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Ky. Lawmakers did not consult federal experts on the limitation of black lung claim exams

Updated at 8 p.m. ET

The federal agency that trains, tests and certifies physicians who read x-rays and diagnose the deadly black lung of coal mining said today that it was not consulted by Kentucky lawmakers in the 14 months that they considered a new law that limits the diagnoses to the pulmonologists who work for the coal companies.

As NPR and Ohio Valley ReSource reported for the first time, the new Kentucky law prohibits certified radiologists from reading the x-rays used to grant state compensation for black lung. That leaves out radiologists with extensive experience in reading chest x-rays and diagnosing black lung, a disease caused by the inhalation of carbon and silica dust.

Instead, the law reserves that task for pulmonologists, and only six in Kentucky are certified to read black lung radiographs. Four of those six normally work for coal companies, according to a NPR review of federal black lung claims.

The National Institute for Occupational Safety and Health, a federal research agency, provides training, testing and certification. The agency certifies "B readers" who are exceptionally qualified to diagnose black lung based on X-rays.

"NIOSH was not consulted on this bill," said spokeswoman Christina Spring, who also provided comparative rates of approval / disapproval of certified physicians who must perform recertification exams.

"There is no evidence that the realization of the ILO classification, a standardized process to describe the findings present in the radiographic chest images used in the evaluation of black lung cases, is done differently by B Readers with a medical background in radiology vs. pulmonology, "said Spring.

In fact, radiologists have a slight advantage: 90 percent passed the exams in the past 10 years, while 85 percent of pulmonologists were recertified.

Call for revocation

"Having that process established replaced by legislators and a political process is inappropriate," said Dr. William Thorwarth, CEO of the American College of Radiology.

"This is a matter of life and death for many people," Thorwarth added. "Politics should be left out of it."

Thorwarth also called on the Kentucky Legislature to repeal the changes, which came in large "reforms" to the state's workers' compensation law.

The revised law is "off base," said Bill Bruce, executive director of the American College of Occupational and Environmental Medicine, a group that represents 5,000 doctors who specialize in occupational, environmental, and occupational injuries, illnesses, and injuries.

"There is no reason to limit the interpretation of X-rays to pulmonary doctors," Bruce told NPR on Monday. "Qualified doctors in other specialties should be able to do it if they have demonstrated competence."

Coal miners in Kentucky who suffer from black lung can apply for state or federal compensation for black lung disease, although state benefits may be higher and easier to obtain.

As reported by NPR, the rate of the advanced stage of the disease, known as complicated black lung, is at epidemic levels.

State claims for black lung in Kentucky have increased about 40 percent since 2014, according to an Ohio Valley ReSource state data analysis.

The State Department of Workers Complaints reports that more than $ 3.3 million in black lung benefits went to coal miners in 2014.

"Open to a better way to do it"

The main sponsor of the legislation was Rep. Adam Koenig, a Republican and real estate agent in Erlanger, Ky., Who told NPR that he "relied on the experience of those who understand the problem – the industry, coal companies and lawyers "during the 14 months he spent working on the changes.

In response to criticism of the law, Koenig said that "not everyone who had a specific interest was involved … I'm not sure I know about NIOSH."

Koenig added that he is "open to a better way to do it" and can request a hearing on possible changes in the law during interim legislative committee meetings this summer and fall.

"If radiologists feel snubbed, we're going to talk about that," he said. "And if they're right, we'll fix it."

The Kentucky Legislature has completed its regular 2018 session except to address any veto by Republican Gov. Matt Bevin, who signed the workers' compensation law that contains the new provisions on black lung.

Objection from pulmonologists

"For all practical purposes, this eliminates the state's black lung compensation program for workers," said Timothy Wilson, a Lexington lawyer representing coal miners. .

Wilson is also president of the Kentucky Workers' Association and participated in confidential negotiations focused on legislation on black lung claims.

"The coal industry was directly involved," Wilson said, but did not name the participants in the talks, as it was agreed that the discussions are confidential.

Even one of the country's leading pulmonology and respiratory disease groups has criticized Kentucky's law and urged repeal.

"This law seems to have been specifically approved to exclude doctors who are neutral" in the evaluation of black lung disease, said Dr. Robert Cohen, a pulmonologist at the University of Illinois, Chicago, who has dedicated 30 years to black lung disease. .

Cohen spoke on behalf of the American Thoracic Society, which represents more than 15,000 pulmonologists, physicians, other health care providers and researchers focused on respiratory diseases.

Kentucky's law "is detrimental to the miners," Cohen said. "It was not taken into account."


Benny Becker is a journalist for Ohio Valley ReSource, a regional journalism contributor who reports on economic and social change in Kentucky, Ohio and West Virginia.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.


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