Amended IN Senate June 20, 2018 Amended IN Assembly April 19, 2018 Amended IN Assembly April 03, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2760Introduced by Assembly Member WoodFebruary 16, 2018 An act to add Article 10.7 (commencing with Section 740) to Chapter 1 of Division 2 of the Business and Professions Code, relating to healing arts. LEGISLATIVE COUNSEL'S DIGESTAB 2760, as amended, Wood. Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs.Existing law provides for the regulation of health care practitioners and requires prescription drugs to be ordered and dispensed in accordance with the Pharmacy Law. Existing law authorizes a pharmacist to furnish naloxone hydrochloride in accordance with standardized procedures or protocols developed by both the California State Board of Pharmacy and the Medical Board of California.This bill would require a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug to the patient and specified others. The bill would make a violation of the bills provisions unprofessional conduct and would subject the prescriber to discipline by a prescriber to referral to the board charged with regulating his or her license. license for the imposition of administrative sanctions, as that board deems appropriate, for violating those provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) Abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of the state.(b) After alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.(c) Almost 2,000,000 people in the United States suffer from substance use disorders related to prescription opioid pain relievers.(d) Nonmedical use of prescription opioid pain relievers can be particularly dangerous when the products are manipulated for snorting or injection or are combined with other drugs.(e) Deaths involving prescription opioid pain relievers represent the largest proportion of drug overdose deaths, greater than the number of overdose deaths involving heroin or cocaine.(f) Driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row in 2016, resulting in the first consecutive decline in national life expectancy since 1963.(g) Should 2017 also result in a decline in life expectancy as a result of drug deaths, it would be the first three-year period of consecutive life expectancy declines since World War I and the Spanish flu pandemic in 1918.SEC. 2. Article 10.7 (commencing with Section 740) is added to Chapter 1 of Division 2 of the Business and Professions Code, to read: Article 10.7 Opioid Medication740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.741. Notwithstanding any other law, a prescriber shall do the following:(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.742.A violation of this article constitutes unprofessional conduct and grounds for disciplinary action by the prescribers licensing board. Each licensing board established under this division, or under an initiative act referred to in this division, shall be charged with enforcing this article as it pertains to that boards prescribers.742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.
Amended IN Senate June 20, 2018 Amended IN Assembly April 19, 2018 Amended IN Assembly April 03, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2760Introduced by Assembly Member WoodFebruary 16, 2018 An act to add Article 10.7 (commencing with Section 740) to Chapter 1 of Division 2 of the Business and Professions Code, relating to healing arts. LEGISLATIVE COUNSEL'S DIGESTAB 2760, as amended, Wood. Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs.Existing law provides for the regulation of health care practitioners and requires prescription drugs to be ordered and dispensed in accordance with the Pharmacy Law. Existing law authorizes a pharmacist to furnish naloxone hydrochloride in accordance with standardized procedures or protocols developed by both the California State Board of Pharmacy and the Medical Board of California.This bill would require a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug to the patient and specified others. The bill would make a violation of the bills provisions unprofessional conduct and would subject the prescriber to discipline by a prescriber to referral to the board charged with regulating his or her license. license for the imposition of administrative sanctions, as that board deems appropriate, for violating those provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
Amended IN Senate June 20, 2018 Amended IN Assembly April 19, 2018 Amended IN Assembly April 03, 2018
Amended IN Senate June 20, 2018
Amended IN Assembly April 19, 2018
Amended IN Assembly April 03, 2018
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
Assembly Bill No. 2760
Introduced by Assembly Member WoodFebruary 16, 2018
Introduced by Assembly Member Wood
February 16, 2018
An act to add Article 10.7 (commencing with Section 740) to Chapter 1 of Division 2 of the Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2760, as amended, Wood. Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs.
Existing law provides for the regulation of health care practitioners and requires prescription drugs to be ordered and dispensed in accordance with the Pharmacy Law. Existing law authorizes a pharmacist to furnish naloxone hydrochloride in accordance with standardized procedures or protocols developed by both the California State Board of Pharmacy and the Medical Board of California.This bill would require a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug to the patient and specified others. The bill would make a violation of the bills provisions unprofessional conduct and would subject the prescriber to discipline by a prescriber to referral to the board charged with regulating his or her license. license for the imposition of administrative sanctions, as that board deems appropriate, for violating those provisions.
Existing law provides for the regulation of health care practitioners and requires prescription drugs to be ordered and dispensed in accordance with the Pharmacy Law. Existing law authorizes a pharmacist to furnish naloxone hydrochloride in accordance with standardized procedures or protocols developed by both the California State Board of Pharmacy and the Medical Board of California.
