Handwritten-prescription ban puts pharmacists in awkward position as "enforcers"

Most doctors produce prescriptions resembling the dance of an inked chicken on meth, despite years of warnings about the dangers of scrawled prescriptions, as well as a state law requiring that prescriptions be "legible."

So the Legislature decided to give them some help, because apparently the word "legible" wasn't clear enough.

Earlier this month, the little bombshell went into effect: No more hand-written prescriptions — unless it's the sort of writing you learned in first grade.

Buried midway through a 61-page, multisubject medical-malpractice "compromise" bill passed this year, the new law defines "legible prescription" as hand printed, typewritten or electronically generated. Cursive, the slanted, loopy writing you learned in third grade, is to be treated as "illegible."

The requirement surprised and irritated many pharmacists, who suddenly find themselves in the uncomfortable role of "enforcer."

Even Allen Vaida, executive director of the Philadelphia-based Institute for Safe Medication Practices, which declared war on handwritten prescriptions in 2000, says putting pharmacists in the middle is a "bad way to go about it."

Pharmacists, according to the state Board of Pharmacy, are now supposed to reject perfectly legible (in the old sense of the word) prescriptions that happen to be in cursive. But what if they're half-printed and half-written? What if they can't find the doctor to verify? What if the patient needs the medication soon?

"Nobody in our company is sending anything back to a doctor [just] because it's written in cursive," said Dan Connolly, pharmacy director at Bartell Drugs.

It'll be business as usual for Bartell pharmacists, he said. "They'll verify any unclear prescriptions, even if they're typed or printed. "I've got doctors who print worse than anybody can write."

Don Downing, an associate professor in the Department of Pharmacy at the University of Washington, says pharmacists faced with a legible but cursive prescription, and no timely way to verify it, likely will "take care of the patient first."

Both Downing and Connolly say they support the intent of the law. "Pharmacists have complained as much as anyone about the hazards of poorly written prescriptions," Downing said.

But this legislation, like most, tends to "oversimplify and create its own issues," says Tom Curry, executive director of the Washington State Medical Association, which supported the change.

Doctors, previously skeptical, had a change of heart after Dr. William O. Robertson, a 27-year foe of handwritten prescriptions, successfully demonstrated to them that they were unable to read their colleagues' signatures.

But Curry wonders: Who's going to enforce this law?

"I don't think we're going to see a cadre of legibility cops," he says.

Robertson, medical director of the Washington Poison Center, says it should now be "unprofessional conduct" to write a prescription. Write, as in runtheletterstogether.

So would the Medical Quality Assurance Commission — fondly known as MedQAC — bust doctors who don't keep their pens in their pockets? Quite likely, "doctors who write" won't ever be the licensing board's top priority.

Blake Maresh, executive director, says the board could take action on serious and repeated violations, depending on the circumstances.

"I don't know quite right now how this will play out," he said. "We're not going to be in the pharmacies and in the doctor's offices checking their penmanship."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com