In the quiet expanse of his Pike County, Ky., home, Danny Smith, 51, contemplates a life marked by memories, both poignant and painful, shaped by years at the now-shuttered Solid Energy mine. His words, laden with the weight of experience, echo through the air as he reflects, "There's a lot of memories here, some good, some bad."
As the sun casts shadows over the gravesite in Smith's lush yard, nestled under towering trees, he confronts the stark reality of an incurable and advanced stage of black lung disease. His parents' resting place, adorned with a monumental headstone, serves as a serene backdrop. Summer's symphony of crickets, birdsong, and rustling leaves envelops the space, a seemingly tranquil setting for Smith's eventual repose—a space that's now prepared.
"I honestly never imagined it would get this bad," confides Smith from his home in the coalfields of eastern Kentucky. The burden of labored breathing permeates his every step, leaving him unsure of enduring a simple phone call. "I have a hard time just walking to the kitchen without losing breath," he admits, detailing a constant state of fatigue and exhaustion.
Fibrotic tissue ravages Smith's lungs, a cruel consequence of his exposure to coal mine dust, particularly the perilous silica dust. NPR and PBS's Frontline documented his struggle in 2018, capturing a moment when he, attempting to mow his lawn, succumbed to violent coughing, expelling dark gray remnants—deceased lung tissue. His diagnosis: progressive massive fibrosis, a fatal stage of black lung disease, accelerated by the toxicity of silica, abundantly present in the quartz surrounding coal seams in central Appalachia.
Mining machines, in their relentless pursuit of coal seams, release fine silica particles into the air, 20 times more toxic than coal dust. Smith's ordeal began at an early age, diagnosed at 39 after a mere 12 years of subterranean toil. In a somber text, he confesses, "As bad as I feel now, and I never thought I would say it, I so wish I had never stepped foot inside a mine."
Smith's narrative stands as a poignant testament to the profound toll exacted by the mining industry, where echoes of past decisions reverberate through the struggles of those like him, caught in the grip of a disease that silences breath and extinguishes hope.
Decades of mounting concern over silica's ominous role in black lung has reached a pivotal moment with the federal Mine Safety and Health Administration (MSHA) unveiling a long-awaited proposed regulation this summer. Advocates, tirelessly pushing for action since 1974, now see a glimmer of progress. The draft rule, a significant leap forward, aims to toughen the silica dust exposure limit, doubling its current stringent measure.
Christopher Williamson, assistant secretary of labor for mine safety and health, emphasizes the inadequacy of the existing standard in safeguarding miners' health. The proposed exposure limit, set at 50 micrograms of silica per cubic meter of dust, resonates with the longstanding pleas of mine safety advocates. For the first time, the MSHA contemplates direct regulation of excessive silica exposures, ushering in the possibility of citations and fines for endangering miners.
However, the agency's estimate of the rule's impact raises eyebrows. Predicting a modest saving of 63 coal miner lives and the prevention of 244 cases of black lung disease over 60 years, critics argue that these numbers grossly underestimate the potential benefits. An investigative collaboration involving Public Health Watch, NPR, Louisville Public Media, and Mountain State Spotlight sheds light on a more comprehensive reality.
Unveiling over 4,000 cases of complicated black lung since 2010, with more than 1,500 diagnoses in the last five years alone, the investigation challenges the agency's calculations. The failure to acknowledge the thousands currently grappling with the disease diminishes the proposed regulation's perceived urgency. Kirsten Almberg, an epidemiologist at the Black Lung Data and Resource Center at the University of Illinois Chicago, underscores the profound human tragedy, emphasizing the inability to quantify the devastation caused by lives and careers cut short.
As the investigation confronts MSHA's predictions with the stark actuality of complicated black lung cases, the incongruity in scale becomes glaringly apparent. The urgency for a regulation deemed essential to saving lives intensifies against the backdrop of individual tragedies, communities in upheaval, and families torn asunder. The quest for effective measures remains an imperative response to a crisis whose true scope demands acknowledgment and action.
Mine safety advocates, acutely aware of the delicate balance in the battle for stricter regulations, fear that a less-than-robust case for the proposed rule might embolden opposition from the formidable mining industry and its allies in Congress. Their concerns center on perceived weaknesses in the rule's enforcement provisions, its broad reach, and the lingering doubt about its efficacy in shielding miners from the pernicious effects of silica exposure.
