least some of BD’s profits were attributable to
    its false advertising. But although it recognized that “BD profited from its false
    advertisements,” the court observed that “it is less certain that the resulting
    sales came at RTI’s expense,” because RTI and BD were not the only
    participants in the safety syringe market. Despite this hesitation, the court
    ultimately found that RTI had produced enough evidence, in the form of
    internal BD emails touting commercial successes attributable to its needle-
    sharpness and waste-space advertisements, to confirm the “rational conclusion
    that some portion of BD’s ill-gotten sales came at RTI’s expense.” It therefore
    weighed the diversion factor slightly in favor of disgorgement.
    On remand, guided by our reminder that “speculative and attenuated”
    evidence of diversion is insufficient to support disgorgement, the district court
    reevaluated the “diversion of sales” factor. It ultimately concluded that the
    factor weighed against disgorgement because RTI had not adequately
    demonstrated diversion. RTI challenges this on two grounds: first, that the
    district court was bound by the case’s prior history to find diversion of sales,
    and second, that the district court abused its discretion in finding no diversion.
    We disagree.
    1
    RTI first argues that the remand court should not have reassessed the
    diversion factor because the fact of diversion of sales was already conclusively
    established, both by the jury’s liability finding and by our opinion. Not so.
    The jury’s finding of Lanham Act liability did not conclusively establish
    diversion of sales. To prevail on a false advertising claim, a plaintiff must
    9
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    demonstrate injury or likely injury due to the defendant’s false advertising. 34
    We have cautioned against “conflat[ing] the injury requirement for [a] false
    advertisement claim with the requirement that [the plaintiff] prove his actual
    damages in order to obtain relief.” 35 We have further explained that “[i]n
    fashioning the appropriate remedy, a legal determination of liability is not
    dispositive,” and in determining whether disgorgement is appropriate a court
    must further consider the “adverse effects, if any, on the plaintiff.” 36 In sum, a
    plaintiff could prove that a defendant is liable for false advertising, but not
    satisfactorily demonstrate tangible harm—such as diverted sales—as a result
    of that false advertising. 37
    Nor did our prior decision establish diversion of sales as the law of the
    case. RTI argues that when we found “no clear error in the district court’s
    conclusion that at least some portion of BD’s profits were attributable to the
    false advertising,” 38 we established that the diversion factor weighed in favor
    of disgorgement. Taken in context, this argument conflates the “attribution of
    profits” requirement with the “diversion of sales” factor.
    When first determining whether disgorgement was appropriate, in
    keeping with our caselaw, the district court addressed the attribution
    34  
    Logan, 263 F.3d at 462
    .
    35  
    Id. at 462.
    Typically, injunctive relief is available even where a false advertising
    plaintiff cannot prove concrete enough damage to qualify for monetary relief. For example,
    while we generally will require a plaintiff seeking monetary relief to demonstrate actual
    consumer confusion or deception, we relax that requirement for a plaintiff seeking purely
    injunctive relief—the latter need only prove that the advertisement tends to deceive
    consumers. See Pizza Hut, Inc. v. Papa John’s Int’l, Inc., 
    227 F.3d 489
    , 497–98 (5th Cir. 2000).
    36 
    Seatrax, 200 F.3d at 369
    .
    37 See 
    Logan, 263 F.3d at 462
    –63 (holding that the plaintiff had not proven damages
    with sufficient particularity to support an award of actual damages, even though the injury
    element of the false advertising claim was met); see also Porous Media Corp. v. Pall Corp.,
    
    110 F.3d 1329
    , 1336 (8th Cir. 1997) (“Once it had established its [false advertising] claim,
    [the plaintiff] still bore the burden of proving an evidentiary basis to justify any monetary
    recovery.”).
    38 RTI 
    I, 842 F.3d at 901
    .
    10
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    requirement and the Pebble Beach factors separately. It found that RTI had
    sufficiently demonstrated that at least some of BD’s profits were attributable
    to its wrongful conduct—internal BD documents suggested that the false
    advertising allowed BD to command premium pricing and claim increased
    market share. Despite finding that some profits were attributable to the false
    advertising, the district court expressed well-founded skepticism that RTI had
    proven diversion of sales—observing that “[a]lthough BD profited from its false
    advertisements, it is less certain that the resulting sales came at RTI’s
    expense,” since it was not clear that every dollar BD earned came out of RTI’s
    pocket. Nonetheless, as we have explained, it ultimately found that “some
    portion of BD’s ill-gotten sales came at RTI’s expense.”
