Opinion ID: 808085
Heading Depth: 2
Heading Rank: 2

Heading: Other Federal and State Claims

Text: Having found that SJMC’s actions fall within the grant of immunity by HCQIA, we must determine the scope of that immunity. HCQIA grants immunity 5 In addition, none of Dr. Cohlmia’s direct competitors at SJMC participated in any stage of the peer review process. See Aple. Supp. App. at 545 and 1096 (identifying competitors as Drs. Garrett, Blankenship, and Fore); id. at 588, 1045, 1201–02, and 1204–05 (listing attendance at the various stages of review). As to expert review, during the hearing presided over by Judge Brett, SJMC engaged the services of a thoracic surgeon who was currently on an extended sabbatical from medical practice—so certainly not a competitor at the time. See id. at 691. -15- only against a monetary damage award, 42 U.S.C. § 11111(a)(1), but not claims for injunctive or other equitable relief. See Imperial v. Suburban Hosp. Ass’n, 37 F.3d 1026, 1031 (4th Cir. 1994) (reviewing the legislative history of HCQIA, and noting that the final language was meant to be limited to damages only because a broader protection “might be abused and serve as a shield for anti-competitive economic actions under the guise of quality controls”). In his complaint, Dr. Cohlmia sought injunctive relief and reinstatement of staff privileges, so we are required to review the merits of his federal and state claims. We agree with the district court that these claims lack merit, and we dispose of them for the same reasons.
Dr. Cohlmia’s complaint raises claims under Sections 1 and 2 of the Sherman Antitrust Act, as well as Section 4 of the Clayton Antitrust Act. Section 1 of the Sherman Act prohibits “[e]very contract, combination . . . or conspiracy, in restraint of trade or commerce.” 15 U.S.C. § 1. But “[i]ndependent action is not proscribed.” Monsanto Co. v. Spray-Rite Serv. Corp., 465 U.S. 752, 761 (1984). “Only after an agreement is established will a court consider whether the agreement constituted an unreasonable restraint of trade.” AD/SAT v. AP, 181 F.3d 216, 232 (2d Cir. 1999). Thus, “to survive [a] motion for summary judgment, the plaintiffs must first demonstrate the existence of an agreement, whether by direct or circumstantial evidence.” Mitchael v. -16- Intracorp, Inc., 179 F.3d 847, 856–57 (10th Cir. 1999). And generally, the Sherman Act only prohibits unreasonable restraints on trade. See Diaz v. Farley, 215 F.3d 1175, 1182 (10th Cir. 2000). Alternatively, Section 2 of the Sherman Act prohibits actions by “person[s] who shall monopolize, or attempt to monopolize, or combine or conspire with any other person or persons, to monopolize any part of the trade or commerce.” 15 U.S.C. § 2. Unlike Section 1, Section 2 can be violated by a single economic unit without requiring any contract, combination, or conspiracy. Six Twenty-Nine Productions, Inc. v. Rollins Telecasting, Inc., 365 F.2d 478, 482 (5th Cir. 1966). But to do so requires “the possession of monopoly power in the relevant market and . . . the willful acquisition or maintenance of that power as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” United States v. Grinnell Corp., 384 U.S. 563, 570–71 (1966). Section 4 of the Clayton Act addresses the question of “antitrust injury” and provides a remedy to “[a]ny person who shall be injured in his business by reason of anything forbidden in the antitrust laws.” 15 U.S.C. § 15. The expansive language is meant to “create a private enforcement mechanism . . . [to] deter violators and deprive them of the fruits of their illegal actions, and . . . provide ample compensation to the victims of antitrust violations.” Blue Shield of Virginia v. McCready, 457 U.S. 465, 472 (1982). -17- In evaluating Dr. Cohlmia’s claims, the district court found that there was no evidence of antitrust injury, no injury in fact, no evidence of causation, and most importantly, no evidence that any conduct was anything other than unilateral. Dr. Cohlmia’s appeal primarily takes issue with three of the district court’s findings: (1) whether there was evidence of antitrust injury, (2) whether SJMC had sufficient market power, and (3) whether there was sufficient evidence of conspiracy.
