Kentucky lawmakers put decisions on black lung treatments in hands of industry-paid doctors
The political assault on science in the age of Trump has reached a point where even medical specialties are rising up in protest. Radiologists are fighting back against a new Kentucky law that excludes them from the black lung claims process for coal miners in the state.
Under the new legislation, if a miner files a black lung claim with the state, only a federally licensed pulmonologist can review the X-rays and ultimately make a diagnosis. Previously, radiologists could offer a diagnosis as well.
The legislation, part of a larger workers’ compensation bill signed into law by Kentucky Gov. Matt Bevin (R) on March 30, is expected to make it more difficult for coal miners stricken with black lung disease to receive benefits for treating their disease and living with black lung. The workers’ compensation bill was supported by the Kentucky Chamber of Commerce and the Kentucky Coal Association. Labor groups strongly opposed it.
The American College of Radiology, a national organization representing more than 38,000 radiologists, said it is troubled that Kentucky lawmakers stepped in to determine who is qualified to read the X-rays of coal miners seeking compensation for black lung disease. A process is already in place to determine whether a physician is qualified to review black lung cases, the group said.
“To have that established process superseded by legislators and a political process is inappropriate,” American College of Radiology Chief Executive Officer William Thorwarth Jr. M.D., said in a statement emailed to ThinkProgress on Monday.
Thorwarth emphasized that politics should be left out of the black lung claims process. “We hope that the Kentucky legislature will rescind this new law and work with medical providers to save more lives,” he said.
Phillip Wheeler, an attorney in Pikeville, Kentucky who represents coal miners seeking state black lung benefits, said it’s possible the new law could be overturned on appeal. The law applies the rule only to workers who file claims for black lung and not workers in other industries who file benefit claims, Wheeler said Monday in an interview with ThinkProgress.
An appeals court could find that the law violates the constitutional guarantee of equal protection under the law by limiting the type of doctors who can be used in black lung cases, while workers in other occupations aren’t subjected to the same limits when they apply for worker’s compensation benefits.
The new law also could prove problematic because it drastically reduces the number of physicians in Kentucky permitted to read the chest X-rays when coal miners file a black lung claim, Wheeler said. Six doctors in Kentucky will now be eligible to conduct the exams, according to an NPR review of federal black lung cases. At least half of them “have collected hundreds of thousands if not millions of dollars form the coal industry over the last 25 to 30 years,” Wheeler said.
“The three primary doctors that will be doing most of these exams have shown a distinct bias against coal miners through the years,” he said.
Physicians who read chest X-rays for work-related diseases like black lung — also called coal workers’ pneumoconiosis — are known as “B readers” and are certified by National Institute for Occupational Safety and Health for both federal and state compensation claims. B readers do not specifically have to be pulmonologists or radiologists, though they can be both.
Black lung is common term for several respiratory diseases that share a single cause: breathing in coal mine dust. Over time, black lung disease causes a person’s lungs to become coated in the black particulates that miners inhaled during their time in the mines. Their passageways are marked by dark scars and hard nodules.
The Kentucky Coal Association “basically drafted the legislation,” Wheeler said, explaining why the new law will likely make it more difficult for miners to win black lung claims cases.
The new Kentucky law coincides with the Trump administration’s decision to examine whether it should weaken rules aimed at fighting black lung among coal miners, a move the administration says could create a “less burdensome” regulatory environment for coal companies.
President Donald Trump pledged to end the so-called war on coal but has thus far done nothing to help coal miners who have spent years working in mines win black lung benefits.
Likewise, Kentucky lawmakers are showing a preference for industry profits over occupational health. Evan Smith, an attorney at the Appalachian Citizens’ Law Center in Kentucky, said in a tweet that the new law will keep the state’s coal miners from using “highly qualified and reliable experts to prove their state black lung claims.”
The law “looks like just another step in the race to the bottom to gut worker protections,” Smith said.
Black lung has made a comeback in recent years. The disease now sickens about one in 14 underground miners with more than 25 years’ experience who submit to voluntary checkups, according to a recent study, a rate nearly double that from the disease’s lowest point from 1995 to 1999.
Kentucky is one of the states that has witnessed the resurgence in the most advanced form of black lung disease, which is debilitating and deadly.
Lawmakers included the provision in the new worker compensation law even though radiologists are considered to be the most qualified among doctors certified to diagnose black lung disease.
State Rep. Adam Koenig, a Republican who represents a district in northern Kentucky, sponsored the legislation. He told NPR that, when writing the law, he relied on the expertise of those who understand the issue — “the industry, coal companies and attorneys.”
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Reposted from Think Progress
