Report: Ky. black lung law targets 1 radiologist

2017 03 09 14 05 24 948 Chest Lung Xray 400

A law passed in Kentucky earlier this year that stripped radiologists of the right to interpret x-rays of coal miners who may have black lung disease was actually targeted at a single radiologist who has been instrumental in documenting the resurgence of black lung in central Appalachia.

That's according to an article published December 13 in the Guardian that profiles Dr. James Brandon Crum, a radiologist who runs a clinic in Coal Run Village, KY. Crum reviews x-rays of coal miners as part of the U.S. government's B-reader program to detect early signs of black lung.

The story describes how Crum, the son of a coal mining family who worked stints in the mines when he was younger, began noticing a cluster of black lung cases in 2015. Crum reported his findings to the U.S. National Institute for Occupational Safety and Health (NIOSH), which administers the B-reader program.

Crum's report prompted NIOSH to perform a study of its own, which was published in December 2016. The study confirmed that there was a resurgence of black lung in eastern Kentucky, with 60 patients reporting symptoms of coal workers' pneumoconiosis, the clinical term for black lung.

NIOSH followed that research with a broader study, published July 2018 in the American Journal of Public Health, that showed the prevalence of black lung disease has risen sharply across the U.S., but in particular in the central Appalachia region. Black lung prevalence in the area in 2017 was 20.6% among miners with more than 25 years of exposure, compared with a low of 7.8% in 2000.

Crum was rewarded for his efforts with HB-2, a law passed in the Kentucky Legislature that prohibited radiologists from being certified in the B-reader program. HB-2 limited participation in the program to pulmonologists, who are thought to be friendlier to coal mining companies.

While HB-2 applies to all radiologists in the state, the law was widely seen as specifically targeting Crum, according to the article in the Guardian. One plaintiff's attorney for coal miners even called the law "The Dr. Brandon Crum Exclusion Bill."

"No one can say that his readings are wrong," the article quotes one source as saying. "So, they just try to find a way to knock him out of the system."

HB-2 is the target of a repeal effort that would rescind the exclusion provision and give Kentucky radiologists like Crum the right to read black lung x-rays once again. That bill will be taken up by Kentucky's general assembly starting in January, according to the article.

The Guardian article concludes by predicting that the resurgence of black lung in Kentucky is just a harbinger for what will soon happen in other coal mining regions around the world. Most of the more productive coal seams have been played out, forcing miners to process more rock during the mining process -- exposing their lungs to more of the crystalline dust that leads to black lung.

"What we're seeing in central Appalachia right now is the prequel to what you will see occurring in the rest of the United States coal fields, over the decades to come," said Crum in the Guardian article.

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