To establish an antitrust injury, Dr. Cohlmia “must allege a business or property injury, an antitrust injury, as defined by the Sherman Act.” Tal v. Hogan, 453 F.3d 1244, 1257–58 (10th Cir. 2006) (internal quotation omitted). “The primary concern of the antitrust laws is the corruption of the competitive process, not the success or failure of a particular firm” or individual. Id. at 1258. Additionally, “only buyers and sellers in the defendants’ market are within the target of the antitrust laws.” Comet Mech. Contractors, Inc. v. E.A. Cowen Constr., Inc., 609 F.2d 404, 406 (10th Cir. 1980). Thus, an antitrust injury requires “an injury of the type the antitrust laws were intended to prevent and that flows from that which makes defendants’ acts unlawful.” Tal, 453 F.3d at 1253 (citation and quotation omitted). Dr. Cohlmia contends that, acting through a “sham peer review process,” SJMC and others conspired to exclude him from the market for cardiology -18- services in Tulsa. He argues his exclusion from the Tulsa marketplace, by itself, harmed competition by reducing the number of physicians available to provide the type of medical services he typically provides. In support of this argument, he relies on the Supreme Court’s decision in Summit Health v. Pinhas, 500 U.S. 322 (1991). In Summit Health, the Court considered the antitrust claim of an opthamologist whose medical privileges were revoked after he refused to use an assistant surgeon—resulting in higher costs for himself—during procedures that he performed at the hospital. The physician was known throughout the industry for his skill and speed in these types of surgeries, and he argued that requiring him to provide an assistant at his own cost was unnecessary and improper. Id. at 326–27. The hospital engaged in a peer review process that ended with the revocation of his medical privileges. The Court found the doctor’s claims “that members of the peer review committee conspired with others to abuse th[e] process and thereby deny [him] access to the market . . . . ha[d] a sufficient nexus with interstate commerce to support federal jurisdiction.” Id. at 333. Dr. Cohlmia argues the Court’s decision applies here as well. But Summit Health was decided on much narrower grounds. Rather than standing for the proposition that the “actual effect on the market is not controlling” and “the federal power to protect free markets may be exercised to punish conduct which threatens to impair competition even when no actual harm results,” Aplt. Br. at 28, Summit Health was decided on purely jurisdictional -19- grounds. The Court was simply answering whether the case should survive a motion to dismiss for lack of federal jurisdiction, and was considering whether an opthamologist in the Los Angeles market was engaged in interstate commerce—the answer was yes. Summit Health does not stand for the proposition that the process SJMC used here injured competition. Nor is there antitrust injury every time someone is excluded from a medical hospital as a result of peer review: A staffing decision does not itself constitute an antitrust injury. “If the law were otherwise, many a physician’s workplace grievance with a hospital would be elevated to the status of an antitrust action. To keep the antitrust laws from being so trivialized, the reasonableness of a restraint is evaluated based on its impact on competition as a whole within the relevant market.” BCB Anesthesia Care Ltd. v. Passavant Mem’l Area Hosp. Ass’n., 36 F.3d 664, 669 (7th Cir. 1994) (quoting Oksanen v. Page Mem’l Hosp., 945 F.2d 696, 708 (4th Cir. 1991)) (emphasis added). In order to recover, Dr. Cohlmia must show that patients are denied access to cardiology services in the relevant market. See also Mathews v. Lancaster Gen. Hosp., 87 F.3d 624, 641 (3d Cir. 1996) (“An antitrust plaintiff must prove that challenged conduct affected the prices, quantity or quality of goods or services, not just his own welfare.”) (internal quotation omitted). Based on these authorities, the question is whether harm to competition has been demonstrated. The district court found no credible evidence from which to -20- infer injury. Rather, the court concluded that “[Dr.] Cohlmia’s loss of privileges