    When we affirmed the district court’s conclusion that “at least some
    portion of BD’s profits were attributable to the false advertising,” we referred
    to the district court’s initial finding that some of BD’s profits were attributable
    to the false advertising, not its considerably more tentative finding that the
    false advertising diverted sales specifically from RTI to BD. Indeed, after
    directing the district court to re-weigh the Pebble Beach factors that we had
    not specifically addressed, we instructed it not to consider “speculative and
    attenuated” evidence of diversion when assessing the “diversion of sales”
    factor—reflecting our understanding that while the district court may have
    properly found some profits attributable to the false advertising, this did not
    necessarily mean that the diversion factor supported disgorgement. 39
    At base, the attribution and diversion inquiries serve different functions
    in assessing the propriety of disgorgement. The “diversion” factor plays an
    39  
    Id. Of course,
    we left open the possibility that the district court could find on remand
    that RTI had lost sales to BD. See, e.g., 
    id. at 895
    (in discussing BD’s potential antitrust
    liability, observing that “RTI may have lost some sales or market share because of BD’s false
    advertising”).
    11
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    important role in establishing the plaintiff’s entitlement to profits. In many
    cases, disgorgement will not be equitable where few or no sales were ever
    diverted from the plaintiff to the defendant, because disgorgement in such
    contexts would grant the plaintiff an unjustified “windfall.” 40 The “attribution”
    requirement ensures that once the district court has determined disgorgement
    is equitable, a defendant will only be forced to disgorge profits attributable to
    the Lanham Act violation. 41 It signifies that, while these inquiries will often
    overlap, they are not coextensive. For example, as the district court recognized
    from the beginning, RTI had presented evidence that BD benefited from its
    false advertising by commanding premium pricing—generating increased
    profits for BD without necessarily diverting sales from RTI.
    In sum, there was no inconsistency between the district court’s
    reweighing of the diversion factor on remand and either the jury verdict or our
    previous opinion on appeal. Although we affirmed the district court’s
    recognition that BD benefited from the false advertising to some extent—
    satisfying the attribution requirement—we left open the possibility that RTI
    would be unable to present anything beyond “speculative and attenuated”
    evidence proving that this benefit came in the form of sales diverted from RTI
    to BD.
    2
    RTI also argues that once the district court reassessed the “diversion of
    sales” factor, it clearly erred in finding that RTI offered insufficient proof of
    diversion. Here too, we disagree. The district court found that the diversion
    factor did not favor disgorgement because the only evidence RTI had presented
    40Cf. Tex. Pig Stands, Inc. v. Hard Rock Cafe Int’l, Inc. (Texas Pig Stands I), 
    951 F.2d 684
    , 696 (5th Cir. 1992) (“The granted permanent injunction adequately remedies the
    complained-of infringement, and awarding [the plaintiff] any of [the defendant’s] profits
    would be far from equitable—it would be a windfall.”); accord Quick 
    Techs., 313 F.3d at 348
    .
    41 See, e.g., Quick 
    Techs., 313 F.3d at 349
    –50.
    12
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    of diverted sales was “speculative and attenuated”; the best evidence of
    diversion RTI produced was internal BD correspondence boasting about the
    commercial impact of its “needle sharpness” and “waste space” claims, and the
    trial court was persuaded that this correspondence did not actually prove that
    RTI’s customers or potential customers chose to purchase from BD instead of
    RTI as a result of the false advertising. Notably, RTI had not produced “a single
    witness or reliable study or data to prove a single example of a diverted sale,”
    nor did it produce evidence that any potential customer “ever saw the waste
    space comparison or relied on it in making purchasing decisions.” 42 At least
    some customers expanded their purchases from RTI after the dates they were
    allegedly presented with the deceptive waste space comparisons. In contrast,
    BD had difficulty selling its retractable syringes during the same period.
