Friday, 19 August 2016

Findings from MonCOEH's review of Queensland's Coal Mine Workers' Health Scheme

The review of Queensland’s Coal Mine Workers’ Health Scheme was prompted by the discovery of cases of “black lung”, or coal workers’ pneumoconiosis (CWP), among Queensland coal miners from mid-2015 after an absence of the condition for almost three decades. The Queensland Government’s Department of Natural Resources and Mines (the entity responsible for administering the surveillance program) engaged SPHPM’s Professor Malcolm Sim, Director of the Monash Centre for Occupational and Environmental Health (MonCOEH), to lead the investigation.

Other specialists including respiratory physicians, radiologists, and an occupational hygienist were also involved in the review which was conducted between January and July 2016. The main aim was to determine whether the respiratory component of the Scheme, in its current form, was adequately designed to detect early signs of CWP and other diseases caused by exposure to coal mine dust. Although limited to a single body region, the review was nonetheless wide-ranging and revealed significant findings.

“Our team identified major deficiencies with Queensland’s Coal Mine Workers’ Health Scheme, at all levels of the system,” said Professor Sim.

Crucially the surveillance program had no clear purpose, and this omission was most likely the main contributor to its overall poor design and function.

Health assessments were being undertaken by too many doctors, or Nominated Medical Advisers (NMAs), whose experience and skills were not formally vetted prior to commencing this role, or periodically thereafter.

“This lack of audit and other quality control measures also extended to health professionals conducting the principal respiratory investigations,” said Dr Mina Roberts from MonCOEH who worked on the review.

An online survey demonstrated that less than half of spirometry (a lung function test) tests were performed by adequately trained staff. Not surprisingly 40 per cent of a sample of 256 tests reviewed had not been executed to an acceptable standard. Furthermore, of 30 spirometry results deemed abnormal (and possibly consistent with coal mine dust exposure), only two had been recognised by NMAs.

Similar findings were noted with the chest x-rays (CXRs) reviewed. Twenty per cent of a sample of 278 CXRs had quality issues that precluded further interpretation; of the remainder, only two of 18 CXRs with early CWP signs had been accurately identified by the original radiologists.

“This outcome could be due in part to insufficient clinical information provided by the referring doctor, still, the coal miners with abnormal investigations potentially experienced further health risks as they were not placed under appropriate workplace restrictions,” said Dr Roberts.

Even where spirometry abnormalities were recognised, these were attributed to cigarette smoking rather than (or in addition to) coal mine dust exposure. The health consequences of hazardous substances can be detected before individuals develop symptoms and this is the rationale of health surveillance. However, subtle changes in health status are apparent only when examined over time. Based on the health records of the confirmed CWP cases, NMAs did not assess workers with this view and thus highlighted problems with non-electronic means of data handling, storage and access.

At the conclusion of the Monash-led review of Queensland’s Coal Miners’ Health Scheme, 11 cases of CWP had been reported to the Department of Natural Resources and Mines, with more expected.

The review team made 18 recommendations that addressed the Scheme’s shortcomings, albeit in the longer term. Several focused on the accreditation of test facilities and training of health professionals, in particular, NMAs who are the linchpin of the system.

“The primary recommendation was for the Department to articulate the purpose of its Health Scheme as this would ultimately guide the design and conduct, and ensure that it remains fit for purpose,” said Professor Sim.

The full report is available on the Department of Natural Resources and Mines website.

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