like that that's fine i don't know if we have any questions for you but we certainly have read your briefs maybe if you would like to address for a moment the point that the government makes which is that it's actually not the law of illinois here that matters what does matter is the circumstances under which the united states substitutes itself is defended for the federal tort claims act and that is a different concept of scope of employment and illinois uses kind of these people were working as physicians assistants and a physician and whether they made mistakes or not doesn't mean they weren't acting within the scope of their employment whether the source of their duty to the patient was something that stemmed from professional training or whether it was something that stems from the fact they were working for the government is also not relevant on the federal tort claims act that's the government's primary argument i'm sure you've read their growth so if you would like to comment on that that would be fine but i'm looking at it you know if we apply illinois from misunderstanding of what law applies here the according to the appellants arguments the united states would never be liable for the torts committed by its doctors and although that would personally relieve my own caseload that's not the policy of the united states we do want to be liable for torts committed by our doctors so i do live in a question the reason the united states is involved at all i understand is because this health center it is covered under the public health statute is that correct correct so how does a person wanted to exhaust administrative remedies to go to the department of health and human services or  do you how does one know where to go if you get negligent care at a health center that falls within this scope well there is a website where the health clinics can be looked up to see whether they're qualified federal clinics there's also a hotline that can be called to determine whether they're on that list so the qualified health clinics one hundred percent funded by the federal government or is it a sharing arrangement  i don't know that your honor i know that they receive federal funding under the public service act and that's what allows them to their employees to be deemed under the federal tort claims act i don't know whether their team federal employees even though they're actually working for this health center they're not like you know somebody who works for the department of justice or or whatever who's obviously a federal employee that's best correct their what their deem for purposes of litigation under the federal tort claims act for torture arising out of their medical care and so the attorney general makes the usual scope of employment certification for people with these who are in these health clinics it get if they if they are working for a health care clinic that receives public service funds and the certified scope of them flyman and will just assume for the sake of argument there's a determination that the card was negligent and violated standards of care etc so the government pays right that's ground under any exception in the or anything that's quite the united states in the beginning of the case would be as we did in this case would substitute itself for it for the health care profession mr card and in the event that the case there was a judgment or settlement the united states would pay for that this is extremely serious malpractise i don't know if you're aware that the stevens johnson syndrome is very rare it's an extraordinarily destructive disease the important thing is that what packard fails to do is not he didn't have to warn houston the taking out during all risks stevens johnson syndrome he has to tell him that if you have any allergic reaction you must immediately go to an emergency room because if you delayed by hours you are going to end up in this horrible  situation i trust your honour's observation that that's not the case that patients like this i personally not familiar with the condition the case has not gotten to the point where we've looked closely at the doctor's conduct or the condition may please the court daniel meyers on behalf of the appellee quality just the district court properly held that each of mr houston's state law claims against quality tests is preempted by federal law additionally the district court did not abuse its discretion by dismissing each of mr houston's claims against quality tests with prejudice because amendment would be futile and light of two recent binding and supreme court cases in the last four and a half years the united states supreme court has held twice that state law claims like the ones that mr houston has brought against quality tests are preempted by federal law because it would be impossible for a generic prescription drug manufacturer to comply with its state law duties without violating federal law so suppose somebody like mr houston in a public spirited way you know wants to do something about inadequate warnings let's say for allopurinol is the f d a entertain applications to change obviously not just the i understand the sameness thing not just the generic but but the original drug and the generic to improve what it says or to get it off the market or to restrict its approved uses or otherwise to modify i believe they do your honor and that is something that mr houston could do now i mean  just as a citizen i'm thinking you know if you can't if you're stuck with this sameness however inadequate these warnings may be and they could be equally miserable right for both the original drug and the generic it's a distasteful thought that there's bartlet no matter how your sympathies lie the law is the law and under the federal law quality test was preempted they were not allowed to change the label or that is i know the drug now i understand they had no unilaterally change its design and also it couldn't be forced when exiting the market is the only way of complying with the state law and it couldn't write like a what they could keep calling a dear doctor letter like please please please give people proper warnings no the the problem with the labeling is there are so many extremely low probability disastrous potential consequences of taking a drug that there isn't room for the miles that's a medical emergency they must immediately go to an emergency that's what's required now i take it if houston had followed the required seizures he could make that a rash go see a doctor but a lot of people get a little rashes you know even from gardening and they don't think that much of it they throw some hydrocortisone on it that this rash isn't a rash that should be treated that way that's your honor it's the warning that the f d a approved for the name brand manufacturer and ellen quality has complied with its federal obligation to use the exact same morning understand as the name brand so this case fits squarely within thank you very much and the thing for the mr houston right the underlying case follows the law and to the liability standards follows the law of illinois but if the doctor is an employee of the united states as these public health doctors are deemed to be then the united states step in once it certifies that that's another words he wasn't off you know in west virginia on the weekend doing something having nothing to do with this clinic he was working for the clinic and thus in the scope of his employment that's the ndoubtably the reason he did not remand is because if there is federal jurisdiction in the federal court then it's not appropriate to remanded to the state court the federal court should keep the case and there they are seeing the judge's understanding this is is a question whether qualities students under the food and drug act name you know and all of its regulations have been complied with he says it sort of has to be that it can't be state law here that's what preemption means it has to be part of the same case and categories yeah it does it's all part of it all arises out of this one incident that happened to you