    These findings closely tracked our reasons for concluding that BD’s false
    advertising, standing alone, could not ground antitrust liability. We observed
    the sophisticated nature of the parties’ customers, not one of which testified to
    a purchase motivated by either of BD’s false claims about needle sharpness or
    waste space, but several of which testified that they were not impacted by
    advertisements. 43 We further observed that “RTI produced no evidence of
    customers being misled or confused and purchasing BD’s syringes instead of
    RTI’s because of the advertisements”—noting RTI’s 67% share of the
    retractable syringe sub-market, RTI’s own experts’ recognition that they could
    not substantiate a causal connection between the false advertising and BD’s
    42  RTI argues that the district court ignored evidence that a presentation including
    the false claims had been used with potential customers. Even if there was some evidence
    that BD presented the false advertising to clients, however, the district court did not clearly
    err in concluding that the false advertising did not affect client decisions or divert sales from
    RTI to BD. Further, RTI’s counsel conceded that in at least one case, an internal document
    prepared for a customer presentation was “not actually given” to that customer.
    43 RTI 
    I, 842 F.3d at 895
    .
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    sales, evidence that certain customers increased their purchases of RTI
    syringes after potentially being exposed to BD’s false statements, and evidence
    that factors other than BD’s advertising predominantly impacted its sales. 44 In
    sum, we concluded that “RTI’s evidence consisted mostly of boastful e-mail
    exchanges between BD sales representatives recounting what they believed
    were successful sales pitches, but notably there was no testimony from the
    customers themselves.” 45 While we discussed these facts in the context of RTI’s
    antitrust claim, the district court appropriately accounted for them in its
    analysis of diversion of sales. We cannot conclude that the district court clearly
    erred in finding that RTI had only presented speculative and attenuated
    evidence of diversion of sales, and that the diversion factor therefore did not
    favor disgorgement.
    Relatedly, RTI suggests that the district court on remand should have
    presumed diversion of sales because BD engaged in intentionally deceptive
    comparative advertising. 46 While some of our fellow circuits have applied this
    presumption to claims for disgorgement in false advertising cases, they have
    largely done so in cases of intentionally false comparative advertising “where
    [it is] reasonable to presume that every dollar defendant makes has come
    directly out of [the] plaintiff’s pocket.” 47 We need not decide the wisdom of this
    44 
    Id. at 896–97.
           45 
    Id. at 897.
           46 RTI also argues that the district court should have presumed diversion from the
    fact that BD’s statements were literally false. While we have held that a plaintiff can
    presumptively satisfy the deception and materiality elements of a false advertising claim by
    showing literal falsity, this speaks to liability, not entitlement to disgorgement. See Pizza
    
    Hut, 227 F.3d at 497
    (“With respect to materiality, when the statements of fact at issue are
    shown to be literally false, the plaintiff need not introduce evidence on the issue of the impact
    the statements had on consumers.” (emphasis added)).
    47 TrafficSchool.com, Inc. v. Edriver Inc., 
    653 F.3d 820
    , 831 (9th Cir. 2011); see also
    Merck Eprova AG v. Gnosis S.p.A., 
    760 F.3d 247
    , 262 (2d Cir. 2014) (“In a false advertising
    case such as this one, where the parties are direct competitors in a two-player market, and
    where literal falsity and willful, deliberate deception have been proved, the presumptions of
    injury and consumer confusion may be used for the purposes of awarding both injunctive
    14
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    presumption in such cases, because it does not apply here. From the beginning,
    the district court recognized that RTI and BD were not the only players in the
    safety syringe market and that it could not presume that any benefit BD
    gained from its false advertising came directly at the expense of RTI. 48 The
    district court therefore did not err in looking for more concrete evidence of
    diversion.
    B
    RTI also challenges the district court’s decision on remand that the
    “adequacy of other remedies” factor disfavored disgorgement. Before we
    reversed BD’s antitrust liability, the district court found that the trebled
    antitrust damages award and six-part injunction were likely adequate to
    remedy any harm caused by the false advertising. Even after we remanded,
    the district court concluded that the steps BD had already taken to comply
    with the injunction were sufficient—so the factor still weighed against
    disgorgement. This conclusion went hand-in-hand with the district court’s
    determination that RTI had not sufficiently demonstrated that it suffered
    concrete harm—in the form of diverted sales or otherwise—as a result of the
    false advertising.
