Discussion of Factors Thought to Influence Complianc The type of formulary and it's effectiveness in dissuading use of nonpreferred drugs is an obvious factor in determining the level of formulary compliance. There are at least two other factors which should be considered when evaluating compliance levels. The first of these is the copay structure, lfa flat copay ~2is used for either an open or closed formulary plan, there would seem to be little incentive on the member's part to become involved in the type of drug being prescribed and dispensed. For a split copay plan, the member may become involved since they will pay less for generic drugs. Several studies have addressed how drug utilization varies with increases in copays and all conclude that utilization drops with higher copays. Foxman et. al. 1987 ; investigated the use of antibiotics for a non-elderly insured population and found statistically significant lower use associated with higher copays. Harris et. al. 1990 ; studied the impact of higher copays on all prescription drugs for a Health Maintenance Organization population and found a decrease in discretionary drug use with higher copays and mixed results for nondiscretionary drugs drug use decreased for some thresholds but not for others ; . Smith. The drug's effectiveness in hospitalized patients with major depression also has not been studied, because diuretics. 1. Buckley NA, McManus PR. Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. BMJ 2002; 325: 13323. Henry JA, Alexander CA, Sener EK. Relative mortality from overdose of antidepressants. BMJ 1995; 310: 2214. Shah R, Uren Z, Baker A, Majeed A. Deaths from antidepressants in England and Wales 19931997: analysis of a new national database. Psychol Med 2001; 31: 120310. McManus PR, Mant A, Mitchell PB, et al. Recent trends in the use of antidepressant drugs in Australia, 19901998. Med J Aust 2000; 173: 45861. Furukawa TA, McGuire H, Barbui C. Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review. BMJ 2002; 325: 991. McDowell R, Fowles J, Phillips D. Surveillance of chemical induced mortality in New Zealand. Wellington: Institute of Environmental Science and Research; 2003.

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1233 table ; , 1995 WL 87122 10th Cir. 1995 ; no negligence shown in $91 claim for lost or damaged ptoperty seized in a search of Federal prisoner's cell Jones v. U.S., Civ. # 4: 94-CV-140 JRE ; M.D. Ga., 15 Apr. 1997 ; U.S. prevails by using photogramatry expert in fatal crash into pole at Ft. Benning Freeman v. U.S., 704 F.2d 154 5th Cir. 1983 ; failure to use mats on terrazzo floor on wet day not negligence Spagnolia v. U.S., 598 F. Supp. 683 W.D.N.Y. 1984 ; same as Freeman Palmer v. U.S., Civ. # 93-54 E.D. Ky., 16 Aug. 1996 ; release by DVA of violent mental patient to group home when DVA knew he would not remain due to long history--U.S. liable for murder of three family members of ex-wife ; . Whether an action or inaction is reasonable is judged by the standards prevailing at the time the act took place. Western Greenhouses v. U.S., 878 F. Supp. 916 N.D. Tex. 1995 ; dumping TCE at USAF base in early 70s was not negligent under standards at time ; . a ; FTCA Excludes Absolute Liability. FTCA includes only liability for negligent acts and excludes absolute liability. Dalehite v. U.S., 346 U.S. 15 1953 Free v. Bland, 369 U.S. 663 1962 Laird v. Nelms, 406 U.S. 797 1972 Simpson v. U.S., 454 F.2d 691 6th Cir. 1972 McCutcheon v. U.S., 1996 WL 607083 W.D.N.Y. ; N.Y. imposing non-delegable duty on landlord to provide proper ingress and egress is strict liability statute and not applicable to HUD housing Geo. Byers Sons Inc. v. East Europe Import Export Inc., 463 F. Supp. 135 D. Md. 1979 Moyer v. U.S., 302 F. Supp. 1235 S.D. Fla. 1969 Coates v. U.S., 181 F.2d 816 8th Cir. 1950 ; . But see Smith v. Pena, 621 F.2d 873 7th Cir. 1980 ; adds negligence requirement to Dram Shop absolute liability statute and circumvents Dalehite ; . b ; Negligence per se. Negligence per se can arise under State law from statutory violation or extreme wrongdoing. See, e.g., Griffin v. U.S., 500 F.2d 1059 3d Cir. 1974 ; substandard polio vaccine approved and released Muhammad v. U.S., 366 F.2d 298 9th Cir. 1966 ; , cert. denied, 386 U.S. 959 1967 ; running stop sign Stephens v. U.S., 472 F. Supp. 998 C.D. Ill. 1979 ; inadequate warning of submerged tree stumps contrary to regulation is negligence per se Rudelson v. U.S., 431 F. Supp. 1101 C.D. Cal. 1977 ; violation of FAA regulations Cronenberg v. U.S. et al., 123 F. Supp. 693 E.D.N.C. 1954 ; no warning flares for disabled vehicle at night Worley v. U.S., 119 F. Supp. 719 D. Or. 1952 ; spring-gun Cerri v. U.S., 80 147.

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