(c) A roentgenographic examination shall be given by or under the supervision of a physician who regularly takes chest roentgenograms and who has demonstrated his ability to take high quality chest roentgenograms in accordance with section 37.21.

(d) Every chest roentgenogram shall—

(1) Be a posteroanterior view on a 14" x 17" or 14" x 14" film;

(2) Be taken with a diagnostic X-ray machine having a rotating anode tube;

(3) Have a broad range of contrast such as that which is produced by using 70-78kV without grid or 110-145kV with grid:

(4) Permit the study of pulmonary detail as well as an adequate viewing of the mediastinum; and

(5) Show the (i) date of exposure; (ii) hospital, clinic, or other facility where the roentgenogram was taken; and (iii) social security number of the miner.

(e) To ensure high quality chest roentgenograms: (1) the maximum exposure time shall not exceed 1/20 of a second; (2) minimum source to film distance shall not be less than 5 feet; and (3) medium speed film and medium speed intensifying screens shall be used.

(f) Upon notification by the Secretary that a film or group of films is not adequate for the purpose for which they were intended, the mine operator shall make provision for additional films or supplemental examinations as may be deemed necessary by the Secretary.

(g) No payment may be required of any miner in connection with any examination or test given to him under the Act.

§ 37.21 Ability to take high quality chest roentgenograms.

Ability to take high quality chest roentgenograms shall be demonstrated by submitting from the physician's files to the panel of radiologists six sample chest roentegenograms which are of acceptable quality to the Panel. These shall have been taken within the last 12 months and shall identify the hospital, clinic, or other facility where each film was taken. These may be the same roentgenograms submitted pursuant to § 37.31 (a) and will be returned to the physician. $37.22 Protection against radiation emitted by roentgenographic equipment. Fixed roentgenographic equipment, its use and the facilities in which such equipment is used, shall conform to the recommendations of the National Council on Radiation Protection and Measurements in NCRP Report No. 33 "Medical X-ray and Gamma-Ray Protection for Energies up to 10 Mev-Equipment Design and Use" (issued Feb. 1, 1968) which document is hereby incorporated by reference and made a part hereof. This document is available for examination at the Bureau, ALFORD, the Bureau of Occupational Safety and Health, 5600 Fishers Lane, Rockville, Md., and at the Public Health Service Information Center or Regional Office Information Centers as listed in 45 CFR 5.31. Copies of the document may be purchased for $1 each from NCRP Publications, Post Office Box 4867, Washington, D.C. 20008. An official historic file of NCRP Report No. 33 will be maintained at the Bureau of Occupational Safety and Health, 5600 Fishers Lane, Rockville, Md.

SPECIFICATIONS FOR READING, CLASSIFYING, AND SUBMITTING FILMS

§ 37.30 Reading and classifying chest roentgenograms.

(a) The interpretation of chest roentgenograms shall be classified in accordance with the ILO or UICC/Cincinnati Classification System and recorded on Form ECA-116.

(b) Reading and classification shall be performed only by a physician who regularly reads chest roentgenograms and who has demonstrated proficiency in the use of the ILO or UICC/Cincinnati Classification Systems in accordance with § 37.31.

§ 37.31 Proficiency in the use of the ILO or UICC/Cincinnati Classifications. Proficiency in the use of the ILO or UICC/Cincinnati Classification Systems shall be demonstrated by either:

(a) Submitting from the physician's files six recent sample chest roentgenograms taken within the last 12 months to the panel of radiologists which are considered properly classified by the panel. The submission shall consist of two without pneumoconiosis, two with simple pneumoconiosis, and two with

complicated pneumoconiosis and will be returned to the physician. (These may be the same roentgenograms submitted pursuant to § 37.21) or;

(b) Successful completion of a course approved by the Bureau in the ILO or UICC/Cincinnati Classification Systems.

§ 37.32 Submitting required chest roentgenograms.

All chest roentgenograms required to be taken under this part, together with their interpretations and the miner identification documents shall be submitted immediately after classification to ALFORD and become the property of the U.S. Public Health Service.

§ 37.33 Notification to miners of abnormal findings.

Findings or suspected findings of enlarged heart, tuberculosis, lung cancer, or any other significant abnormal findings other than pneumoconiosis shall be communicated by the physician reading and classifying the roentgenogram to the miner or new miner or to his designated physician, as indicated on the miner's identification document, and a copy of the communication shall be submitted to ALFORD.

NOTE: Guidelines for the selection of equipment and recommendations for the technique for obtaining high quality roentgenograms are available to any interested person. Requests should be directed to the Bureau of Occupational Safety and Health, 1014 Broadway, Cincinnati, Ohio 45202.

