New Kentucky Law Excludes Radiologists from Reading Black Lung Radiographs

A new law passed in Kentucky could reduce diagnosis rates of black lung in the state. The bill backed by Republican Representative Adam Koenig allows only NIOSH-certified pulmonologists to interpret chest x-rays in black lung compensation cases. Previously, B reader radiologists could also read chest radiographs in black lung claims.

Black lung has become increasingly common among miners. Around one in 14 miners with at least 25 years of experience are diagnosed with the condition.

According to NPR, there are only six pulmonologists in Kentucky with NIOSH certification, the qualification to assess pneumoconiosis — otherwise known as B Reader, and four of them regularly work for coal companies and their respective insurance partners. Phillip Wheeler, an attorney representing coal miners, said that at least three of these physicians “have collected hundreds of thousands if not millions of dollars from the coal industry over the last 25 to 30 years.” The law also prohibits out-of-state radiologists from contributing diagnoses.

"It is curious to me that the legislators feel that the pulmonologist is more qualified to interpret a chest radiograph than a radiologist is," said Kathleen DePonte, MD, a radiologist based in Norton, VA told NPR. DePonte has evaluated over 100,000 black lung images in the last 30 years.

Koenig told reporters that he sponsored the bill because he had heard “anecdotal stories” about physicians confusing lung cancer for black lung. Although both lung cancer and black lung provoke similar masses, coal miners who’ve inhaled silica dust are more likely to develop lung cancer since silica is a carcinogen.

Although miners can also seek out federal compensation for black lung cases, national programs can be extremely slow to roll out benefits for workers. Sometimes they’re forced to wait over 10 years to receive a federal benefit decision. According to NPR, some die before getting assistance.

There is a possibility that the law could be overturned in an appeals court. The American College of Radiology (ACR) is adamantly opposed to the law. In a statement to ThinkProgress, ACR CEO William Thorwarth, JD, MD, said, “To have that established process superseded by legislators and a political process is inappropriate. We hope that the Kentucky legislature will rescind this new law and work with medical providers to save more lives.”