This bill would require a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug to the patient and specified others. The bill would make a violation of the bills provisions unprofessional conduct and would subject the prescriber to discipline by a prescriber to referral to the board charged with regulating his or her license. license for the imposition of administrative sanctions, as that board deems appropriate, for violating those provisions.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) Abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of the state.(b) After alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.(c) Almost 2,000,000 people in the United States suffer from substance use disorders related to prescription opioid pain relievers.(d) Nonmedical use of prescription opioid pain relievers can be particularly dangerous when the products are manipulated for snorting or injection or are combined with other drugs.(e) Deaths involving prescription opioid pain relievers represent the largest proportion of drug overdose deaths, greater than the number of overdose deaths involving heroin or cocaine.(f) Driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row in 2016, resulting in the first consecutive decline in national life expectancy since 1963.(g) Should 2017 also result in a decline in life expectancy as a result of drug deaths, it would be the first three-year period of consecutive life expectancy declines since World War I and the Spanish flu pandemic in 1918.SEC. 2. Article 10.7 (commencing with Section 740) is added to Chapter 1 of Division 2 of the Business and Professions Code, to read: Article 10.7 Opioid Medication740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.741. Notwithstanding any other law, a prescriber shall do the following:(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.742.A violation of this article constitutes unprofessional conduct and grounds for disciplinary action by the prescribers licensing board. Each licensing board established under this division, or under an initiative act referred to in this division, shall be charged with enforcing this article as it pertains to that boards prescribers.742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. The Legislature finds and declares all of the following:(a) Abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of the state.(b) After alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.(c) Almost 2,000,000 people in the United States suffer from substance use disorders related to prescription opioid pain relievers.(d) Nonmedical use of prescription opioid pain relievers can be particularly dangerous when the products are manipulated for snorting or injection or are combined with other drugs.(e) Deaths involving prescription opioid pain relievers represent the largest proportion of drug overdose deaths, greater than the number of overdose deaths involving heroin or cocaine.(f) Driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row in 2016, resulting in the first consecutive decline in national life expectancy since 1963.(g) Should 2017 also result in a decline in life expectancy as a result of drug deaths, it would be the first three-year period of consecutive life expectancy declines since World War I and the Spanish flu pandemic in 1918.
SECTION 1. The Legislature finds and declares all of the following:(a) Abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of the state.(b) After alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.(c) Almost 2,000,000 people in the United States suffer from substance use disorders related to prescription opioid pain relievers.(d) Nonmedical use of prescription opioid pain relievers can be particularly dangerous when the products are manipulated for snorting or injection or are combined with other drugs.(e) Deaths involving prescription opioid pain relievers represent the largest proportion of drug overdose deaths, greater than the number of overdose deaths involving heroin or cocaine.(f) Driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row in 2016, resulting in the first consecutive decline in national life expectancy since 1963.(g) Should 2017 also result in a decline in life expectancy as a result of drug deaths, it would be the first three-year period of consecutive life expectancy declines since World War I and the Spanish flu pandemic in 1918.
SECTION 1. The Legislature finds and declares all of the following:
### SECTION 1.
(a) Abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of the state.
(b) After alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.
(c) Almost 2,000,000 people in the United States suffer from substance use disorders related to prescription opioid pain relievers.
(d) Nonmedical use of prescription opioid pain relievers can be particularly dangerous when the products are manipulated for snorting or injection or are combined with other drugs.
(e) Deaths involving prescription opioid pain relievers represent the largest proportion of drug overdose deaths, greater than the number of overdose deaths involving heroin or cocaine.
(f) Driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row in 2016, resulting in the first consecutive decline in national life expectancy since 1963.
(g) Should 2017 also result in a decline in life expectancy as a result of drug deaths, it would be the first three-year period of consecutive life expectancy declines since World War I and the Spanish flu pandemic in 1918.
SEC. 2. Article 10.7 (commencing with Section 740) is added to Chapter 1 of Division 2 of the Business and Professions Code, to read: Article 10.7 Opioid Medication740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.741. Notwithstanding any other law, a prescriber shall do the following:(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.742.A violation of this article constitutes unprofessional conduct and grounds for disciplinary action by the prescribers licensing board. Each licensing board established under this division, or under an initiative act referred to in this division, shall be charged with enforcing this article as it pertains to that boards prescribers.742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.
SEC. 2. Article 10.7 (commencing with Section 740) is added to Chapter 1 of Division 2 of the Business and Professions Code, to read:
### SEC. 2.
Article 10.7 Opioid Medication740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.741. Notwithstanding any other law, a prescriber shall do the following:(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.742.A violation of this article constitutes unprofessional conduct and grounds for disciplinary action by the prescribers licensing board. Each licensing board established under this division, or under an initiative act referred to in this division, shall be charged with enforcing this article as it pertains to that boards prescribers.742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.
Article 10.7 Opioid Medication740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.741. Notwithstanding any other law, a prescriber shall do the following:(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.742.A violation of this article constitutes unprofessional conduct and grounds for disciplinary action by the prescribers licensing board. Each licensing board established under this division, or under an initiative act referred to in this division, shall be charged with enforcing this article as it pertains to that boards prescribers.742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.
Article 10.7 Opioid Medication
Article 10.7 Opioid Medication
740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.
740. For purposes of this article, prescriber means a person licensed, certified, registered, or otherwise subject to regulation pursuant to this division, or an initiative act referred to in this division, who is authorized to prescribe prescription drugs.
741. Notwithstanding any other law, a prescriber shall do the following:(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.
741. Notwithstanding any other law, a prescriber shall do the following:
(a) Offer a prescription for naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:
(1) The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.
(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.
(3) The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.
(b) Provide Consistent with the existing standard of care, provide education to patients receiving a prescription under subdivision (a) on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist. drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression.
(c) Provide Consistent with the existing standard of care, provide education on overdose prevention and the use of naloxone hydrochloride or another opioid antagonist drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to one or more persons designated by the patient, or, for a patient who is a minor, to the minors parent or guardian.
A violation of this article constitutes unprofessional conduct and grounds for disciplinary action by the prescribers licensing board. Each licensing board established under this division, or under an initiative act referred to in this division, shall be charged with enforcing this article as it pertains to that boards prescribers.
742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.
742. A prescriber who fails to offer a prescription, as required by subdivision (a) of Section 741, or fails to provide the education and use information required by subdivisions (b) and (c) of Section 741 shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board. This section does not create a private right of action against a prescriber, and does not limit a prescribers liability for the negligent failure to diagnose or treat a patient.