In 1990 and again in 1995 Oregon significantly cut back benefits for injured workers. Oregon is not the only one.
In Kentucky, their legislature has made it much more difficult for coal miners to get compensation for black lung disease. One of the big changes is to limit the doctors who can read x-rays to diagnose the condition. The doctor has to be certified by the federal government and must be a pulmonologist. Radiologists are excluded, despite the fact that their training is to read x-rays. The pulmonologists are primarily captives of the coal mine owners.
The solution to spending too much money on injured workers is, all too frequently, to cut benefits. That means that the workers’ pay the cost, and to some extent, responsibility is transferred to Social Security. It is a cost shift from the people best equipped to pay onto the people least able to pay.
Kentucky Lawmakers Limit Black Lung Claims Reviews Despite Epidemic
March 31, 20189:58 AM ET
Heard on Weekend Edition Sunday
A measure signed into law in Kentucky this past week would prevent federally-certified radiologists from judging X-rays in state black lung compensation claims, leaving diagnoses of the disease mostly to physicians who typically work for coal companies.
The new law requires that only pulmonologists — doctors who specialize in the lungs and respiratory system — assess diagnostic black lung X-rays when state black lung claims are filed.
Up until now, radiologists, who work in evaluating all types of X-rays and other diagnostic images, had been allowed to diagnose the disease as well.
Just six pulmonologists in Kentucky have the federal certification to read black lung X-rays and four of them routinely are hired by coal companies or their insurers, according to an NPR review of federal black lung cases.
The two remaining pulmonologists have generally assessed X-rays on behalf of coal miners but one is semi-retired and his federal certification expires June 1.
Among the radiologists excluded by the law is Dr. Brandon Crum, who helped expose the biggest clusters ever documented of complicated black lung, the advanced stage of the fatal disease that strikes coal miners.
“I do believe the coal industry is writing this bill to exclude certain doctors that they don’t like,” said Phillip Wheeler, an attorney in Pikeville, Ky., who represents coal miners seeking state black lung benefits.
Experts in reading X-rays
The changes are part of sweeping reforms to Kentucky workers’ compensation law, known as House Bill 2. Workers’ comp provides medical and wage replacement benefits for miners suffering from black lung.
Dr. Crum is the most visible of the excluded radiologists. His clinic in Coal Run Village, Ky., was the focus of a 2016 study by epidemiologists from the National Institute for Occupational Safety and Health (NIOSH). They verified 60 cases of complicated black lung that had been diagnosed in a period of about 20 months in 2015 and 2016.
NIOSH had previously reported 99 cases nationwide over a five-year period.
At the same time, NPR and Ohio Valley ReSource reported nearly 1,000 cases across central Appalachia, prompting NIOSH epidemiologists to declare it the worst epidemic of complicated black lung they’d ever seen. Our ongoing survey of black lung clinics and law offices has the current count of advanced black lung diagnoses at more than 2,200 since 2010.
“Throughout the United States, I know of nowhere where radiologists are taken completely out of the evaluation for potential black lung disease,” Dr. Crum said. “That’s what we’re primarily trained in.”
Physicians who read chest X-rays for work-related diseases like black lung are known as “B readers” and are certified by NIOSH for both federal and state compensation claims. B readers do not specifically have to be pulmonologists or radiologists, though they can be both.
Radiologists, on the other hand, focus entirely on reading multiple types of X-rays and other diagnostic images.
The law also bars out-of-state radiologists who are both NIOSH-certified B readers and medically-licensed in Kentucky. That includes Dr. Kathleen DePonte, a radiologist in Norton, Va., who has read more than 100,000 black lung X-rays in the past 30 years.