美国国家公共电台 NPR Kentucky Lawmakers Limit Black Lung Claims Reviews Despite Epidemic

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KORVA COLEMAN, HOST:

We've been covering a surge in black lung cases across Appalachia. That's the disease that destroys the lungs of coal miners like Mackie Branham.

MACKIE BRANHAM: I'm in bad shape, man. I mean, I can no longer provide for my family. And I can't get out and do nothing around the house like I normally would. It tires your nerves up.

COLEMAN: NPR's Howard Berkes has been looking at a new Kentucky law that critics say will lead to fewer sick miners getting the state benefits that they need. Hi, Howard.

HOWARD BERKES, BYLINE¹: Hi, Korva.

COLEMAN: Howard, what's in this new Kentucky law?

BERKES: This is a change in Kentucky workers' compensation law, which gives disabled coal miners who are suffering from black lung - that's the disease that results from inhaling² coal dust. It gives them medical care, and it gives them money to live on. Now, they have to prove that they have the disease and that it disabled them. And they do that primarily with X-rays of their lungs. Before the change in the law, any physician with a special federal certification could read those X-rays and decide whether the lungs were damaged by this disease. The new law says that only pulmonologists can now do that. And there are only six pulmonologists in the state who are certified³ to read black lung X-rays. And get this. Four of them have a history of working for coal companies.

COLEMAN: If most of these pulmonologists have worked for coal companies, Howard, what does this mean for miners trying to get benefits?

BERKES: Well, you have to understand that coal companies or their workers' comp insurance carriers have to pay for the black lung benefits that miners receive. And the coal companies or their carriers typically challenge any positive X-ray readings the coal miners might have as part of their claims. So we're talking millions of dollars a year that they have to pay out. And the epidemic⁴ of advanced disease that NPR has documented suggests the claims and the costs are likely to increase perhaps significantly. So if pulmonologists alone are judging the diagnostic X-rays, and most of them have a history of working for coal companies, there's a concern that fewer miners will actually qualify even when they should.

COLEMAN: So the law bans radiologists from conducting these X-ray diagnoses. What difference will that make to somebody like Mackie Branham who we heard from earlier?

BERKES: It removes radiologists like Dr. Brandon Crum who diagnosed Mackie Branham and who also first raised the alarm about this epidemic of advanced disease back in 2016. Now, Crum was featured in both NPR reporting about this and in a study conducted by federal epidemiologists that confirmed his diagnoses at his Kentucky clinic. Other radiologists with extensive black lung experience are also affected⁵. And, you know, this is what radiologists do. This is their profession, reading X-rays and other images. And some have read thousands over the years specifically as part of black lung claims. I found a report back in 1999 that showed that radiologists actually did better than pulmonologists in passing the federal exams that are required for them to become certified.

COLEMAN: And the people behind this change - why did they support it?

BERKES: The Republican lawmaker who sponsored the change, Representative Adam Koenig, said there had been wildly different diagnosis⁶ rates in the state. He said that one X-ray reader found black lung 40 percent of the time, while another had a rate of 90 percent. So he said he's just trying to standardize⁷ this process. But when I asked him why he was leaving out radiologists and leaving it to just these pulmonologists who mostly work on behalf of coal companies, he told me he relied on the expertise⁸ of those who understand the issue - the industry, coal companies and attorneys.

COLEMAN: What about other coal-mining states? Are you hearing anything about similar moves elsewhere?

BERKES: There is some concern already among advocates for coal miners in West Virginia that lawmakers there are considering the same thing. And there's now discussion among black lung activists⁹ about mobilizing opposition¹⁰. The Kentucky move caught them by surprise.

COLEMAN: Thank you, Howard.

BERKES: You're welcome, Korva.

COLEMAN: NPR's Howard Berkes has an ongoing¹¹ investigation¹² of the epidemic of advanced black lung disease.

(SOUNDBITE OF DANIJEL ZAMBO'S "COMING HOME")