Two Kentucky representatives have pre-filed a bipartisan bill to repeal a new law that limits which doctors can evaluate black lung workers compensation claims.
The new law — which was part of a larger bill that made sweeping changes to the state’s workers' compensation system — says that the federally certified doctors who review black lung X-rays have to be pulmonologists. Radiologists, who specialize in reading X-rays, will no longer qualify.
The change reduces the number of doctors eligible to diagnose black lung from 10 to 4.
Rep. Angie Hatton, a Democrat from Whitesburg and co-sponsor of the bill to repeal the changes, said the new measure has made it harder for workers to get black lung claims evaluated.
“The only purpose it serves is to eliminate a lot of the claims and eliminate some doctors who were seen as worker-oriented. That’s what it did, it targeted them and got rid of them,” Hatton said.
Black lung is a disabling condition caused by long-term exposure to coal dust. Because the condition is caused by their work environment, coal miners are eligible to have their medical expenses and a small stipend paid by their employer if they are diagnosed with the disease.
Earlier this year the Republican-led legislature passed House Bill 2, which overhauled Kentucky’s workers’ compensation system in a variety of ways, including the changes to who can diagnose black lung claims for workers’ compensation purposes.
The Kentucky Chamber of Commerce and Kentucky Coal Association promoted the legislation, which they said would help reduce business’ workers' compensation insurance rates and modernize the state’s labor laws.
Rep. Robert Goforth, a Republican from East Bernstadt, is co-sponsoring the bill to repeal the black lung changes. He said a lot of legislators didn’t understand the changes to the black lung evaluation process that were included in House Bill 2.
“Most of us want what’s best for the coal miner and what’s best for the coal industry," Goforth said. "We understand that coal keeps the lights on, but we also have to protect those workers that are risking their lives to harvest that coal so we can keep the lights on.”
Goforth was one of 10 House Republicans who voted against House Bill 2, which ended up passing 55-39 earlier this year.
Who Should Read The X-Rays?
The only two qualified pulmonologists that have contracted with the state to diagnose black lung are located in Lexington. Before the law went into effect, workers could receive a physical evaluation in either Lexington or Greenville, located in the western Kentucky coal fields.
X-rays conducted during the physical evaluation would then be evaluated by qualified radiologists in either Lexington or Pikeville.
Brandon Crum, the radiologist who reviewed black lung X-rays in Pikeville, said he doesn’t understand why the state no longer allows radiologists to review black lung claims.
“You really eliminated the individual who was the most trained, who does their entire residency reading X-rays and films, and put it onto pulmonologists who are not nearly as trained as radiologists to read X-rays,” Crum said.
Rep. Adam Koenig, a Republican from Erlanger and sponsor of the measure, argues that it’s too early to know whether the changes have led to a drop in black lung claims and that the proposed repeal is a “solution looking for a problem.”
“If it’s not working I’m open to fixing it, but they have no basis to say that it’s not working. At least no facts to say that it’s not working. This thing hasn’t even been law but for five months,” Koenig said.
He said the changes were made in reaction to a 2011 Kentucky Supreme Court ruling that struck down part of the state’s workers’ compensation law because coal miners faced tougher requirements than did people who contracted pneumoconiosis apart from mining.
Under the changes that passed earlier this year, miners who suffer from black lung and those who contract lung-related diseases from other professions are evaluated the same way.
The sweeping changes to Kentucky’s workers’ compensation program came amid a historic increase in black lung cases across the country. State black lung claims in Kentucky have risen about 40 percent since 2014, according to a recent analysis by Ohio Valley ReSource and NPR.
Tyler White, president of the Kentucky Coal Association, argues that pulmonologists are better equipped to make black lung determinations because radiologists’ qualifications “are considerably more general in nature.”
“While radiologists are trained medical professionals, a radiologist might base an evaluation upon solely viewing an image while a pulmonary specialist who is a B-reader has the history, exam, pulmonary findings, blood gas studies and the radiographic results to allow for more thorough, consistent and accurate evaluations,” White wrote in a statement.
Though only two pulmonologists have contracted with the state to review black lung claims and two radiologists previously did so, the changes reduce the total number of doctors available to do the reviews.
There are 10 doctors in Kentucky who have the federal “B-reader” certification that allows them to review black lung claims according to the National Institute For Occupational Safety And Health website — 6 of them are radiologists and 4 are pulmonologists.
The American College of Radiologists has called for the state to repeal the law.
Stephen Hobbs, president of the Kentucky chapter of the American College of Radiology, said radiologists are better qualified to make black lung determinations.
“There is no medical reason to not have radiologists do these types of interpretations," Hobbs said. "When there’s not a medical reason for doing something you have to ask yourself why make that change.”
Donald Givens is the director of the Coal Miners' Respiratory Clinic in Muhlenberg County which conducted physical black lung exams. He said that shifting black lung evaluations away from the state’s western coalfields will lead to more afflicted workers going untreated.
“If you delay their care, I mean people could die because of this. That’s what I’m trying to explain to people, there is urgency in getting this fixed,” Givens said.