For Top-Ranked Hospital, Tough Questions About Black Lung and Money

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The decision ultimately falls to administrative law judges, who often are forced to weigh conflicting accounts from doctors hired by each side. One factor they use in deciding the case is the background of the doctor who makes the decision, said retired Administrative Judge Edward Miller. And few doctors reading black lung X-rays have better credentials than Wheeler.

"His paper credentials are excellent," Miller said. "He was a Harvard undergraduate. I think he went to Harvard Medical School. He's been associated with-- Johns Hopkins for years and years and years. And I think is credited with a very distinguished career."

Miller is the father of an ABC News employee.

What judges cannot consider, Miller said, is whether a doctor exhibits a pattern in how they read coal miner X-rays. And among judges, Miller said, there is little doubt about the pattern displayed by Wheeler and the Hopkins team. Coal companies hire Wheeler, Miller said, "because they're apparently assured, I think, that he is one of the reliable doctors that they can expect will not find [black lung disease] when he reads the X-ray."

Wheeler said in his interview with ABC News that he simply called cases as he saw them. In sworn depositions, he has acknowledged that he cannot recall finding a severe case of the disease in decades. Wheeler said he believes coal companies turn to his Johns Hopkins team less for his findings than because of the hospital's respected name.

"I'd rather have them come to an academic center that's got worldwide recognition than go to a facility that nobody's ever heard of outside of Baltimore," Wheeler said.

One such case involved Day, the longtime miner from Glen Fork, West Virginia. Day said he promised his wife he would never work underground in the mines, but the money was alluring and the options were slim.

"Now I'm paying the price," Day told ABC News.

Today, Day spends most of his time hooked up to an oxygen machine, slumped in a reclining chair in the small clapboard house he shares with his wife, his daughter and her family. Even though he has been treated for black lung disease for years, an administrative judge turned down his claim for benefits. The decision was based largely on testimony from Wheeler, who said Day was more likely suffering from tuberculosis or a disease called histoplasmosis – which is a fungal infection caused by bird or bat droppings.

In his interview, Wheeler explained why he often writes in his reports that he considers histoplasmosis the most likely cause of the lung damage he's seeing. The disease is endemic to the region of the U.S. where most coal mining occurs, and while it is harmless to most people, it can produce spots on the lungs that resemble the damage caused by black lung, he said.

"If I were a betting person, I would always bet on histoplasmosis, because it's very common," he said.

Dr. Daniel Culver, a pulmonologist who treats black lung disease at the Cleveland Clinic, said Wheeler is missing a crucial factor when he identifies the lung damage he is seeing as being compatible with histoplasmosis – that the patients have spent decades working in coal mines.

"The tenure of mining influences the likelihood of black lung disease," Culver said. "And that has to go into the calculation."

As he does in nearly every report he writes, Wheeler also concluded Day's definitive diagnosis would only be possible if he submitted to a biopsy of his lung tissue. "The diagnoses come out of pathology," he told ABC News. "They do not come from X-rays."

This too, is an issue that raises concerns among Wheeler's critics. The process of awarding black lung benefits was never intended to require miners to prove, beyond any doubt, that they had contracted black lung disease, said Cline, the attorney. The law never required a biopsy, he said, only an X-ray that showed there was damage compatible with black lung, and evidence that the damage was severe enough to keep the miner from being able to work.

Other doctors interviewed by ABC News said they do not believe, as Wheeler asserts, that a biopsy is necessary to reach a conclusion when coal workers are seeking black lung benefits.

"I have actually never done a biopsy to determine if a patient had black lung," Brooks said. "It's just simply not necessary."

Moreover, it can be risky, Brooks said. He said in about 10 percent of cases, the act of inserting a needle to extract tissue can cause a lung to collapse. And though it is rare, biopsies can lead to complications that are even more serious. "It's not like going to the dentist and having your teeth cleaned," he said.

Day said his doctor considered the invasive procedure too risky.

With Steve Day's permission, ABC News and the Center for Public Integrity sent his medical records to Dr. John Parker, chief of pulmonary and critical-care medicine at West Virginia University. Parker was not told of Wheeler's earlier involvement in Day's legal case. But after reviewing the X-rays and CT scans, he said he was surprised that any doctor could look at the images and not immediately identify the cause of the lung damage. It was, he said, "a classic presentation" of black lung.

"I think that there is bias in someone's interpretation if they don't consider black lung the major, if not only, explanation for this radiograph," Parker said. "It disappoints me," Parker added, "because physicians are in a special fraternity, sorority, a profession in which scientific and intellectual honesty is paramount to our patients and to society."

Day confesses he is still angry about the doctors whose opinions left him without the benefit payments that could help his wife and family through the winter. Not only were they denied the compensation, they were asked to return $46,000 in payments they had received after initially winning, then awaiting an administrative court ruling on the company's appeal.

Ultimately, the government forgave their debt, but Day's wife, Nyoka said the added stress it induced was just one more insult to her husband, and to all coal miners. Asked how she felt about the government's efforts to support coal miners who are suffering from black lung, Nyoka Day returned again and again to the same word.

"Cheated."

"My kids were cheated. My grandchild is cheated. He's cheated," she said tearfully, pointing to her husband. "He gave his life in the mines … And it's unfair. If he doesn't have black lung, black lung never did exist for anybody."

Chris Hamby is an investigative reporter for the Center for Public Integrity.

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