The backdrop of the 2023 investigation adds a compelling layer to this narrative. Journalists conducted a comprehensive survey of 25 black lung clinics, both private and federally funded, across 13 states. Data was also sought from the National Institute for Occupational Safety and Health (NIOSH), drawing from a program testing working miners for black lung disease. The Black Lung Data and Resource Center at the University of Illinois Chicago contributed to the data collection and reporting, while silica dust data was sourced from the Mine Safety and Health Administration and analyzed by Justin Hicks of Louisville Public Media.
The investigative findings cast a shadow over the Mine Safety and Health Administration's predictions. The agency's anticipated reduction in black lung cases through stricter regulation appears minuscule compared to the stark reality reported by black lung clinics. In the last decade, three clinics in southwestern Virginia and eastern Kentucky alone documented over 1,500 cases—six times the number the proposed rule aims to prevent over 60 years.
Dr. Brandon Crum, a radiologist specializing in black lung X-ray assessments at United Medical Group in Pikeville, Ky., expressed surprise at the persistent severity of the disease. "As of now, we are almost at 700 cases of complicated black lung," he disclosed. "I'm surprised that we continue to see that much disease and the severity of the disease. We're seeing younger and younger miners get it... Men in their 30s, 40s, and 50s on a regular basis." Stone Mountain Health Services in southwestern Virginia, operating two clinics, reported more than 800 cases of complicated black lung in the last decade.
These revelations underscore a growing chasm between regulatory projections and the stark reality faced by miners and healthcare providers on the ground, intensifying the urgency for comprehensive and effective measures to safeguard the well-being of those at the heart of the mining industry.
Pulmonologist Drew Harris, serving as the medical director at Stone Mountain, finds himself grappling with skepticism regarding the Mine Safety and Health Administration's (MSHA) disease predictions. The absence of consideration for the ongoing and persistent disease over the past decade is a glaring oversight, according to Harris. "Not factoring into their risk prediction the amount of disease that is currently happening and had been happening for 10 to 15 years... is not acceptable," he asserts.
In southwest Virginia and eastern Kentucky, a pair of respiratory therapy clinics echo this sentiment, reporting caseloads that defy MSHA's projections for avoided disease and death. Marcy Martinez, a respiratory therapist operating New Beginnings Pulmonary Rehab, shares a devastating reality, "We lost 11 men in the last seven months... 147 deaths have occurred in my clinics, from black lung, in 10 years. And that is heartbreaking." Martinez laments the apparent lack of comprehension within the agency about the harsh realities faced by miners and their families.
A wall adorned with photos of miners afflicted by complicated black lung at New Beginnings Pulmonary Rehab serves as a poignant reminder of the toll exacted by the disease. Martinez expresses skepticism about the agency's understanding of the true situation on the ground, stating, "I don't think they have a concept of what the reality is out there..."
Kirsten Almberg, from the University of Illinois Chicago, sheds light on the nuances of the agency's predictions, explaining that the risk analysis relies on precise data regarding miners' silica dust exposure—an element lacking in the thousands of cases reported by clinics and NIOSH. While the agency acknowledged the potential underestimation in its proposal, there remains an evident omission regarding the documented cases of disease over the past decade.
Initially deflecting questions about its risk analysis and concerns regarding the proposed rule until the public comment period concluded, MSHA later responded directly to Public Health Watch. The agency acknowledged the consideration of suggestions pointing to a potential underestimation of the proposed silica dust limit's benefit, emphasizing Assistant Secretary Williamson's participation in a recent national conference of black lung clinics, where insights from clinic staff, health experts, researchers, and affected coal miners were shared.
"Williamson is deeply troubled by the amount of disease — including the most advanced forms — that health experts continue to report in Appalachia," reveals a statement from the agency. The ominous specter of complicated black lung disease, vividly portrayed in the fibrotic tissue-riddled lungs showcased in radiologist Brandon Crum's Pikeville, Ky., office, underscores the pressing need for decisive action.
However, the path towards a final rule remains veiled in uncertainty, with the Mine Safety and Health Administration (MSHA) yet to unveil a timeline. The intricate web of required reviews and approvals from the Labor Department and the Office of Management and Budget suggests that the final language could be months away.
The proposed crackdown on silica dust emerges against the backdrop of a fraught history marked by the mine safety agency's prolonged failure to shield miners from the insidious effects of toxic dust. The proposal, while acknowledging overexposure at coal mines, seems to downplay the urgency for comprehensive action. The rule cites compliance figures, noting that 93% of silica dust samples have adhered to existing limits since 2016. However, this seemingly reassuring statistic conceals the alarming reality that the remaining 7% of samples translate to 5,300 instances of excessive exposure based on the newly proposed limit, as per data analyzed by Louisville Public Media and Public Health Watch.
