Chris Hamby, Breathless and Burdened. The Center for Public Integrity, three-part series, 29 October, 30 October, and 1 November 2013. “This yearlong investigation examines how doctors and lawyers, working at the behest of the coal industry, have helped defeat the benefits claims of miners sick and dying of black lung, even as disease rates are on the rise and an increasing number of miners are turning to a system that was supposed to help alleviate their suffering.” This series won the 2014 Pulitzer Prize for Investigative Reporting. One part of the three-part, 25,000-word series was produced in partnership with the ABC News Investigative Unit, whose work included an in-depth Nightline segment.” Updates from The Center for Public Integrity, 30 September 2015: “‘Sweeping reforms’ proposed for black lung benefit program” and “Johns Hopkins terminates black lung program.”
Winner of the 2014 Goldsmith Prize for Investigative Reporting.
Excerpts from stories:
For almost two centuries, [the law firm Jackson Kelly PLLC] has served the coal industry. It is the go-to place for many of the industry’s giants when they want to beat back a miner’s claim for benefits…. Some of the firm’s tactics go beyond aggressive advocacy, crossing into unethical behavior, according to current and former judges, lawyers and state disciplinary officials. As a result, sick and dying miners have been denied the modest benefits and affordable medical care that would allow them to survive and support their families.
The role of lawyers in orchestrating sophisticated legal strategies to defeat claims for benefits is just the first chapter in the story of a system in which well-paid specialists thrive as miners struggle, the Center’s yearlong investigation, Breathless and Burdened, found. Coal companies rely on a cadre of doctors with prestigious affiliations, including a unit at the nation’s top-ranked hospital [Johns Hopkins], to trump the opinions of miners’ physicians. Experts for hire continue a century-old tradition: denying scientific evidence that black lung can assume different appearances in different people, locking an entire class of sick miners out of the benefits system.
Jackson Kelly, documents show, over the years has withheld unfavorable evidence and shaped the opinions of its reviewing doctors by providing only what it wanted them to see. Miners, often lacking equally savvy lawyers or even any representation, had virtually no way of knowing this evidence existed, let alone the wherewithal to obtain it….
Until now, Jackson Kelly’s conduct in black lung cases has remained largely buried in voluminous files that are confidential because of the private medical and financial information they contain.
Over the past year, however, the Center [for Public Integrity] has identified key cases and obtained written permission from miners or their surviving family members to view their entire case files. These 15 files span 40 years and include hundreds of thousands of pages. The Center also reviewed the limited publicly available information on dozens more of the firm’s cases….
In the federal black lung system, cases often boil down to dueling medical experts, and judges rely heavily on doctors’ credentials to resolve disputes.
When it comes to interpreting the chest films that are vital in most cases, [Dr. Paul] Wheeler is the coal companies’ trump card. He has undergraduate and medical degrees from Harvard University, a long history of leadership at Johns Hopkins and an array of presentations and publications to his credit. In many cases, judges have noted Johns Hopkins’ prestige and described Wheeler’s qualifications as “most impressive,” “outstanding” and “superior.” Time and again, judges have deemed him the “best qualified radiologist,” and they have reached conclusions such as, “I defer to Dr. Wheeler’s interpretation because of his superior credentials.”
Yet there is strong evidence that this deference has contributed to unjust denials of miners’ claims, the Center found as part of a yearlong investigation, “Breathless and Burdened.” The Center created a database of doctors’ opinions — none previously existed — scouring thousands of judicial opinions kept by the Labor Department dating to 2000 and logging every available X-ray reading by Wheeler. The Center recorded key information about these cases, analyzed Wheeler’s reports and testimony, consulted medical literature and interviewed leading doctors. The findings are stark:
- In the more than 1,500 cases decided since 2000 in which Wheeler read at least one X-ray, he never once found the severe form of the disease, complicated coal workers’ pneumoconiosis. Other doctors looking at the same X-rays found this advanced stage of the disease in 390 of these cases.
- Since 2000, miners have lost more than 800 cases after doctors saw black lung on an X-ray but Wheeler read the film as negative. This includes 160 cases in which doctors found the complicated form of the disease. When Wheeler weighed in, miners lost nearly 70 percent of the time before administrative law judges. The Labor Department does not have statistics on miners’ win percentage in all cases at this stage for comparison purposes.
- Where other doctors saw black lung, Wheeler often saw evidence of another disease, most commonly tuberculosis or histoplasmosis — an illness caused by a fungus in bird and bat droppings. This was particularly true in cases involving the most serious form of the disease. In two-thirds of cases in which other doctors found complicated black lung, Wheeler attributed the masses in miners’ lungs to TB, the fungal infection or a similar disease.
- The criteria Wheeler applies when reading X-rays are at odds with positions taken by government research agencies, textbooks, peer-reviewed scientific literature and the opinions of many doctors who specialize in detecting the disease, including the chair of the American College of Radiology’s task force on black lung.
- Biopsies or autopsies repeatedly have proven Wheeler wrong. Though Wheeler suggests miners undergo biopsies — surgical procedures to remove a piece of the lung for examination — to prove their cases, such evidence is not required by law, is not considered necessary in most cases and can be medically risky. Still, in more than 100 cases decided since 2000 in which Wheeler offered negative readings, biopsies or autopsies provided undisputed evidence of black lung.
Update: Chris Hamby, Black lung claims by 1,100 coal miners may have been wrongly denied. The Center for Public Integrity, 22 July 2014.
Update: Chris Hamby, Years After Black Lung Claim Was Wrongly Denied, Coal Miner Gets His Due. Buzz Feed, 5 November 2014. “They overcame now-discredited testimony by a prominent Johns Hopkins doctor and almost a decade of legal wrangling with a coal company. Now the family of deceased miner Steve Day gets what they were owed all along.”