Changes Aim to Weed Out Problem Doctors in Black Lung Reviews

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By Sam Pearson

July 5 — Federal regulators are finalizing standards meant to ensure coal miners' X-rays are handled properly when doctors evaluate them for signs of black lung disease.

The National Institute for Occupational Safety and Health published July 5 a guidance document setting up a quality assurance program for doctors certified to examine X-rays of coal miners to determine if they have symptoms of pneumoconioses, or black lung disease.

The document implements a memorandum of understanding between NIOSH and the Department of Labor's Office of Workers' Compensation Programs reached in September 2015.

The quality assurance program will put procedures in place for NIOSH officials to evaluate how doctors have classified coal miners' radiographs that were submitted to the federal Black Lung Benefits Program and specify what corrective action is called for when problems are identified.

“By formalizing this agreement with OWCP, together we will establish a new mechanism to help ensure that chest X-ray readings used in black lung benefits proceedings meet the highest standards,” David Weissman, director of NIOSH's Division of Respiratory Disease Studies, said in a statement announcing the memorandum of understanding last year.

Doctors to Sit on Panel

Under the newly announced rules for the program, NIOSH will convene a Chest Image Evaluation panel of at least six doctors who are certified as B readers. These doctors will evaluate anonymously X-ray images that come from contested benefits proceedings. NIOSH officials will rely on the panel's findings to determine if doctors are appropriately classifying the images in benefits proceedings. Panelists can be removed at the discretion of NIOSH staff if the agency finds the panelist “continues to provide inaccurate classifications despite feedback.”

A B reader will be deemed to be interpreting X-ray images inaccurately if five doctors randomly selected from the Chest Image Evaluation panel disagree with the interpretation.

Steve Sanders, the director of the Appalachian Citizens' Law Center in Whitesburg, Ky., told Bloomberg BNA July 5 the changes were “a positive step.”

Sanders said he was still reviewing the new rules but had concerns that the requirement for five panelists to agree could make it hard to overrule doctors who are biased against finding evidence of pneumoconioses.

The memorandum of understanding was a response to a report by the Department of Labor Inspector General in April 2015 that issued 23 recommendations for reducing the amount of time it takes for administrative agencies to determine if a miner has black lung disease and is eligible for federal benefits, the agencies said.

The report examined systematic issues in the Black Lung Benefits program first raised in a series of articles published by the Center for Public Integrity in 2013. The articles found doctors at Johns Hopkins University who were certified to examine coal miners' X-rays almost never found evidence of black lung disease, contrary to other experts' opinions. Their approach made the university's black lung unit a favored vendor for coal companies in benefits disputes.

The university shut down the unit in September 2015.

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To contact the editor responsible for this story: Larry Pearl at

For More Information

The document, “Quality Assurance Review of B Readers' Classifications Submitted in the Department of Labor (DOL) Black Lung Benefits Program,” is available at

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