Delving into the historical context, data scrutinized by NPR and Frontline reveals a staggering 21,000 excessive silica dust samples in the 30 years leading up to 2016, based on the existing limit. The newly proposed limit, if applied retrospectively, would encompass a staggering 52,000 instances of exceeding safe exposure levels. This signifies that for three decades, coal miners operated in environments permeated by perilous levels of silica dust, a substance known for its ease of inhalation, lung lodging, and potential to cause severe disease and death.
The risk intensified over the years as mining depleted the thickest coal seams, leaving thinner seams embedded in rock. The cutting of these thinner seams generated more fine silica particles, contributing to the escalating threat. Alarmingly, internal agency memos dating back to 1996, obtained by NPR, acknowledged the problem, even identifying a cluster of severe black lung disease linked to silica dust exposure. Despite sending warnings to mining companies and suggesting voluntary actions to mitigate exposure, the agency's response proved insufficient over the years. The looming question remains: will the proposed rule, if enacted, be the catalyst for the overdue and robust protection that miners desperately need?
The Mine Safety and Health Administration (MSHA) has undertaken coal and silica dust enforcement campaigns, including surprise inspections at mines with persistent excessive dust exposure. Despite these initiatives, specific regulation of silica dust remained elusive until the recent proposal. Mine safety advocates commend the agency for two significant changes: doubling the silica dust exposure limit and, for the first time, directly regulating silica dust. However, amidst the progress, concerns emerge, creating a dust devil in the details.
Advocates highlight elements of the proposal that seemingly allow self-policing by mining companies, raising questions about the effectiveness of agency oversight and enforcement. Here are the primary concerns and proposed improvements according to miner advocates:
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As the proposed rule navigates the path towards potential implementation, striking a balance between industry cooperation and robust regulatory measures becomes imperative. The agency's commitment to miners' safety and health must manifest not just in rule proposals but also in the stringent enforcement of those rules, assuring miners and their advocates that tangible steps are being taken to address the longstanding challenges posed by silica dust exposure.
Operators bear legal obligations, and the assumption is that they will adhere to the law, with consequences for non-compliance. This foundational belief in legal compliance underscores the proposed rule's approach to mitigating silica dust exposure in mining operations. However, a shadow looms over this premise, as history reveals instances of dust sampling fraud, resulting in fines for a Kentucky company and an employee sentenced to prison this year, along with convictions in another case last year.
One glaring gap in the proposed rule is the absence of a comprehensive description of MSHA's oversight and enforcement mechanisms for mining company sampling and responses to hazardous dust levels. The agency responds by asserting its commitment to existing oversight routines mandated by federal law, encompassing quarterly inspections, including MSHA's silica dust sampling and analysis. While inspectors can request mining company records of dust sampling and corrective actions, the reality remains that inspectors are only present in coal mines a fraction of the time, missing the majority of operator-conducted sampling and subsequent changes to control excessive dust.
Drew Harris of the Stone Mountain clinics underscores the critical role of enforcement, stating, "Without enforcement of the rule... it's essentially useless. If people don't follow the rule or there's no incentive to follow the rule, it's not going to have an effect." Cecil Matney Jr., a West Virginia coal miner with 25 years of experience, adopts a more direct stance, asserting that holding companies accountable is paramount to rule adherence. "If you're not holding the company responsible for something, they're gonna break that rule," Matney asserts.
In response to concerns, MSHA acknowledges the possibility of enhancing oversight and enforcement, especially concerning excessive dust detected in mining company samples. The agency contemplates a requirement for operators to report instances where their samples exceed the silica dust limit to the MSHA district manager, enabling appropriate enforcement action and compliance assistance.
Amidst these considerations, another issue emerges: the time-consuming nature of dust sample analysis. Advocates argue that quicker technology is available, emphasizing the need for expeditious measures to address potential hazards. As the proposed rule undergoes scrutiny and potential revisions, the delicate balance between industry compliance, robust enforcement, and technological advancements remains at the forefront of discussions surrounding the future of miner safety and health.
The current process of analyzing silica dust samples, taking a week or more to reach labs and deliver results, poses a critical lapse in addressing potential hazards. During this waiting period, excessive exposures persist, shift after shift, contributing to a pressing need for a more immediate response to safeguard miner health. A new sampling process, capable of providing results right at the end of every sampled shift, offers a solution to this time-sensitive issue. While some mining companies voluntarily adopt this expedited process, the Mine Safety and Health Administration (MSHA) does not mandate its use, deeming it unreliable for compliance and enforcement. Developed by the National Institute for Occupational Safety and Health (NIOSH), the new process's accuracy can be impacted by the presence of other components in the dust, as noted in an emailed statement by the federal research agency.