Approved: August 12, 1970.

ELLIOT L. RICHARDSON,

Secretary.

NOTE: The incorporation by reference provision in this document was approved by the Director of the Federal Register on July 7, 1970.

[F.R. Doc. 70-10794; Filed, Aug. 18, 1970; 8:45 a.m.]

Senator WILLIAMS. You have a target date of June 30, 1971, for the chest examination or X-ray for coal miners?

Dr. KEY. That is correct.

Senator WILLIAMS. Chest examination?

Dr. KEY. Chest roentgenograms, X-rays of the chest of 90,000 coal miners.

Senator WILLIAMS. That is a little less than a year from now.

Dr. KEY. That is right.

Senator WILLIAMS. What are your main problems in getting to the miners to perform these X-ray examinations? You said the difficulty of getting into the smaller mines. You don't get into the smaller mines to do that?

Dr. KEY. It is more convenient from the miners' standpoint if the examinations are done at the changehouse. Because of road conditions, it is frequently difficult to get X-ray equipment up to the small mine. We have been successful, I am happy to report, in being able to contract for the examinations in a number of the coal mining States, including the major coal-producing States of Pennsylvania, West Virginia, and Kentucky, so that the Public Health Service will not have to use its mobile units in these States. We can concentrate our activities on some of the other States.

Senator WILLIAMS. You are now in the process of making these examinations. Just how is it working out? What happens, for example, when you find a man, say, age 40 and the reading shows trouble? How is that handled?

Dr. KEY. In the national study of coal workers' pneumoconiosis, which began last August, we have examined almost 2,400 miners. These exams will be counted as complying with the act, even though many of them were given before the act. We do not see the necessity of going back and reexamining the men just to comply with the letter of the law.

Thus far none of these men has been transferred to a less dusty mine area, but we anticipate that this action will follow in the next month

or two.

Senator WILLIAMS. Mr. Popick?

Mr. POPICK. I was going to add on a going basis we would expect that if Dr. Key's studies and X-rays in the individual cases suggested that the man had a condition which would make him eligible for black lung benefits under the benefits portion of the program, that he would be referred to us or we would get a notice of this, so that the question of his right to benefits could be considered on a systematic basis.

So, we expect to tie in our activities very closely here on that point. Senator WILLIAMS. I was interested in the new development in uniform procedures in X-ray. You mentioned the ILO, I believe, as one of the agencies creating this.

Dr. KEY. Yes. This is an international uniform system for reading and classifying X-ray films of the chest, so that

Senator WILLIAMS. What does "classified" mean in this context? Dr. KEY. "Classified" relates to the degree of pneumonconiosis seen by chest X-ray and whether it is simple or complicated. This is needed for a standardized handling of the classification on which legal action may be taken, such as transfer of a miner or awarding black lung benefits.

Senator WILLIAMS. When you mention ILO, at least their work in that area, do you communicate with the international medical societies on questions such as black lung?

Dr. KEY. Yes, we do. A number of the Public Health Service consultants in radiology served on both the International Labor Organization Committee which developed their classification system, and the International Union Against Cancer Committee, which developed an earlier classification system. These are very closely comparable for the purpose of the Coal Mine Health and Safety Act in regard to transfer to a less dusty area and in regard to awarding black lung benefits based on statutory provision of complicated pneumoconiosis. Senator WILLIAMS. We only have one staff member who has any working history with the International Labor Organization and he is not here right now. I am sure he would be interested in this, Gene Mittelman. He regularly visits the ILO conventions.

A question is suggested on the confidentiality of medical examinations. This is a sensitive area, isn't it?

Dr. KEY. Yes, sir.

Senator WILLIAMS. Can you give us the picture as you see it? Dr. KEY. As I mentioned in the testimony, we had two meetingsone in January and one in February-on the content and conduct of medical examinations. At the early meeting, I supported the situation that had existed between management and the union for a number of years, in that we would require an expressed consent from the local union before the members could be examined by a company doctor. The industrial physicians in those companies with captive mines objected to this policy, pointing out that industrial physicians are not less ethical than other physicians and that the practice of industrial medicine is accepted in the rest of industry in the United States.

I asked the advice of the Office of General Counsel in HEW, and finally decided that since the operators had been given the responsi

bility for providing the medical examinations, it would be unreasonable to require those who already had industrial physicians and X-ray facilities to duplicate their resources by having to contract with independent clinics or hospitals. Accordingly, the medical examination specifications now require that the plan submitted by the operators include a statement of the steps that have been taken to assure confidentiality of medical records and roentgenographic findings.