    We have already explained why the district court did not clearly err in
    finding that further injunctive relief was unnecessary. For similar reasons, we
    cannot conclude that the district court clearly erred here. RTI has not
    demonstrated that the district court misunderstood or overestimated the scope
    relief and monetary damages to a successful plaintiff.”); Balance Dynamics Corp. v. Schmidt
    Indus., Inc., 
    204 F.3d 683
    , 694–95 (6th Cir. 2000) (“[L]iteral falsity, without more, is
    insufficient to support an award of money damages to compensate for marketplace injury
    such as harm to goodwill . . . . While literal falsehood or the likelihood of deception may be
    sufficient to entitle [the plaintiff] to injunctive relief or reimbursement for responsive
    advertising, it should not permit [the plaintiff] to recover for injuries to goodwill in the
    absence of some more substantial indication that these injuries actually occurred.”).
    48 See RTI 
    I, 842 F.3d at 888
    , 896.
    15
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    of the actions BD had already taken to comply with the injunction before it was
    vacated. Nor has RTI shown that the district court clearly erred in finding that
    the steps BD already took—including notifying over 750 distributors and
    Group Purchase Organizations—were adequate to remedy any harm RTI had
    experienced as a result of BD’s actions, especially since RTI ultimately offered
    only “speculative and attenuated” evidence of harm to its business as a result
    of the false advertising. We have previously held that when a Lanham Act
    plaintiff has already received or will benefit from substantial injunctive relief,
    disgorgement may amount to a “windfall.” 49
    The district court’s treatment of this factor hinged on a straightforward
    application of the principle that where the relief that a plaintiff has already
    received is otherwise adequate to remedy any harm posed to the plaintiff, an
    award of profits may not be equitable. 50 It did not abuse its discretion in
    weighing this factor against disgorgement.
    C
    Finally, RTI argues that the district court abused its discretion when it
    weighed the Pebble Beach factors to find that the equities did not favor
    disgorgement. RTI avers that the district court erred by assigning significant
    weight to the “palming off” factor. It also argues that the district court should
    have awarded disgorgement based solely on the need to deter future false
    advertising.
    49 See, e.g., Quick 
    Techs., 313 F.3d at 350
    (citing Texas Pig Stands 
    I, 951 F.2d at 696
    ).
    50 There is also no tension between the district court’s conclusions here and our
    reminder that “equitable relief is normally appropriate only in the absence of an adequate
    remedy at law (i.e., money damages).” RTI 
    I, 842 F.3d at 902
    . Here, a large portion of the
    injunctive relief had already been secured, and the district court was asked to determine
    whether the fact that BD had already taken several steps to comply with the injunction
    helped to mitigate the need for monetary relief. We do not necessarily approve of a general
    rule that, ex ante, injunctive relief is preferable to disgorgement.
    16
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    1
    The “palming off” factor applies when a Lanham Act defendant attempts
    to pass off its goods as the plaintiff’s. RTI has never argued that BD palmed off
    its syringes as RTI’s. Instead, it submits that “palming off” is an irrelevant
    factor in false advertising cases, and that the district court should have looked
    instead to the general loss of goodwill RTI experienced due to BD’s false claims.
    On remand, the district court observed that the “diversion of sales” and
    “palming off” factors are “especially important factors” in the Pebble Beach
    analysis under our caselaw. It concluded that disgorgement was inequitable
    because three Pebble Beach factors, “including the two most important,”
    weighed against disgorgement. RTI argues that this approach sets false
    advertising plaintiffs at a disadvantage relative to trademark infringement
    plaintiffs: while an appropriate measure of egregious conduct in trademark
    cases, palming off will rarely be demonstrated in Lanham Act cases that do not
    involve trademark claims.
    If a false advertising plaintiff has otherwise shown concrete harm due to
    the false advertising, such as diverted sales, a court should not heavily weigh
    the absence of palming off against disgorgement. Here, however, the district
    court appropriately considered the absence of palming off as another way in
    which RTI could have demonstrated concrete harm as a result of BD’s false
    advertising, but did not. The district court concluded that since RTI
    demonstrated neither diversion of sales nor palming off, disgorgement of BD’s
    profits would grant RTI an unjustifiable windfall.