at [SJMC] has [not] had market wide impact on the provision of any of the surgery or interventional cardiology services [he] claims to provide. Market wide prices, quantity or quality were not affected by [Dr.] Cohlmia’s loss of privileges.” Aplt. App. at 3124. We agree with this assessment of the record. Finally, Dr. Cohlmia points to a Third Circuit case, Brader v. Allegheny Gen. Hosp., 64 F.3d 869 (3d Cir. 1995), for the proposition that the denial of medical staff privileges can injure competition. We do not quarrel with that general proposition. But although Dr. Cohlmia alleged facts in his complaint sufficient to survive a motion to dismiss—which is what the district court concluded in Cohlmia I—to overcome a motion for summary judgment, he must “meet his burden of presenting specific facts, by reference to specific exhibits in the record”; it is not the court’s job to “comb the record in order to make” the non-movant’s arguments for him. Mitchell v. City of Moore, 218 F.3d 1190, 1199 (10th Cir. 2000). The court in Brader acknowledged as much: “[a]fter Summit Health, the adequacy of a physician’s contentions regarding the effect on competition is typically resolved after discovery, either on summary judgment or after trial.” 64 F.3d at 876. Here, Dr. Cohlmia failed to show evidence of an -21- “impact on competition as a whole within the relevant market.” BCB Anesthesia Care, 36 F.3d at 669 (internal quotation omitted). 6 In sum, as the district court found, there is no record evidence of antitrust injury.
Another element of an antitrust claim requires the plaintiff to show the defendant can wield “market power.” To do so, a plaintiff must show evidence of either power to control prices or the power to exclude competition. Reazin v. Blue Cross & Blue Shield, Inc., 899 F.2d 951, 966 (10th Cir. 1990). Power over price and competition may depend on various market characteristics, such as “market trends, number and strength of other competitors, and entry barriers.” Shoppin’ Bag of Pueblo, Inc. v. Dillon Cos., 783 F.2d 159, 162 (10th Cir. 1986). “Market share is relevant to the determination of the existence of market or monopoly power, but market share alone is insufficient to establish market power.” Reazin, 899 F.2d at 967 (internal quotation marks omitted). And the 6 Dr. Cohlmia cites a number of other cases in support of his view that antitrust injury can be demonstrated without an “actual lessening of competition or an increase in prices.” Aplt. Br. at 32 (quoting Blue Shield of Virginia, 457 U.S. at 482). But the cases he cites were primarily decided at the motion to dismiss stage when the court is still determining jurisdiction, and are predicated on a finding of “an abusive peer review process”—a finding we rejected above by concluding that SJMC is entitled to HCQIA immunity. See Balaklaw v. Lovell, 14 F.3d 793, 795 n.2 (2d Cir. 1994); Fuentes v. South Hills Cardiology, 946 F.2d 196 (3d Cir. 1991); Mishler v. St. Anthony’s Hosp. Sys., 694 F.2d 1225 (10th Cir. 1981); Full Draw Prods. v. Easton Sports, Inc., 182 F.3d 745 (10th Cir. 1999). -22- absence of market share may give rise to a presumption that market power does not exist. Id. at 969–70. Dr. Cohlmia’s expert testified that SJMC controlled between 15.8% and 19.3% of the market, and SJMC does not dispute this quantitative conclusion. From this testimony, Dr. Cohlmia argues that market share “between 17% and 25% . . . is sufficient to show monopoly power.” Aplt. Br. at 34 (citing Valley Liquors, Inc. v. Renfield Importers, Ltd., 822 F.2d 656, 667 (7th Cir. 1987)). But as SJMC notes, this is hardly a bright-line, or even a commonly accepted, metric. See Reazin, 899 F.2d at 968 (We have not determined “a firm market share percentage . . . before a finding of monopoly power can ever be sustained. We prefer the view that market share percentages may give rise to presumptions, but will rarely conclusively establish or eliminate market or monopoly power.”); see also Colorado Interstate Gas Co. v. Natural Gas Pipeline Co., 885 F.2d 683, 694 n.18 (10th Cir. 1989) (“While the Supreme Court has refused to specify a minimum market share necessary to indicate a defendant has monopoly power, lower courts generally require