The Public Health Service will make spot checks of the medical records to make sure that confidentiality is not being compromised. Senator WILLIAMS. There are problem areas in this that I have no idea how you are handling. Now some miners have been advised not to cooperate in the X-ray examinations, not to have their chest. X-rayed. Are you familiar with that?

Dr. KEY. I am not familiar with that.

Senator WILLIAMS. There is a bulletin containing such advice that has gone to a lot of miners.

Mr. Popick, are you familiar with it?

Mr. POPICK. I have seen it, mostly because the question that was raised with us is whether this call for a lack of cooperation was being directed at the medical examinations we were calling for in connection with processing disability claims.

It was our belief, as we read this bulletin, that it was not aimed at us, but it was more relevant to the question of the periodical examination. I am afraid I don't have any more information on that to submit.

Senator WILLIAMS. Periodic medical examinations by the operators? Mr. POPICK. Well, I thought under the program that Mr. Key has. I am not a really reliable source of information on this particular point.

Mr. FEDER. Dr. Key, the bulletin that Mr. Popick was referring to that we saw on our last trip to West Virginia is a bulletin published by the Black Lung Association. On the back page in very bold type was a warning to men about taking the regular examination, "Your employer will find out the result of the medical examination and you will be fired." These are not the exact words, but this was the warning. This is based on, I won't say the history of 19 years in West Virginia, but at least the belief of the miners in West Virginia that over the period of 19 years where they have developed some stage of silicosis they have been fired with impunity. There is a serious question whether that can be done under Federal law.

These miners in West Virginia are very worried about this. It is no surprise to me to see that half of the southern West Virginia coal miners will not take the medical examination until they know for a fact that their employer, even if the situation where it is an industrial physician gives the examination, that the employer will not find out the results of that X-ray unless the employee agrees to let him have it. Then, too, somehow the Public Health Service should broadcast that across the country, so that these miners have the assurance that the employer will not find out, or will know what protection they will get if the employer does find out.

This is the concern. There are allegations under West Virginia law they have been fired for 19 years. They certainly will not trust the Federal law.

Are there any proceedings that have been developed to insure this confidentiality, to make sure that he is acting as a physician and not as an employee of the operator?

Dr. KEY. I have no other assurances, other than the information in the operators' plans and the checks that the Public Health Service will initiate on its own. I agree with you this is an important area of concern, because if the miners are fearful about the results of the test being revealed to the operators, they won't take the examinations and our whole preventive program will be compromised.

I was reading through the act this morning trying to pick out the exact references which protected the miners against discrimination. based on revealing of results of this X-ray examination. The closest I could come to it was section 110(b) (1). But the X-ray examination was not specifically mentioned. It was implied, but not mentioned. Mr. FEDER. I think you are right in the reading of 110(b) (1), it is implied and not mentioned. The only other reference which is probably the greater protection is the provision in the act which requires any miner who shows evidence of pneumoconiosis to be transferred to another job without a cut in pay. I read that as prohibiting his being discharged from any job. Of course, that would be a violation of the act.

Dr. KEY. I think the Public Health Service would be well advised, in view of this information that you report, to review its confidentiality procedures and publicize what steps have been taken throughout the mining industry so that we can get a good response.

Senator WILLIAMS. That seems like a good solution on that.
Mr. Siegel?

Mr. SIEGEL. I have a question or two for Mr. Popick.

Senator WILLIAMS. Do you have a statement?

Mr. POPICK. I have some remarks.

STATEMENT OF BERNARD POPICK, DIRECTOR, BUREAU OF DISABILITY INSURANCE, SOCIAL SECURITY ADMINISTRATION

Mr. POPICK. I am the Director of the Bureau of Disability Insurance, which is the component of the Social Security Administration charged with the primary responsibility for the administration of the black lung benefit provisions of the act.

I want to say that we, too, appreciate the opportunity to appear before the subcommittee and report on the progress that we have been able to make in administering the provisions of title IV of the act.

When the Federal Coal Mine Health and Safety Act of 1969 was signed last December 30, the Social Security Administration had been on notice for about 2 weeks that we might be involved in the administration of the benefit provisions. This statement is significant at the outset in viewing in perspective the task we faced in undertaking the implementation of these provisions, particularly since the law was made effective with the date of its signature by the President, with benefits to begin for eligible claimants in the month in which they filed application, and with no provision for payment of benefits in any case prior to that time.

With virtually no leadtime then to prepare for the administration of this legislation, we were immediately faced with the urgent need for quick action on several major fronts.