Despite its limitations, mine safety advocates argue that this new process represents the best available technology, citing a phrase from federal law that could potentially necessitate its required use, even if not fully refined. Richard Miller, a retired labor policy director for the House Committee on Education and Labor, contends that MSHA has the authority to issue a technology-forcing standard, compelling operators to utilize the best available technology, whether off-the-shelf or on-the-horizon.
The proposed rule, however, falls short of addressing the urgency of implementing this technology. Critics highlight the need for more frequent sampling and rapid correction of hazardous conditions, asserting that the new device could significantly enhance safety measures.
Another contentious point in the proposal revolves around allowing miners to continue working even when dangerous dust levels are detected. The rule permits work in such conditions on a "temporary" basis while mine operators take corrective action to bring dust levels down to the legal limit. In these situations, miners would be required to wear protective dust masks or respirators. The mining industry has long contended that miners can work safely in excessive dust levels as long as protective gear is worn. The National Mining Association, in its comments on the proposal, emphasized the necessity of supplemental controls, such as masks and respirators, asserting that relying solely on engineering controls hasn't effectively prevented disease and death. This debate underscores the ongoing tension between industry practices and the imperative to prioritize and enhance miner safety in the face of potential health hazards.
The protective masks issued to miners, ostensibly designed to shield them from hazardous dust, often prove ineffective and, in some cases, counterproductive. Danny Johnson, a retired coal miner with complicated black lung, shares his firsthand experience, describing the masks as causing constant air gasping and discomfort. "You put them over your face... and you're gasping for air all the time," he laments. Additionally, the masks become uncomfortably hot during use, creating a challenging working environment. Miners have raised concerns about the efficacy of these masks, leading to hundreds of lawsuits, some resulting in multimillion-dollar verdicts and settlements.
While more modern respirators are acknowledged for their effectiveness in preventing dust inhalation, they bring their own set of challenges. Some miners argue that these respirators can partially obstruct vision and impair hearing—critical faculties for those engaged in strenuous and perilous work requiring clear sightlines and effective communication. Drew Harris of the Stone Mountain clinics questions the sustainability of instructing miners to continuously rely on respirators in toxic environments, emphasizing the need for prohibiting work until the mine atmosphere is cleared of dangerous dust levels.
This perspective aligns with a fundamental principle of workplace safety known as the hierarchy of controls, where the elimination of hazards is considered the first "preferred" action, and the use of personal protective equipment, such as dust masks and respirators, is positioned as the last resort.
Despite these concerns, the Mine Safety and Health Administration (MSHA) acknowledges that these issues will be taken into consideration during the development of the final rule. The regulatory landscape faces further complexity as the scope of protection is expanded to cover all mines, not just coal mines—an ambitious task that poses significant regulatory challenges. Debbie Johnson, a black lung nurse familiar with the struggles faced by coal miners, emphasizes the urgency of addressing silica dust as a life-threatening concern, stating, "It's the silica dust that's killing them." As the regulatory process unfolds, balancing the imperative for enhanced protection with the practicalities of implementation remains a daunting challenge.
The impact of the proposed rule extends beyond the 930 coal mines to encompass a vast network of 11,000 other mines collectively known as metal/nonmetal mines. Employing 144,000 more miners than coal mines, these metal/nonmetal mines face an unprecedented regulatory shift, necessitating the implementation of extensive dust sampling and medical surveillance infrastructure that currently does not exist. For the first time, these mines will be required to sample for silica dust and provide miners with medical screening for potential diseases, marking a substantial regulatory burden for both the mines and the regulating agency.
The National Mining Association voices concerns in its response, asserting that a uniform approach may complicate sampling efforts and hinder the smooth and rapid adoption of this crucial initiative. Safety advocates express apprehension that the inclusion of metal/nonmetal mines in the proposal might dilute MSHA's focus on fully protecting coal miners, who are already grappling with widespread health challenges.
