Breathless and Burdened

Published — October 30, 2013 Updated — May 19, 2014 at 12:19 pm ET

Consulting fees in black lung cases flow directly to Johns Hopkins


Johns Hopkins is not the only university where doctors frequently appear as coal-company witnesses in federal black lung benefits cases, but the Baltimore institution appears to be a special case.

Other schools require doctors to perform such consulting on their own time and limit the hours they spend doing it. There is a line, albeit a sometimes fuzzy one, between the doctor’s opinion as a consultant and as a university representative.

Experts at schools including the University of Cincinnati, Washington University in St. Louis and Case Western Reserve University submit opinions that often favor coal companies, but this consulting is not part of their work for the university.

At Johns Hopkins, no line exists. It is part of the doctors’ jobs to provide interpretations for coal companies, who are willing to pay top dollar for a report from one of these doctors.

Lawyers who represent miners said the doctors they use charge between $65 and $100 to read an X-ray. Johns Hopkins charges $100 to read an X-ray with no abnormalities; the rate rises to $750 if there are markings to be interpreted, as in the bulk of black lung cases, said Dr. Paul Wheeler, the longtime leader of the section. When the doctors testify, they charge $600 an hour, he said.

Earlier this year, Wheeler said during a deposition the fee for an X-ray with abnormalities was $500. When the Center for Public Integrity asked Hopkins which amount — $500 or $750 — was correct, university officials declined to answer.

The university said the fees from deposition testimony go to a scholarship fund while the fees from X-ray readings go to the radiology department.

University representatives refused to say how much money Hopkins receives from coal companies, but said the radiologists in its Pneumoconiosis Section review between 2,000 and 3,000 possible black lung cases a year. These doctors also read films in cases other than black lung benefits claims, and provide interpretations to companies that want to monitor the health of their workers. It is unclear whether the number of cases referenced by the university includes all of this work or only black lung cases; university representatives did not answer a request for clarification.

During a deposition in a case decided in 2009, a doctor no longer at the university testified that radiologists received bonuses for being “productive.” The physician could not be reached for comment. Wheeler said he didn’t know how his salary or bonuses were calculated.

In a statement, referencing its doctors’ status as government-certified X-ray interpreters, or “B Readers,” the university said: “There are no financial incentives associated with this program for our B-readers or the radiology department. There are no bonuses or other salary supplements paid to doctors related to the volume of examinations read, expert testimony, or other aspects of the B-reader program at Johns Hopkins.”

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