a minimum market share of between 70% and 80%.”). Thus, while high market shares may give rise to presumptions of market power, a market share of less than 20% is woefully short under any metric from which to infer market power. See also Domed Stadium Hotel, Inc. v. Holiday Inns, Inc., 732 F.2d 480, 490 (5th Cir. 1984) (“[U]ndisputed evidence of low market share may make monopolization an impossibility as a matter of law.”); IIB -23- Areeda & Hovenkamp 250 (“We . . . presume that market shares below 50 or 60 percent do not constitute monopoly power . . . . [and e]ven without an absolute rule, a clear presumption will almost always be decisive.”). Given the low market share at issue here, Dr. Cohlmia argues he can still demonstrate market power by showing “other compelling structural evidence . . . to support monopolization.” Dimmitt Agri.. Indus., Inc. v. CPC Int’l, Inc., 679 F.2d 516, 529 (5th Cir. 1984). Since the market share percentages held by SJMC are well shy of clear market power, in determining whether there is any “other compelling structural evidence,” we consider the strength of competition and the difficulty or ease of entry into the market. Shoppin’ Bag, 783 F.2d at 162. With respect to the strength of competition, there are four hospital systems in Tulsa that perform the types of surgeries at issue and SJMC is not even the largest—Saint Francis is. In addition, a specialty heart hospital operated by Saint Francis competed with SJMC, HMC, and SouthCrest at the relevant times here. While performing surgery is a capital-intensive process, for a market the size of Tulsa, four hospital systems do not indicate significant market power by any one player. To the contrary, the record shows each participant in Tulsa had a roughly equivalent share of the market, and no one entity was exercising market power. 7 7 Additionally, we disagree with Dr. Cohlmia’s citation to Oltz v. St. Peter’s Community Hosp., 861 F.2d 1440 (9th Cir. 1988), for the proposition that anti-competitive behavior by a hospital can evidence antitrust injury for “two different segments of the economy. . . . the market in which anesthesia providers (continued...) -24- As to barriers of entry, SJMC points out that fourteen new surgeons have entered the market since 1994, with many of them being recruited by Dr. Cohlmia. While Dr. Cohlmia makes a legitimate argument that exclusion by one hospital can lead to a domino effect of exclusion by other hospitals, he still does not overcome the fact that the mishandled surgeries justified SJMC’s peer review. And as we discussed above, the peer review process resulted in a suspension decision affirmed by a neutral evaluator. The peer review process is no more an entry barrier than any standard requiring professionals to maintain certain professional credentials. Assuming that SJMC lacked the requisite market power, Dr. Cohlmia’s claims may still be pursued for those Section 1 violations that do not require a showing of market power. Thus, a demonstration of anticompetitive conduct can be based on actual adverse effects to competition. FTC v. Indiana Fed’n of Dentists, 476 U.S. 447, 460–61 (1986). Dr. Cohlmia’s claim falls short here as well. He points to SJMC’s “concerted refusal to deal with Plaintiff and the coercion of patients.” Aplt. Br. at 36. But he is not entitled to practice at SJMC or any other hospital; and he 7 (...continued) compete for staff privileges . . . [and] the patient market for anesthesia services.” Id. at 1447. While the Ninth Circuit did so hold, the facts in Oltz indicate that St. Peter’s had an 84% market share for surgical services. Id. at 1442. In such a case, an exclusive agreement to exclude the plaintiff from the market—where such a large showing of market share is demonstrated and conceded by the defendants—is fair evidence of antitrust injury. -25- never explains how his patients were coerced by SJMC. If he is referring to a reduction of choice in the market for physicians, that argument is simply circular and refers back to his claims of market power, which he cannot support. In sum, we agree with the district court that Dr. Cohlmia has not demonstrated SJMC has sufficient market power to control prices or exclude competition.