    The district court correctly read our caselaw, which establishes that a
    plaintiff who cannot demonstrate diversion or palming off faces an uphill battle
    17
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    in obtaining disgorgement. 51 While a plaintiff seeking disgorgement need not
    demonstrate damages with the same degree of particularity as one seeking
    actual damages, 52 we are wary of disgorging profits to a party who can only
    speculate as to harm caused by the Lanham Act violation.
    RTI argues that in lieu of palming off, the district court should have
    accounted for loss of goodwill that RTI experienced as a result of the false
    advertising. Because the Pebble Beach factors are non-exclusive, district courts
    are always free to consider other facts affecting the equity of disgorgement.
    RTI argues that even where a Lanham Act plaintiff has not shown diversion of
    sales or palming off, disgorgement of the defendant’s profits may still be
    equitable where the plaintiff shows harm due to loss of consumer goodwill.
    In principle, RTI is correct. Even without sufficient evidence of diverted
    sales or palming off, proof of lost goodwill might weigh in favor of
    disgorgement—especially, though perhaps not only, where the plaintiff can
    show that the loss of goodwill tangibly affected the plaintiff’s business or would
    have affected the plaintiff’s business had the plaintiff not taken steps to
    resuscitate consumer perception. But here, RTI’s evidence of lost goodwill and
    steps taken to combat that lost goodwill, like its evidence of diverted sales, was
    51  See Streamline Prod. Sys., Inc. v. Streamline Mfg., Inc., 
    851 F.3d 440
    , 459 (5th Cir.
    2017) (noting that monetary damages are especially unwarranted under the Lanham Act
    either “in the absence of a showing of wrongful intent” or where there is “lack of sufficient
    proof of actual damages”); Sw. Recreational Indus., Inc. v. FieldTurf, Inc., No. 01-50073, 
    2002 WL 32783971
    , at *9 (5th Cir. Aug. 13, 2002) (unpublished opinion) (noting the absence of
    diversion and palming off in affirming a denial of disgorgement); 
    Seatrax, 200 F.3d at 372
    (noting that disgorgement was unjustified in light of a lack of willful infringement, lack of
    palming off, sufficiency of injunctive relief as a deterrent, and lack of “sufficient proof of
    actual damages”); Pebble 
    Beach, 155 F.3d at 555
    (emphasizing lack of proof of actual damages
    or intent to confuse or deceive).
    52 See Lexmark Int’l, Inc. v. Static Control Components, Inc., 
    572 U.S. 118
    , 135–36
    (2014) (explaining that disgorgement or injunctive relief may be appropriate in false
    advertising cases even where actual damages cannot be quantified with “sufficient
    certainty”).
    18
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    speculative. 53 As we have already explained, RTI pointed to no concrete
    evidence of lost goodwill that affected the purchasing decisions of its
    sophisticated customer base—in fact, as we recognized, RTI’s market share in
    the retractable syringe sub-market increased and its sales nearly doubled over
    the relevant period of false advertising. 54 The district court did not abuse its
    discretion in failing to place significant weight on the bare possibility that RTI
    lost goodwill with consumers due to BD’s advertising, without more, just as it
    did not abuse its discretion in placing significant weight on the fact that RTI
    had not otherwise demonstrated concrete harm.
    2
    In sum, the district court did not abuse its discretion in determining that
    where RTI had not sufficiently demonstrated that its business suffered due to
    BD’s false advertising and where BD had already taken significant steps to
    correct the false statements, disgorgement was not equitable. That another
    court could have evaluated the facts differently does not justify reversal,
    especially as “an award of profits with no proof of harm is an uncommon
    remedy in a false advertising suit.” 55
    RTI argues that this outcome conflicts with our holding in Maltina Corp.
    v. Cawy Bottling Co., which concluded that diversion of sales is not a
    prerequisite to disgorgement because disgorgement may also remedy unjust
    enrichment or deter future infringement, 56 thus helping to “take all the
    53  RTI cites evidence that its employees who were worried about loss of goodwill “had
    to expend effort and energy to go around and try to . . . tell people and convince them that it
    wasn’t true” and “spent a lot of time going to customers and trying to correct the
    misinformation, a lot of meetings, direct meetings, letter-writing, things like that.”
