KALISPELL (LEE) - Sure, you've heard the one about the parents who, when told about little Johnny's wretched penmanship, respond with "Yes! We knew he was going to be a doctor!"

But do you know the one about the prescription for Isordil that was mistaken for Plendil, and the patient died?

Or the one about the pharmacist who couldn't decipher Coumadin from Cordarone from Cardura? Losec from Lasix?

"Some of what comes through here is just chicken scratch," said pharmacist Pam Bates, who for 18 years has been decoding doctors' orders from behind the counter at Kalispell's Stoick Drug. "It just blows your mind when you see how bad they really are. It looks like Hebrew or something."

In fact, Whitefish pharmacist Jim MacKenzie a 34-year veteran of the handwriting horrors says "it's probably happened to everybody; not very often, but if you've been working as a pharmacist long enough, sure, you've probably read a prescription wrong."

"That does happen, absolutely," agreed Missoula pharmacist Trisha Kopecky, who has dispensed meds for 17 years.

"But we're humans," she said. "The job demands perfection, and nobody's perfect. Not when it comes to handwriting on prescriptions."

Which is why many pharmacists are cautiously embracing a new state law that took effect Oct. 1, making it a civil offense for a physician to pen an illegible prescription.

"I think people looked at it initially as a joke," said state legislator Arlene Becker. But the Democrat from Billings, who also is a nurse, was deadly serious when she helped carry the bill.

"Eventually," she said, "people realized what we were trying to do, and they supported the idea."

The idea, Becker said, was to "address what was becoming more and more of a safety issue. It's intended to be a wake-up call for physicians. But it's not meant in any way to be punitive."

In fact, Becker said, existing law already allows a patient harmed by handwriting to sue the doctor. The new law, she said, should actually limit that sort of courtroom drama, providing a formal "in-house" channel for complaints and making the civil case explicit.

According to Anne O'Leary, legal counsel for the state Board of Medical Examiners, complaints will be submitted to the health provider's licensing board, which, after review, can respond by holding a hearing.

If either side disagrees with the board's decision, the matter can be moved into the courts, where doctors face fines of up to $500 for each illegible script. But even Becker doesn't expect cases to get that far.

Mostly, she said, the new law is a tool to help pharmacists who are tired of spending hours on the phone asking for clarity about doctors' orders.

"It would be hard to enforce, but I think it's going to do the job of making doctors more aware," MacKenzie, the Whitefish pharmacist, said. "Now, it's been put right out there in front of them. I mean, you just can't make mistakes when you're giving people potent drugs."

So far, O'Leary said, "we have not had any complaints come in. It's a new law that hasn't been tried yet."

It may, however, be only a matter of time until it is.

Throughout the nation, handwriting plays a role in about 6 percent of hospital patients injured by medication. Some 7,000 deaths are blamed each year on drug errors, and an estimated quarter of those are mix-ups involving drug names.

That's why the Alzheimer's drug Reminyl was recently renamed Razadyne. Turns out, Reminyl looked too much like Amaryl, a diabetes medication.

"I've seen a lot of crappy handwriting in the last 18 years," Bates said, "and I've definitely seen R's that look like A's."

Similarly, the stomach medication Losec was renamed Prilosec because of handwriting confusion with Lasix, a diuretic. That's more than a four-letter mistake if you're the one bleeding to death from a stomach ulcer.

But Lamictal, an anti-epileptic, remains Lamictal, despite its superficial similarity with Lamisil, an antifungal used to treat athletes foot and other skin irritations.

Sometimes, Bates said, pharmacists can decipher the intended drug based on a patient's age, or gender, or perhaps by the dosage.

But the same sort of people who might take Quinine for leg cramps might also take Quinidine for heart arrhythmia, "and the dosages prescribed for both are often quite similar."

When the first couple of letters unravel into a wavy line for the rest of the script, Bates said, there's potential for problems.

