GLEN FORK, W.Va. — Across Laurel Creek and down a dirt road in this sleepy valley town is the modest white house where Steve Day grew up. For more than 33 years, it was where he recuperated between shifts underground, mining the rich seams of the central Appalachian coalfields and doing his part to help make Peabody Energy Corp. the nation’s most productive coal company. Now, it’s where he spends most days and nights in a recliner, inhaling oxygen from a tank, slowly suffocating to death.
More than a half-dozen doctors who have seen the X-ray and CT images of his chest agree he has the most severe form of black lung disease. Yet his claim for benefits was denied in 2011, leaving him and his family to survive on Social Security and a union pension; they sometimes turn to neighbors or relatives for loans to make it through the month.
The medical opinions primarily responsible for sinking his claim didn’t come from consultants-for-hire at a private firm or rogue doctors at a fringe organization.
They came from a respected household name: the Johns Hopkins Medical Institutions.
The more I read this report the angrier I got. All thanks to real data put together that allowed unseen tendencies to be revealed, for intuitive suggestions to become objective reality.
It appears that a single medical institution is responsible for many coal miners not getting any benefits for their lung disease,f or having to die sooner than needed in intense agony as they struggle to breath. Would you trust a doctor’s opinion that only agreed with those of other doctors 2% of the time, out of thousands of cases?
The report constructed a database of decisions regarding black lung claims. It took a lot of work but what they found was that the Johns Hopkins unit hardly ever finds black lung when other doctors find it easily. Their diagnosis is that the X-rays reveal tuberculosis or a fungal disease but not black lung.
And these doctors use their reputation to overrule the diagnosis from lesser doctors at institutions that are not Johns Hopkins.
It is interesting that the coal companies pay big dollars to Johns Hopkins for their analysis of the X-rays. Here is the telling infographic that boggles the mind, from just one of the Johns Hopkins doctors looking over 1500 cases:
1500 cases where a single Johns Hopkins doctor – the head of the unit – made a diagnosis. He looked at 3400 X-rays. Red is a negative diagnosis for black lung; green a positive. In none of the cases did Wheeler find any stage 3 disease and only found the possibility of black lung in 4% of the cases. However, he also believed that another disease – such as TB – was responsible for 2% of those cases.
So, in 1500 cases, he thought only about 30 of them were actually caused by black lung. Other diseases like tuberculosis were really responsible, in his opinion.I guess there is a huge outbreak of TB in coal miners.
Many judges, in their rulings, simply deferred to the expertise of the Johns Hopkins doctors. Their name was so much more important than the doctors from other lesser institutions.
And judges that recognized the bias had little they could do. To discredit an expert, they had to find a logical flaw:
But, to discredit his readings and award benefits to a miner, as Levin did, judges must identify a logical flaw or some other reason not to give his opinion greater weight than those of other doctors. Former judges said they knew certain doctors almost never found black lung, but said they were barred from taking these experiences in other cases into consideration. In four cases reviewed by the Center, judges who have questioned Wheeler have seen their decisions vacated by an appeals board.
This doctor apparently does not like X-rays and will really only believe a biopsy – something that is not only expensive and not required but has risks to the patient. Yet in over 100 cases where Wheeler said there was no black lung, biopsies showed that there were.
And when shown test X-rays used by the government to certify readers for black lung, Wheeler got them wrong. Yet he continues to be certified for interpreting these X-rays. In fact, it appears he does not follow protocol when reading the X-rays. Yet he still reads them.
Autopsies performed on several people after death demonstrated that Wheeler was wrong – they did have black lung. They should have gotten benefits. That they did not would cause a normal doctor to be saddened, as shown in the article. Wheeler does not appear to be nearly as concerned, at least in his responses, about being wrong.
It certainly appears that Wheeler would rather thousands of people with black lung not be compensated, rather than let one get compensation unfairly. Thus there are likely thousands who will die in needless agony all so he can prevent that one person from gaming the system.
He has let his own confirmation bias cloud his judgement. That is what this deep data analysis indicates. He is not acting as an independent examiner of what the X-rays show but is spreading his own view on the matter, one that is out of touch with a huge number of colleagues.
In written opinions, judges have said Wheeler’s assumptions seem to have “affected his objectivity” and “inappropriately colored his readings.” Another wrote in 2011 that Wheeler had a “bias against a finding of complicated [black lung] in ‘young’ individuals.”
So let’s hope that future lawyers will be able to use this objective data to show the non-objective opinions of Johns Hopkins doctors. An ‘independent’ examiner who lets their bias cloud the examination is not really independent at all.