    54 RTI 
    I, 842 F.3d at 897
    .
    55 See 
    TrafficSchool.com, 653 F.3d at 831
    .
    56 See Maltina Corp. v. Cawy Bottling Co., Inc., 
    613 F.2d 582
    , 584–85 (5th Cir. 1980);
    see also Texas Pig Stands 
    II, 966 F.2d at 957
    (“This Court recognizes Maltina to be the law
    of the Fifth Circuit in its holding that (i) absence of competitors or (ii) failure of proof showing
    19
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    economic incentive” out of a Lanham Act violation. 57 It observes that Maltina
    rejected the view that disgorgement is only a means of “compensating . . . for
    loss or diverted sales,” and therefore held that diversion of sales is not
    necessarily a prerequisite to disgorgement. 58
    Maltina does not mandate disgorgement in every case where
    disgorgement might conceivably remedy unjust enrichment or deter future
    infringement, regardless of whether it would be equitable to disgorge profits to
    a particular plaintiff. To do so would effectively make disgorgement automatic
    any time the defendant has any profits attributable to a Lanham Act violation,
    in sharp contrast to our repeated reminder that disgorgement is ultimately an
    equitable remedy subject to the district court’s sound discretion. Here, where
    the district court found that injunctive relief was sufficient and monetary relief
    would grant RTI an unjustified windfall, it did not abuse its discretion in
    refusing to award disgorgement—other potential purposes of disgorgement
    notwithstanding. 59
    diversion of the mark owner’s sales is no defense to the claim for Defendant’s profits under
    15 U.S.C. § 1117.”).
    57 Am. 
    Rice, 518 F.3d at 340
    (observing that “infringing conduct should be unprofitable
    to infringers”).
    The parties discuss the relevance of the Lanham Act’s provision that at least certain
    monetary awards “shall constitute compensation and not a penalty.” 15 U.S.C. § 1117(a). The
    statute is ambiguous as to whether this limitation applies to all monetary awards under the
    section, or whether it only applies to enhancements or reductions for inadequate or excessive
    awards. We have generally read this provision to broadly hold that any monetary damages
    under the Lanham Act should constitute compensation and not a penalty. See, e.g.,
    Streamline Prod. 
    Sys., 851 F.3d at 459
    (“The Lanham Act . . . . instructs that . . . monetary
    damages [in the form of profits, damages, or costs] ‘shall constitute compensation and not a
    penalty.’”); 
    Logan, 263 F.3d at 464
    n.15 (“Section 1117(a) states that the damages provided
    thereunder are ‘subject to the principles of equity’ and ‘shall constitute compensation and not
    a penalty.’”). Our decision here, though, does not hinge on this provision but rather on the
    well-settled principles of equity repeatedly explained in our Lanham Act caselaw.
    58 
    Maltina, 613 F.2d at 584
    .
    59 The district court distinguished Maltina on the grounds that trademarks and trade
    dress are unique “protected property right[s].” See 
    Maltina, 613 F.2d at 585
    (“This recognition
    of a trademark as property is consistent with the view that an accounting is proper even if
    the defendant and plaintiff are not in direct competition, and the defendants’ infringement
    20
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    This is not a case, moreover, where the defendant violated the Lanham
    Act and emerged unscathed. BD complied with the district court’s original
    injunction for nearly two years, including by notifying hundreds of
    intermediary distributors and Group Purchasing Organizations and by
    implementing a training program for employees and distributors. Further, our
    caselaw ensures that where a false advertiser succeeds in diverting sales or
    otherwise demonstrably harms another party’s consumer goodwill, the district
    court will account for this in assessing the equities of disgorgement. While RTI
    may have failed to demonstrate such harm here, future would-be false
    advertisers would do well to heed that warning. RTI has demonstrated no
    interest in deterrence or remedying unjust enrichment that overcomes the
    district court’s well-founded emphasis on other equitable considerations.
