BILLINGS (LEE) -- The jokes started when Ben Phipps announced he was going to medical school. People asked him, "Are you practicing your handwriting?"

Phipps, a resident physician at Deering Community Health Center, didn't think his penmanship was all that bad -- until his colleagues nominated him to talk to The Gazette about doctors' handwriting.

"Penmanship was my worst class," Phipps admitted. "It's definitely not good."

Deservedly or not, doctors are notorious for having wretched writing. And unlike other professions, lives can depend on the legibility of their script.

With that in mind, the 2005 Montana Legislature passed a law making it a civil offense for any medical provider to write an illegible prescription. The law went into effect Oct. 1.

"It's really meant to be a very courteous warning to the medical community saying this can be a problem," said Rep. Christopher Harris, D-Bozeman, who introduced the bill. "It's not meant to be punitive in any way."

Under the law, complaints about illegible prescriptions can be filed with the board that licensed the offending practitioner. For instance, complaints about physicians can be

made to the state Board of Medical Examiners.

Anne O'Leary, legal counsel for that body, said last week that no complaints had been filed so far. Until one is, it is unclear how they will be handled, she said.

"It's brand new, so we'll just have to wait and see how it works," O'Leary said.

According to the law, licensing boards can decide whether to investigate individual complaints, impose sanctions or turn cases over to county attorneys for prosecution. All or none could happen in any case, O'Leary said.

If a case is successfully prosecuted, up to $500 in fines can be levied for each illegible prescription.

Harris, who is an attorney, said medical professionals in the Legislature supported the bill because illegible prescriptions can lead to serious medical errors. What if Zyrtec, an antihistamine, was dispensed instead of Zyprexa, an antipsychotic, because the prescriber's handwriting was illegible?

Rep. Arlene Becker, D-Billings, co-sponsored the legislation.

"I'm a nurse, and I see handwriting which is atrocious," Becker said. "We used to make jokes about how we thought it was a class they taught in school -- how to write so you can't read it."

Whether medical professionals actually have worse handwriting than everyone else is debatable, and it's a popular debate. A Google search for "doctors" and "handwriting" brings up almost 500,000 items. The second one on the list is a study concluding physicians get a bad rap.

Dr. Mark Rumans, chief of staff at Deaconess Billings Clinic, thinks lousy writing afflicts medical providers and people in other professions equally.

"It's just that what (doctors) are writing is important," Rumans said.

His own penmanship could use some work.

"I've never been accused of having good handwriting, that's for sure," Rumans said. "Even back in high school or grade school, it's not been good."

Phipps, the medical resident at Deering, said he watched his writing deteriorate during medical school.

"If you look at a person's penmanship from the first year to the fourth year, it's changed, and it's not an improvement," he said. "When you're seeing 10 patients in two hours and writing something on all of them, legibility goes out the door. I think it falls to the wayside because we're rushed."

Plus, Phipps said, providers write the same things over and over again.

"I know what I'm writing," he said. "You just get to where you're scribbling it."

Dr. Kathie Kadri, a former pharmacist who practices internal medicine at St. Vincent Healthcare, estimated she writes 80 prescriptions and patient orders a day. Kadri said she usually prints, which makes her writing easier to read, but she has been asked to interpret it.

"Nobody intentionally has bad handwriting," she said. "They don't intentionally write something a pharmacist can't read. The most frightening thing we can do is make a mistake that harms a patient."

Although anyone can file a complaint about a provider's rotten writing, the law is geared toward helping pharmacists, Harris said. Trying to interpret messy prescriptions takes up their time, and, without the law, pharmacists who asked doctors to clean up their acts had no backing.

Harris said pharmacists in Bozeman have thanked him for the legislation, but not everyone in the profession is happy with the law.

"I think it's stupid," said Hertha Voorhis, a pharmacist at First Pharmacy in Billings. "I think it's a little extreme that it had to go to that point."

Voorhis said she handles between five and 10 unreadable prescriptions a month.

"If you can't read something, you call the doctor," she said. "I would never just turn them over."

Voorhis said part of her job is to check scripts for accuracy. Does the dose match the drug? Does the drug match the patient?

"A good pharmacist is going to know that customer and catch changes," she said.

Carla Cobb, a pharmacist at Deering, also questioned whether the law was necessary.

"I don't really see it changing physicians' handwriting. I certainly haven't so far," Cobb said.

Cobb said pharmacies take other steps to prevent errors, including posting lists of easily confused medications.

"There are so many drugs that look alike and sound alike," she said. "If it's not clear, a mistake could be made."

For instance, the drug Toprol is for people with high blood pressure, while Topamax treats seizures. Imagine the seizure patient who gets Toprol by mistake, Cobb said.

Or imagine the patient who gets Lamisil, an antifungal medication, instead of Lamictal, a mood stabilizer and anti-epileptic.

Doses can also be misinterpreted. Kadri, the St. Vincent doctor, said a pharmacist once misread a prescription she wrote for potassium and quadrupled the dosage.

"If you get way too much potassium, your heart stops," she said.

Luckily, the error was caught right away. The patient was unharmed, and Kadri immediately changed the way she wrote scripts.

If the law doesn't make pretty writers out of all providers, it might do something else.

"Maybe this will be a good incentive to move toward electronic records," Cobb said.

At Deaconess, many prescriptions are already dispensed electronically. It make them more readable, and the computer program was designed to catch dosing mistakes or potential drug interactions.

Within a few years, most prescriptions will probably be issued electronically, making the illegible prescription law obsolete. That will leave pharmacists like Cobb with a valuable but unmarketable skill.

"I always say I can read any handwriting because I'm a pharmacist," Cobb said.

Diane Cochran may be reached at 657-1287 or dcochran@billingsgazette.com.