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Johns Hopkins Stops X-ray Service After Report

November 4, 2013
Written by: , Filed in: Chest Radiology, Diagnostic Imaging, Medical Ethics
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An uproar following an ABC News report last week has led Johns Hopkins Medicine in Baltimore to suspend a 40-year-old program providing second-opinion reads of lung X-rays for coal companies.

The companies paid for the reads during disputes with miners over possible cases of pneumoconiosis—commonly known as black lung.

Johns Hopkins announced the move in a statement Friday:

Following the news report we are initiating a review of the pneumoconiosis B-reader service. Until the review is completed, we are suspending the program.

The TV report was part of an investigation by ABC and the Center for Public Integrity, a nonprofit investigative reporting organization. It focused on the difficulty miners face in getting disability payments for black lung. You can find the ABC report here and the Center for Public Integrity story here.

The stories say the Johns Hopkins B-reads have played a major part in denying benefits to miners because the radiologists almost never find black lung when they read X-rays. According to the stories, Paul Wheeler, MD, the 78-year-old leader of the unit, has read X-rays in 1,573 black lung cases since 2000. In not a single one of those cases has he found complicated coal workers’ pneumoconiosis, the severe form of the disease that automatically triggers benefits.

Administrative law judges deciding black lung cases give the Johns Hopkins reports great weight, the stories say.

Dr. Wheeler usually reports film as negative, adding comments that white spots could be black lung but are more likely tuberculosis or histoplasmosis, according to the stories. He says that only a biopsy or an autopsy, not an X-ray, can confirm black lung. Even when given black lung reference X-rays, meant to show radiologists what black lung looks like on film, Dr. Wheeler diagnosed probable histoplasmosis.

When ABC’s Brian Ross asked Dr. Wheeler if it mattered to him that his reports and testimony have led “hundreds if not thousands of miners to be denied benefits that they think they deserve,” the radiologist responded: “It would matter to me if I were wrong. And no one’s proven to me that I’m wrong.”

Except, according to ABC and the Center for Public Integrity, biopsies or autopsies in more than 100 cases in which Dr. Wheeler offered negative readings did confirm black lung.

During a 2010 deposition, according to the Center for Public Integrity story, a miner’s lawyer asked Dr. Wheeler whether he could cite medical literature to support his views.

The doctor replied, “I don’t think I need medical literature.”

Related CME seminar (up to 12 AMA PRA Category 1 credits™): UCSF Cardiovascular & Pulmonary Imaging

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