The new law, signed Friday by Gov. Matt Bevin, is part of a revamp of state workers' compensation laws. It "requires that only pulmonologists — doctors who specialize in the lungs and respiratory system — assess diagnostic black-lung X-rays when state black lung claims are filed," Berkes and Becker report. "Up until now, radiologists, who work in evaluating all types of X-rays and other diagnostic images, had been allowed to diagnose the disease as well."
The law is likely to make state benefits harder to get (and they were hard to get already) because only six Kentucky pulmonologists "have the federal certification to read black-lung X-rays and four of them routinely are hired by coal companies or their insurers, according to an NPR review of federal black-lung cases," the reporters write. "The two remaining pulmonologists have generally assessed X-rays on behalf of coal miners but one is semi-retired and his federal certification expires June 1."
One Kentucky radiologist who lacks federal certification is Dr. Brandon Crum, "who helped expose the biggest clusters ever documented of complicated black lung, the advanced stage of the fatal disease that strikes coal miners," a story heavily reported by Berkes. Crum said, "I know of nowhere where radiologists are taken completely out of the evaluation for potential black lung disease. That's what we're primarily trained in."
The law also excludes out-of-state doctors, such as Dr. Kathleen DePonte, a radiologist in Norton, Va., 20 miles from the Kentucky border, "who has read more than 100,000 black lung X-rays in the past 30 years," Berkes and Becker report, quoting her: "It is curious to me that the legislators feel that the pulmonologist is more qualified to interpret a chest radiograph than a radiologist is. This is primarily what radiologists do. It is radiologists who receive all the special training in reading X-rays and other imaging."
The bill's sponsor, Republican Rep. Adam Koenig of Erlanger in Northern Kentucky, said he "relied on the expertise of those who understand the issue — the industry, coal companies and attorneys. . . . If this process doesn't work, I'll be the first in line to figure out how to do it better."
UPDATE, April 8: Berkes and Becker report that Koenig and other state officials did not consult the National Institute of Occupational Safety and Health about the bill, and the CEO of the American College of Radiology called on the legislature to repeal the new law.