After working underground in the coal mines of southern West Virginia for almost 35 years, Steve Day thought it was obvious why he gasped for air, slept upright in a recliner, and inhaled oxygen from a tank 24 hours a day.
More than half a dozen doctors who saw the masses in his lungs or the test results showing his severely impaired breathing were also in agreement.
The clear diagnosis was black lung.
Yet, when I met Steve in April 2013, he had lost his case to receive benefits guaranteed by federal law to any coal miner disabled by black lung. The coal company that employed the miner usually pays for these benefits, and, as almost always happens, Steve’s longtime employer had fought vigorously to avoid paying him. As a result, he and his family were barely scraping by, sometimes resorting to loans from relatives or neighbors to make it through the month.
Like many other miners, he had lost primarily because of the opinions of a unit of doctors at the Johns Hopkins Medical Institutions that had long been the go-to place for coal companies seeking negative X-ray readings to help defeat a benefits claim. The longtime leader of the unit, Dr. Paul Wheeler, testified against Steve, and the judge determined that his opinion trumped all others, as judges have in many other cases.
Today, however, there is final and overwhelming evidence that Wheeler was wrong: Steve’s autopsy.
On July 26, what was left of Steve’s lungs gave out. He was 67 years old. The doctor who performed the autopsy found extensive black lung. With the permission of Steve’s family, I shared his autopsy report with three leading doctors who specialize in black lung and related diseases. Each said essentially the same thing: Steve had one of the most severe cases of black lung they had seen.
“A majority of his lungs had been replaced by scar tissue with coal dust,” said Dr. Francis Green, a professor of medicine at the University of Calgary and one of the world’s top experts on the pathology of black lung.
Dr. David Weissman, who heads a federal agency’s division that certifies doctors — including Wheeler — to read chest X-rays, said it was “very concerning” that a certified reader would fail to recognize a case as severe as Steve’s.
Reached by phone, Wheeler said, “I’d love to talk to you, but the hospital has asked that everything be referred to the legal team.”
A Johns Hopkins spokesperson would not comment on Steve’s case, but noted that the black lung X-ray reading program headed by Wheeler has been suspended, pending an internal review. The spokesperson refused to provide details about the review, saying only that it “is proceeding as rapidly as possible, and I can assure you that Johns Hopkins takes it very seriously.”
Eight months before he died, Steve filed a new claim for benefits, presenting evidence that the masses in his lungs had grown and his breathing had worsened even further. He underwent an exam by a doctor of the company’s choosing, and even this physician found severe black lung.
In late September, a Labor Department claims examiner issued an award of benefits. But this is only a first step in what is usually a protracted process of appeals. Indeed, Steve also had won at this initial level in 2005. The company that employed Steve, now a subsidiary of Patriot Coal Corp., appealed that decision, leading to the denial of the claim by a judge.
Patriot refused to say whether it would continue to fight Steve’s current claim. “Patriot Coal follows set procedures in the handling of claims,” a spokesperson said in a statement. “We will continue to follow our procedures and will respond accordingly.”
I asked whether, given the overwhelming autopsy evidence, the company would be willing to concede that Steve had a legitimate claim for benefits. “We have procedures we follow in reviewing a claim, and we will follow these procedures with this claim, as with all others,” a spokesperson responded. She would not say what those procedures are.
Paul Frampton, an attorney at the firm Bowles Rice LLP, handles a large number of black lung cases on behalf of coal companies and defeated Steve’s previous claim. He is again representing Patriot Coal in the current claim. He did not respond to repeated voicemails and emails.
Steve became the face of a series of investigative stories I wrote last year while at the Center for Public Integrity; the series logo featured an image of him holding his hardhat with tubes feeding oxygen through his nostrils. He freely shared his story, granted me access to deeply personal records, and became a symbol of the struggles many other miners face.
Now, his autopsy report and his personal story highlight how Wheeler’s approach to reading chest films, applied in thousands of cases over decades, led to wrongful denials — with devastating consequences.