Drew Harris of the Stone Mountain clinics emphasizes the crisis-level need to prioritize protections for coal workers, acknowledging the importance of safeguarding metal/nonmetal workers as well. However, MSHA chief Christopher Williamson defends the agency's broader responsibility, stating that it has obligations to protect the safety and health of all miners. He highlights the agency's fiscal year 2024 budget request, seeking a significant increase of over $20 million for expanded enforcement, including $7 million earmarked specifically for silica dust enforcement. Additionally, more than $2 million is designated to enhance the capacity of MSHA's labs to accommodate the expected surge in dust samples collected by agency inspectors. Williamson emphasizes the agency's demonstrated commitment to prioritizing this initiative and seeks additional funding to support these critical efforts.
However, challenges loom on the budgetary front, with the House Appropriations Committee proposing a substantial cut of nearly $63 million to the agency's requested budget. The fate of this budget request, supported by the White House, ultimately rests on Congressional approval.
In Logan County, West Virginia, coal miner Cecil Matney Jr. reflects on the profound impact of the proposed rule, contemplating the future of younger miners. Diagnosed with complicated black lung at the age of 50, Matney expresses uncertainty about witnessing his children grow up, underscoring the urgent need for comprehensive measures to protect the health and well-being of miners across different sectors.
Cecil Matney Jr., a coal miner in Logan County, West Virginia, vividly describes the physical toll of his job, likening the sensation to a ton of bricks on his chest when struggling to breathe. The severity is such that Matney's wife has even woken him up, fearing he was on the brink of death due to breathlessness. Despite these challenges, Matney continues to work under a special federal program that places him in mining roles away from hazardous dust.
The decline in coal plant and mine operations since 2011 has led to the loss of over 50,000 mining jobs, but around 40,000 coal miners persist in the U.S. mining industry. The demand for American coal, particularly high-value metallurgical coal used in steel production, sustains foreign interest. The extraction of this valuable "met" coal drives mining companies to cut increasingly thinner seams and expose more silica-bearing rock, contributing to heightened silica dust exposure. Last year, over 12,000 miners worked in metallurgical mines, according to the Energy Information Administration.
Radiologist Crum observes a troubling trend, noting that while the overall number of miners has decreased over the past two decades, the percentage of miners contracting black lung is likely higher, with a significantly elevated rate of severe disease.
Meanwhile, in Canada, Kentucky, Danny Smith, connected to an oxygen tube, reflects on his current state. Smith, now reliant on constant oxygen, expresses agreement with the need for stronger measures to protect miners from silica dust, the very substance that has made his life increasingly challenging. Facing a potential double-lung transplant, Smith also reminisces about the once-prosperous coal fields in his corner of Appalachia, acknowledging the comfortable lives that mining jobs enabled for the community. Despite the economic benefits, Smith confesses a poignant sentiment: "I would rather be poor and [have] no home than feel what I've been feeling lately and knowing it will only get worse." His words capture the complex reality faced by miners, torn between the economic opportunities provided by mining and the profound health risks associated with the profession.
This narrative is brought to you by Public Health Watch, a non-profit investigative newsroom committed to delving into public, environmental, and occupational health issues. In collaboration with Louisville Public Media and Mountain State Spotlight, this story has been crafted to shed light on the pressing concerns surrounding black lung disease and silica dust exposure among miners. The piece, updated with additional reporting, stems from an earlier version published on August 31 on Public Health Watch and partner platforms.
The collaborative efforts of the team involved in this report include Howard Berkes, a retired NPR investigations correspondent with a significant role in the 2018 Frontline investigation that exposed the epidemic of complicated black lung disease and the regulatory lapses contributing to it. Justin Hicks, the data reporter for Louisville Public Media and the Kentucky Center for Investigative Reporting, brings a quantitative perspective to the story. Allen Siegler, the public health reporter for Mountain State Spotlight, contributes insights into the situation in West Virginia. Carmel Wroth undertakes the editorial responsibilities, ensuring a cohesive and impactful narrative for NPR's audience. Together, this dedicated team endeavors to bring awareness to the critical issues affecting the health and safety of miners, advocating for informed discourse and potential solutions to address the challenges faced by these workers.
In conclusion, this collaborative narrative underscores the ongoing challenges faced by miners, particularly those grappling with the devastating impacts of complicated black lung disease resulting from exposure to silica dust. The compelling stories, expert insights, and investigative reporting highlight the urgent need for comprehensive measures to safeguard the health and well-being of miners across different sectors. As the proposed regulations to limit silica dust exposure undergo scrutiny, the multifaceted issues surrounding enforcement, oversight, and protection for both coal and metal/nonmetal miners come to the forefront. The storytellers and reporters involved in this project aim to spur awareness, dialogue, and action to address these critical health concerns, emphasizing the importance of prioritizing the safety of those who contribute to the vital but perilous mining industry.