An inference of conspiracy is impermissible if the defendants “had no rational economic motive to conspire, and if their conduct is consistent with other, equally plausible explanations.” Matsushita Elec. Indus., Co. v. Zenith Radio Corp., 475 U.S. 574, 596 (1986). Dr. Cohlmia argues he demonstrated ample evidence of conspiracy, and that the district court failed to consider his evidence taken as a whole, rather than individually. Dr. Cohlmia’s arguments are predicated on his belief that SJMC was conspiring against him to block his specialty heart hospital—an unsuccessful venture that failed to attract any investors. Dr. Cohlmia’s claims are speculative at best, and even viewing these arguments in the best light possible, there is simply no evidence of an actual conspiracy. For the same reasons as the district court, we agree summary judgment on the conspiracy claims was proper. In sum, the district court did not err in granting summary judgment on the federal antitrust claims. -26-
Next, we turn to Dr. Cohlmia’s state antitrust claims. Under the Oklahoma Antitrust Reform Act, it is unlawful for any person to monopolize, attempt to monopolize, or conspire to monopolize any part of trade or commerce in a relevant market within the state. Okla. Stat. Tit. 79 § 203(B). This is essentially the same as the federal test and, as with those claims, the district court properly awarded summary judgment. One notable difference though, is that it is unlawful for any person in control of an essential facility to unreasonably refuse to give a competitor access if the effect of such refusal is to injure competition. Id. at § 203(C). An “essential facility” is, among other things, a facility “which is controlled by an entity that possesses monopoly power.” Id. at § 203(D)(3)(a). As discussed above, SJMC lacked monopoly power, so for the same reasons, the state law claim fails. In addition, Dr. Cohlmia had privileges at several of the other local hospitals at the time of his suspension from SJMC, so he was not “locked out,” Aplt. Br. at 10, of an essential facility, as required by the Act. And it is not anti-competitive for a hospital to restrict privileges of medical professionals deemed unsafe to practice in a facility. See Pontius v. Children’s Hosp., 552 F. Supp. 1352, 1370 (W.D. Pa. 1982) (reasoning that it would be “inappropriate to apply a doctrine which would prevent a hospital from keeping doctors it had adjudged unqualified off of its staff”). -27- Dr. Cohlmia points to an Oklahoma case where the court struck down a contractual provision preventing a surgeon from practicing within a 20-mile radius of Tulsa. Cardiovascular Surgical Specialists, Corp. v. Mammana, 61 P.3d 210, 214–15 (Okla. 2002). But that case involved an onerous non-compete agreement (ironically, drafted by Dr. Cohlmia’s corporate entity, a defendant in the case) that completely excluded the surgeon from the market for two years. In finding anti-competitive activity, the court was clear that the non-compete effectively banned the surgeon “from practicing . . . within 100 miles” of the community where he had previously been employed, and was “much broader than necessary to protect any legitimate interest of” his former employer. Id. at 214. In this case, SJMC has properly received HCQIA immunity, and, at the time of his suspension, Dr. Cohlmia had staff privileges at several other area hospitals where he could practice. The record is clear that Dr. Cohlmia was upset with this turn of events, but he ultimately chose to voluntarily resign his privileges at two hospitals and move his primary practice to Tahlequah—which is still in the market area as defined by his own expert. There is simply no basis to conclude that SJMC violated Oklahoma state antitrust law or specifically, the “essential facility” doctrine. 8 8 Dr. Cohlmia refers back to the district court’s opinion denying SJMC’s motion to dismiss, Cohlmia I, as evidence of “the misuse of the peer review process.” Aplt. Br. at 37. But the district court was ruling on Dr. Cohlmia’s motion to dismiss—which is based on different evidentiary standards than a (continued...) -28- In sum, the district court properly granted summary judgment to SJMC on Dr. Cohlmia’s state antitrust claims. Although he presented a coherent theory to survive an initial motion to dismiss, once discovery was completed, the record lacked sufficient evidence to support his claims.
