Part 2 of the Center for Public Integrity’s remarkable expose on the black lung benefits process, “Breathless and Burdened,” is out this morning. And as the headline explains, it focuses on the medical unit at Johns Hopkins University which — in its work for coal companies — rarely finds black lung disease, helping the industry to defeat miners’ claims for federal benefits.

Investigative reporter Chris Hamby writes:

The Johns Hopkins University often receives attention for its medical discoveries and well-regarded school of public health, and its hospital recently was ranked the nation’s best by U.S. News and World Report.

What has remained in the shadows is the work of a small unit of radiologists who are professors at the medical school and physicians at the hospital. For 40 years, these doctors have been perhaps the most sought-after and prolific readers of chest films on behalf of coal companies seeking to defeat miners’ claims.

His story continues:

Their reports — seemingly ubiquitous and almost unwaveringly negative for black lung — have appeared in the cases of thousands of miners, and the doctors’ credentials, combined with the prestigious Johns Hopkins imprimatur, carry great weight. Their opinions often negate or outweigh whatever positive interpretations a miner can produce.

For the credibility that comes with these readings, which the doctors perform as part of their official duties at Johns Hopkins, coal companies are willing to pay a premium. For an X-ray reading, the university charges up to 10 times the rate miners typically pay their physicians.

Yet as part of its year-long investigation, the Center for Public Integrity said it found “strong evidence” that the deference the system gives to Johns Hopkins doctors “has contributed to unjust denials of miners’ claims.” Some of their evidence, especially regarding the top Hopkins’ doctor, Dr. Paul Wheeler:

— 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.

— 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.

And then, in an incredibly telling part of the story, Chris Hamby explains:

Wheeler said he is sure miners who don’t have black lung are being wrongfully compensated. “They’re getting payment for a disease that they’re claiming that is some other disease,” the doctor said.

He takes issue with a law passed by Congress in 1969 that was crafted to lessen the burden of sick miners while limiting coal companies’ liabilities. Benefit payments for a miner start at just over $600 a month and max out at about $1,250 monthly for a miner with three or more dependents. Because these caps are low and miners are presumed to be at a particular risk for the disease, the system does not require they prove their cases beyond all doubt. Still, miners must show that they have black lung and that, because of it, they are totally disabled. About 85 percent of claims are denied at the initial level.

“I think if they have [black lung], it should be up to them to prove it,” Wheeler said. To him, this means undergoing a biopsy. If miners don’t submit to the procedure, he said, it suggests they may be afraid the results will show they have something other than black lung.

Biopsies are rarely necessary to diagnose the disease and can put the patient at risk, according to the American Lung Association, the National Institute for Occupational Safety and Health (NIOSH), the Labor Department, a paper published by the American Thoracic Society and prominent doctors interviewed by the Center.

Told his higher standard of proof, which he maintains is ordinary medical practice, is not required by law, Wheeler held firm.

“I don’t care about the law,” he said.

The center’s story said:

University officials questioned the findings by the Center and ABC, requesting extensive documentation, which the news agencies provided. After initially promising responses, officials at Johns Hopkins did not answer most questions but instead provided a general written statement.

“To our knowledge, no medical or regulatory authority has ever challenged or called into question any of our diagnoses, conclusions or reports resulting from the … program,” the statement said.

I’ve asked Johns Hopkins if they have any additional response to this story, and I’ll post whatever they have to say.

UPDATED: Kim Hoppe, a Hopkins spokeswoman, referred me to this statement from the school, which ABC posted with its story.

Also out today is the ABC News version of the story, available here, which reported:

Other experts in black lung disease told ABC News that Wheeler’s medical views seem far outside the mainstream, and several bluntly questioned Wheeler’s approach. Dr. Michael Brooks, a radiologist at the University of Kentucky who sees thousands of black lung cases, said Wheeler’s results were “either a case of someone really having no idea of what they’re doing or being willfully misleading. One of those two possibilities.”

The ABC News investigation found that doctors like the team from Johns Hopkins are part of a professional corps of lawyers and experts that have helped coal companies tamp down the number of black lung awards to mine workers. The most recent figures released by the U.S. Department of Labor indicate that only 14 percent of miners who claim to be sick are initially granted benefits. A 2008 study by the Government Accountability Office found that coal companies appeal about 80 percent of those cases. After appeals, about half of the miners who initially were awarded benefits – or less than 10 percent who initially applied – actually receive them.

UPDATED 2: I asked her for a more specific statement, responding to the story as published, and she told me:

We take very seriously the questions raised in this news report about our B-reads for pneumoconiosis and suggest you refer to our full statement online.

And the ABC piece quotes at least one West Virginia political leader who actually is willing to express some outrage about all of this:

“It is a total, national disgrace,” said Sen. Jay Rockefeller, D-W.Va., of the findings. “The deck is stacked in theory and in practice against coal miners, men and women, and it is tragic.”

And:

“The doctor should not be working at Hopkins University or anywhere else,” said Sen. Rockefeller after being told about Wheeler and the investigation’s findings.

UPDATED:

In a front-page story for the Charleston Daily Mail, Dave Boucher asked a variety of West Virginia officials for reactions to the center’s initial story about the Jackson Kelly law firm:

Typically more than happy to talk about issues involving coal, several West Virginia Republican and Democratic lawmakers either chose not to comment or did not respond to requests for comment from the Daily Mail.

State Senate President Jeff Kessler, D-Marshall, said Monday he had yet to read the report. An attorney by trade, Kessler said during two years when he was in law school he clerked for the federal benefits review board that considers black lung cases.

Kessler said he was familiar with black lung statutes and the allegations of hiding evidence that have previously been reported.

“They’re serious, and obviously, if true, it would undermine the administration of justice and people’s opportunity to get redress in a legal proceeding,” Kessler said.

“It’s absolutely wrong. It needs to be investigated. If proven to be true, there needs to be serious repercussions including loss of license or more.”

In addition to Kessler, the Daily Mail requested comment from all five members of West Virginia’s national congressional delegation, Gov. Earl Ray Tomblin, House Speaker Tim Miley, state Attorney General Patrick Morrisey, West Virginia Coal Association President Bill Raney and United Mine Workers Association spokesman Phil Smith.

Other than Kessler, Sen. Jay Rockefeller, D-W.Va., was the only other official who chose to respond Monday.

You can watch more tonight on World News at 6:30 a.m. and Nightline at 12:35 a.m. Part 1 of Chris Hamby’s work is available online here, and we’ve summarized that story — focused on the coal industry law firm Jackson Kelly — in today’s Gazette.