All pharmacists call the doctor when there's a question, she said, but what happens when the druggist thinks it's clear, but it's not?

"You can read it, so you assume everyone else can, too," said Dr. Louise Swanberg, chief of staff at Kalispell Regional Medical Center. But, of course, it's the reader, not the writer, who must find it legible.

Swanberg recently helped craft and deliver a new penmanship policy at her hospital, the sort of program that's becoming, like Montana's new law, ever more common. Even the national Medical Defense Union, in its 10 commandments of record-keeping, tops the list with "Thou shalt write legibly."

Swanberg kicked off her hospital's new handwriting handbook with a presentation to the staff, including 100 examples of tricky script generated by you guessed it none other than her audience.

In at least one case, she said, "even the person who wrote it didn't know what it said."

Of the 150 or so doctors on staff at Kalispell Regional, she said, "most are pretty legible. But we do have a half-dozen who are, shall we say, challenged."

That's probably no more or less than in any other profession, she said, but with doctors, penmanship can prove lethal. Little Johnny, it seems, might want to look into a new line of work.

Swanberg's own writing is relatively easy on the eye, but it's not perfect.

"My problem is abbreviations," she said.

For years, it's been said that doctors went to school to learn to write in code, and pharmacists went to school to learn how to decode doctors.

In reality, doctors went to school to learn, among other things, a bunch of Latin-based abbreviations that are no longer, to borrow an abbreviation, OK.

The old QID - meaning four times a day - is too often confused with QD: one time a day, a simple mistake that could come with dire consequences. Likewise, substituting "U" for units could change 10 U to 100 if the "U" is mistaken for a "0."

And so part of Swanberg's new policy erases the old abbreviations, asking doctors to take the time to spell out words such as "daily."

Time, in fact, is a big reason doctors have such a bad writing rap. Always in a rush, often writing the same words over and over, usually using scribbled abbreviations, doctors tend to start the day strong and then fade as the hours pass.

And in today's world, where there are more people, more drugs and more outpatient treatment, there are necessarily more prescriptions being written. More prescriptions mean more possibilities for problems, which means more attention from legislators, which means more laws like Montana's new dose of preventative penmanship.

"I'm not a big fan of a bunch of new rules and laws," said pharmacist Kopecky. "But it's not a bad thing that some of the responsibility is put back on the doctors. Now maybe there will be a little more accountability."

"You read about it," Kopecky said. "There are actually people dying because of this."

Mostly, she reads about it in the industry trade magazines, journals such as Pharmacy Times. Toward the back of each issue is a page of photocopied prescriptions, sent in by readers. It's a popular puzzle, to riddle out the script, with answers in small print at the bottom of the page.

But the puzzle, like the problem, might soon be a thing of the past, with more offices moving toward a system of electronic medical records.

Of course, those systems are expensive, and raise questions of confidentiality and security. Technology isn't quite there yet, Swanberg said, and typing in the data can actually take longer than writing it out, making the systems unpopular with doctors already pressed for time.

"It's going to be painful," she said of the high-tech shift, "and it's going to take some time. But if it prevents an error, then it's totally worth it."

Meanwhile, she'll continue to meet with her "Saturday school" students, the few physicians who didn't quite learn to cross their "t's" back in third grade. For some, the new rule might mean a bad report card in their permanent file. Others might not be allowed to leave the floor until the ward clerk signs off on their written orders.

"That's a hassle," Swanberg said. "And with doctors and everyone else, there is a tendency to reform your ways once the hassle factor gets to be great enough."

"We have to teach some old doctors new tricks," she said, "and that's never easy."

Her approach so far has been to laugh a bit at the worn-out joke of it all, then to emphasize the seriousness of it all which, in fact, is exactly the spirit in which the law was written.

"We didn't want this to be some big threat hanging over the docs," Becker said, "but it is a real issue, and we needed to create a culture of awareness. It's something that everybody laughs about, and that's OK. But it can be very serious, too."