Dr. Cohlmia also contends the district court erred in dismissing his tortious interference with contract claim. We disagree. To state a claim for tortious interference with business or contractual relations, the plaintiff must show: (1) he or she had a business or contractual right that was interfered with; (2) the interference was malicious and wrongful and was not justified, privileged, or excused; and (3) damage was proximately sustained as a result of the interference. Mac Adjustment, Inc. v. Property Loss Research Bureau, 595 P.2d 427, 428 (Okla. 1979). Dr. Cohlmia claims that SJMC interfered with his contracts with two groups: his patients and an insurer, Blue Cross/Blue Shield.
As to interference with patient contracts, Dr. Cohlmia argues that, at the time SJMC suspended his privileges, both he and his patients were forced to leave 8 (...continued) ruling for summary judgment. In this appeal, we review the grant of summary judgment based on whether Dr. Cohlmia has marshaled record evidence to support his claims, not mere allegations of wrongful conduct. -29- the Tulsa market in order to continue treatment. As SJMC points out, the relationship between a doctor and a patient is at-will; there is no contract at issue. See also Vesom v. Atchison Hosp. Ass’n, 279 F. App. 624, 640 (10th Cir. 2008) (finding that to recover, plaintiff must show a “contractual relationship or exclusive arrangement with his patients on which to base his prospective loss”). Dr. Cohlmia acknowledges this point, but argues that as a result of SJMC’s conduct, his interactions with patients were made “more burdensome or expensive.” Aplt. Br. at 46; see also John A. Henry & Co., v. T. G. & Y. Stores Co., 941 F.2d 1068, 1071–72 (10th Cir. 1991). SJMC counters that Dr. Cohlmia presented no evidence to support these allegations, and, at the time of his suspension, Dr. Cohlmia had privileges at three other local hospital systems where he could serve his patients. 9 Aple. Br. at 49. The district court held that Dr. Cohlmia failed to offer proof of his damages and damages are not automatically presumed on the basis of a loss of privileges. Aplt. App. at 701–02. In rebutting this determination, Dr. Cohlmia relies on the Fifth Circuit’s decision in Kiepfer v. Beller, 944 F.2d 1213, 1220 (5th Cir. 1991), which held that a physician can establish sufficient evidence for a tortious interference claim by showing that defendant physicians interfered with his ability 9 Dr. Cohlmia disputes this characterization, stating that the area hospitals were “already taking measures to deny [his] privileges,” in a “secret” review process. Aplt. Rep. Br. at 14. But even so, his privileges were still intact at the time of SJMC’s suspension. And in any event, as discussed below, Dr. Cohlmia failed to provide proof of his damages, which is required for recovery. -30- to obtain patient referrals. But in that case, the doctor at trial “sufficiently proved that his damages—the complete loss of his referral practice—was a proximate result of the [tortious interference.]” Id. at 1220. Here, there is no evidence demonstrating a loss of patients or monetary damages. But Dr. Cohlmia argues that the district court improperly denied his request to submit an expert report detailing his damages. The court rejected the report because Dr. Cohlmia failed to comply with the requirements of Federal Rule of Civil Procedure 56(f), by not filing an affidavit indicating that he was unable to present facts essential to justify his opposition to summary judgment. 10 Given that he failed to comply with the Rules, it was not an abuse of discretion for the district court to reject Dr. Cohlmia’s filing based on his failure to comply with Rule 56(f). 11
As with his patients, Dr. Cohlmia fails to provide evidence of economic damage to his relationship with Blue Cross/Blue Shield. The only reference in Dr. Cohlmia’s briefs to this issue is that he “had to undergo appellate procedures to remain available under the Blue Cross/Blue Shield insurance plans of 10 In 2010, Rule 56(f) was amended and the substance is now embodied in Rule 56(d) instead. For simplicity’s sake, we refer to Rule 56(f) to comport with the record in this case. 11 The merits of this evidentiary report are discussed in greater detail below in subsection 4. -31- thousands of patients.” Aplt. Br. at 45. While not specifically explained, it appears Dr. Cohlmia is arguing that, once his privileges were suspended at one hospital, he had to be “recertified” by other hospitals, to continue as a provider in the insurance system. While this likely imposed some time cost, as with his allegations as to patient interference, Dr. Cohlmia failed to properly submit evidence detailing his losses. Accordingly, the district court did not err in its grant of summary judgment with respect to tortious interference with contract. 