    * * *
    The district court’s denial of disgorgement of profits from RTI’s
    competitor was made against the larger backdrop of its prosecution of a
    meritless antitrust claim against BD for conduct in the marketplace—during
    a time in which RTI nearly doubled its own sales and increased its share of the
    retractable syringe sub-market to two-thirds. RTI elected not to test its proof
    of Lanham Act damages before the jury, but rather to later argue, as now, that
    equity mandates disgorgement. Its effort to carry the flag of “public interest”
    and guide the profits of its competitor to its own coffers here must fail. That
    has not diverted sales from the plaintiff.”). RTI argues that the Lanham Act also protects
    trade reputation and goodwill as property interests. We need not sift through whether a
    business’s goodwill is a property right similar to its trademark interests; at a minimum,
    without demonstrating that RTI’s goodwill was harmed in a way that affected potential
    customers’ decisions, RTI has not shown harm to its goodwill that parallels the harm caused
    a markholder whose mark is used without consent. Cf. 
    Maltina, 613 F.2d at 585
    (“Here, the
    only valuable property [the plaintiff] had when he arrived in this country was his right to the
    ‘Cristal’ mark. [The defendant] used this property, and an accounting is necessary to partially
    remedy its unjust enrichment.”).
    21
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    effort must be taken outside—to the marketplace. There the public interest is
    best vindicated. The district court did not abuse its discretion.
    V
    We affirm the district court’s denial of disgorgement and further
    injunctive relief.
    22
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    JAMES E. GRAVES, JR., Circuit Judge, dissenting:
    Because I conclude that the district court erred in reweighing the
    diversion factor and in finding insufficient evidence to support disgorgement,
    I would vacate and remand. Therefore, I respectfully dissent.
    As stated in the majority’s recitation of the procedural history, the jury
    found for Retractable Technologies, Inc. (RTI) on one of its antitrust claims,
    attempted monopolization of the market for safety syringes, and all the
    Lanham Act false advertising claims. The jury awarded $113.5 million in
    antitrust damages. The district court trebled the antitrust damages and added
    attorneys’ fees, resulting in a total of approximately $352 million. The district
    court concluded that RTI was entitled to disgorgement of Becton Dickinson &
    Co.’s (BD) profits under 15 U.S.C. §1117(a), but, found that the trebled
    antitrust damages and injunction were potentially adequate remedies.
    Specifically, the district court found that, under the factors outlined in
    Pebble Beach Co. v. Tour 18 I Ltd., 
    155 F.3d 526
    , 554 (5th Cir. 1998), four of
    the six factors favored disgorgement: 1) that BD had the intent to confuse or
    deceive; 2) that sales were at least slightly diverted; 3) that RTI did not
    unreasonably delay; and 4) public interest in making misconduct profitable.
    The court concluded that the two remaining factors, the adequacy of other
    remedies and whether it was a case of palming off, disfavored disgorgement.
    The district court also granted a six-part injunction prohibiting BD from
    making certain advertising claims about needle sharpness for five years and
    about medical savings for three years; to notify various entities about its false
    statements; to post notice on its website for three years; and implement a
    training program for employees and distributors.
    On appeal, this court reversed BD’s antitrust liability, meaning RTI was
    no longer entitled to the $352 million in trebled antitrust damages, and
    23
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    remanded for a new assessment of disgorgement remedies based on the
    Lanham Act false advertising claims. See Retractable Techs., Inc. v. Becton
    Dickinson & Co., 
    842 F.3d 883
    (5th Cir. 2016). Regarding the Pebble Beach
    factors, the panel affirmed three portions: 1) The district court’s conclusion
    that at least some of BD’s profits were attributable to false advertising; 2) the
    finding that BD intended to confuse or deceive; and 3) the finding that RTI did
    not unreasonably delay. Retractable 
    Techs., 842 F.3d at 901
    .
    On remand, the district court evaluated the equities of disgorgement
    under the Pebble Beach factors and found that disgorgement was not
    warranted. Specifically, the district court found that public interest favored
    disgorgement, but that RTI had not shown diversion of sales or palming off.
    The remand court further weighted both diversion and palming off more
    heavily than the other factors and found that prior temporary injunctive relief
    was an adequate remedy. RTI then filed this appeal.
    The majority now affirms, concluding that the district court did not err.
    I disagree. The district court had previously determined that the diversion
    factor at least slightly indicated that sales had been diverted. This court
    affirmed that finding. It is helpful to look at the actual language used by this
    court:
    BD first argues that RTI failed to identify what portion of BD's
    profits (if any) were attributable to false advertising. Additionally,
    BD contends that the district court abused its discretion in
    weighing three of the Pebble Beach factors, inasmuch as the court
    (1) did not specify any amount of diverted sales; (2) failed to find
    that BD willfully engaged in false advertising; and (3) erred in
    holding that RTI did not unreasonably delay in filing suit.
    We find no clear error in the district court's conclusion that at least
    some portion of BD's profits were attributable to the false
    advertising. Indeed, BD acknowledged in the district court, its
    24
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    expert witness's opinion that $7.2 million in profits—netting to
    $560,000 after deductions for costs and expenses—could be
    attributable to the waste space advertisements. In Logan or Texas
    Pig Stands, by contrast, there was no evidence of attribution.
    Similarly unassailable is the finding that BD had the intent to
    confuse or deceive by continuing to use advertisements it knew
    were false. That BD may not have willfully engaged in false
    advertising does not change this analysis because a finding of
    willfulness is not a prerequisite to remedial disgorgement. Quick
    
    Techs., 313 F.3d at 349
    . Finally, we have approved the district
    court's finding that RTI did not unreasonably delay.
    Retractable 
    Techs. 842 F.3d at 901
    (emphasis added). After setting out the
    factors, including diversion, that BD was taking issue with in the first
    paragraph, the court then said, “We find no clear error in the district court’s
    conclusion that at least some portion of BD’s profits were attributable to the
    false advertising.” This was clearly addressing the diversion factor included in
    the prior paragraph. The court then set out a specific amount that could be
    attributable.
    Moreover, this court’s additional language regarding diversion does not
    contradict such a reading. This court said:
    Nevertheless, the district court's equitably-founded decision not to
    impose disgorgement rested in large part on the premise that RTI
    was adequately compensated by a $340 million antitrust award.
    Having overturned the antitrust judgment, we must remand to the
    district court for a thorough re-weighing of the remaining factors
    and the entirety of the record to determine whether and how much
    profit BD should disgorge to compensate for the Lanham Act
    violations. In particular, when assessing the “diversion” factor, the
    district court should bear in mind that speculative and attenuated
    evidence of diversion of sales will not suffice.
    Retractable 
    Techs. 842 F.3d at 901
    (emphasis added). This court’s language
    regarding diversion clearly indicates a reference to the assessment of the
    25
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    amount of profits to disgorge. This court did not say when reweighing the
    diversion factor as it said regarding the “remaining factors”; it said when
    assessing the diversion factor. Moreover, this court had already affirmed the
    district court on the diversion factor. This language indicates this court was
    referencing the “how much” profit to disgorge, as the district court had not
    initially made that exact calculation other than to say it was properly included
    as part of the trebled antitrust damages. But the district court had clearly
    already found that “RTI produced evidence that on occasion BD relied on these
    false advertisements to divert sales from RTI directly” and “[t]his evidence
    confirms the rational conclusion that some portion of BD’s ill-gotten sales came
    at RTI’s expense.” (emphasis original).
    For these reasons, I conclude that it was error for the remand court to
    reweigh the diversion factor. Further, RTI offered evidence of diversion. The
    district court had already found it sufficient to establish some diversion and
    this court had already affirmed. Because this court had already affirmed the
    district court on three factors favoring disgorgement (diversion, BD’s intent to
    confuse or deceive, and no unreasonable delay by RTI), there were only three
    factors left for the remand court to reweigh.
    Of those remaining three factors, the remand court found that the public
    interest factor favored disgorgement. Thus, only the two remaining factors,
    the adequacy of other remedies and palming off, could disfavor disgorgement.
    Moreover, the remand court improperly weighted the absence of diversion and
    palming off to the exclusion of other factors.         Diversion was settled.
    Regardless, there is no authority for weighting these factors more heavily.
    Additionally, in light of these errors and the fact that the adequate remedies
    the district court had previously found no longer exist, the district court
    likewise erred in its reconsideration of the adequacy of other remedies.
    26
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    For these reasons, I would vacate and remand. Thus, I respectfully
    dissent.
    27