4. Intentional Interference with Prospective Economic Advantage Dr. Cohlmia’s final claim contends that SJMC wrongfully interfered with his medical practice. To state a claim for malicious interference with prospective business relations, the plaintiff must show: (1) the existence of a valid business relation or expectancy; (2) knowledge of the relationship or expectancy on the part of the interferor; (3) an intentional interference including or causing a breach or termination of the relationship or expectancy; and (4) resultant damage to the party whose relationship has been disrupted. Boyle Services, Inc. v. Dewberry Design Group, Inc., 24 P.3d 878, 880 (Okla. Civ. App. 2001). In order to prevail, the plaintiff must show that the defendant used “some intentional or improper conduct or means.” Overbeck v. Quaker Life Ins. Co., 757 P.2d 846, 848 (Okla. Civ. App. 1984). -32- Dr. Cohlmia identified two business expectancies that he claims were interfered with by SJMC: (1) potential new patients, and (2) potential lost profits from his specialty heart hospital venture. The new patient claim suffers from the same defects discussed above regarding the insufficiency of evidence relating to existing patients, and need not be restated here. As to the lost profits claim, Dr. Cohlmia claims SJMC was attempting to frustrate his efforts to build and operate a new specialty heart hospital in the Tulsa area. The district court found that this claim also suffered from “the absence of proof of damages.” Aplt. App. at 702. Claims for damages based on future profits are generally prohibited since they are typically uncertain and speculative. Weyerhaeuser Co. v. Brantley, 510 F.3d 1256, 1267 (10th Cir. 2007) (citations omitted). Oklahoma state law holds that when a party seeks to recover loss of future profits, the profits should be coming from an established business that shows with some certainty the future losses. Plummer v. Fogley, 363 P.2d 238, 241 (Okla. 1961). Dr. Cohlmia submitted an expert report to establish future profits, but the court ruled that the report was inadmissible because Dr. Cohlmia failed to comply with the requirements of Rule 56(f). See Aplt. App. at 701-02 (ruling); 1480 (report). Even if the court had received the report, SJMC argues that it “does not speak to the certainty of profits, but is an extrapolation of tax returns and reliance -33- on a pro forma (which is not part of the record and itself hearsay and unreasonable).” Aple. Br. at 54. We agree. The expert report relies on economic projections going out several years detailing Dr. Cohlmia’s expected profits from his specialty heart hospital, but such projections are speculative at best. Given that the consultant retained by Dr. Cohlmia for the specialty heart hospital project concluded that the project “would not be successful” in June 2002—over a year before SJMC’s suspension of Dr. Cohlmia—and that Dr. Cohlmia failed to attract a single investor after distributing his PPM, the district court did not err in concluding Oklahoma law required more evidence to support a damage award. The district court did not err in granting summary judgment with respect to the intentional interference with prospective economic advantage claim. 5. Various Other Motions As noted above, Dr. Cohlmia’s arguments realize the meager state of the record regarding damages. But he argues that the district court erred by overruling his motions to supplement the record. Unfortunately, Dr. Cohlmia does not explain why the district court erred and simply points to cases showing that summary judgment reversal is necessary when error occurs. The district court was well within its discretion to reject Dr. Cohlmia’s motions for the simple fact that he did not comply with the required procedures -34- for submission. Additionally, there is nothing here to suggest that they were so substantively important that the outcome in this case would have been different.