As Mine Protections Fail, Black Lung Cases Surge 

by Howard Berkes 
NPR All Things Considered 
July 9, 2012
http://www.npr.org/2012/07/09/155978300/as-mine-protections-fail-black-lung-cases-surge

Part one of a two-part series.

It wasn't supposed to happen to coal miners in Mark
McCowan's generation. It wasn't supposed to strike so
early and so hard. At age 47 and just seven years after
his first diagnosis, McCowan shouldn't have a chest
X-ray that looks this bad.

"I'm seeing more definition in the mass," McCowan says,
pausing for deep breaths as he holds the X-ray film up
to the light of his living room window in Pounding
Mill, Va.

"The mass is larger and more defined in the right upper
lobe," he continues, clinically describing the solid
streak that shows up white on the X-ray of his lungs.
"If you know white is bad and black is good, I'm in a
lot of trouble."

McCowan went from a clean X-ray at age 35 to
progressive massive fibrosis -- an advanced stage of
coal workers' pneumoconiosis, or black lung -- in just
five years.

"You go from being normal to where ... one day you try
to do something you used to do, and you can't do it and
you're just heaving to catch your breath," McCowan
says. "And you say this is crazy. It can't be this bad.
And then you realize a couple months down the road that
it can be. And you realize a year down the road after
that that you ain't seen nothing yet."

An 'Epidemic' Among Miners

A joint investigation by NPR and the Center for Public
Integrity (CPI) has found that McCowan is not alone.
Incidence of the disease that steals the breath of coal
miners doubled in the last decade, according to data
analyzed by epidemiologist Scott Laney at the National
Institute for Occupational Safety and Health (NIOSH).

Cases of the worst stage of the disease have quadrupled
since the 1980s in a triangular region of Appalachia
stretching from eastern Kentucky through southern West
Virginia and into southwestern Virginia.

The Appalachia region between eastern Kentucky,
southern West Virginia and southwestern Virgina has
seen a dramatic return of black lung.

Black lung experts and mine safety advocates have
warned of the resurgence of the disease since 1995. New
reporting by CPI and NPR reveals the extent to which
federal regulators and the mining industry failed to
protect coal miners in the intervening years.

An analysis of federal data by CPI and NPR also shows
that the mining industry and federal regulators have
known for more than two decades that coal miners were
breathing excessive amounts of the coal mine dust that
causes black lung. CPI and NPR also found that the
system for controlling coal mine dust is plagued by
weak regulations and inaccurate reporting that
sometimes includes fraud.

"This is clearly a public health epidemic," Laney says.
"This is a rare disease that should not be occurring.
It's occurring at a high proportion of individuals who
are being exposed."

Especially shocking to Laney and others focused on
black lung is the grip the disease has on younger
miners and its rapid evolution to progressive massive
fibrosis, or complicated black lung.

At the Upper Kanawha clinic in Cedar Grove, W.Va., the
black lung caseload doubled in the last 10 years,
according to program coordinator Debbie Wills, and
began to include younger miners in their 40s and more
serious disease.

Patty and Gary Quarles lost their son, Gary Wayne
Quarles, in the explosion at Upper Big Branch mine.
Their son's post-mortem diagnosis indicated he had
black lung, a puzzling finding since he was only 33.

"The first 10 years or so that I worked here I had four
patients with complicated black lung," says Wills, who
has worked at the clinic since 1989. "We knew them all
intimately because there were so few of them. Now we
have at least 50 diagnosed with complicated black
lung."

The autopsies of the 29 victims of the 2010 explosion
at what was then Massey Energy's Upper Big Branch mine
also show an escalation of cases. Twenty-four of the
victims had sufficient lung tissue for testing, and of
those, 71 percent had the nodules and lesions on their
lungs that signify the disease.

That's a rate 10 times the average for southern West
Virginia, says Davitt McAteer, a former federal mine
safety chief who led an independent investigation of
the explosion, in Raleigh County, W. Va., and reviewed
the autopsies.

"What was shocking was the number of miners who showed
evidence of black lung," McAteer says, "particularly
among younger miners ... and miners who you would not
have expected to have black lung."

That includes some victims who spent fewer than 10
years underground and at least two who were only in
their 20s.

"It's unbelievable," says Gary Quarles, whose son Gary
Wayne Quarles was 33 when he died at Upper Big Branch.
His autopsy showed signs of black lung. "Being in the
mines for 13 to 15 years and already considered having
black lung ... that's uncalled for."

Quarles, who is 55 and spent twice as many years
underground, says his chest X-rays are negative for the
disease.

Federal Law Aims To Curb Black Lung

The Federal Coal Mine Health and Safety Act of 1969 was
supposed to sharply cut exposure to coal mine dust. The
act set a standard for coal dust exposure (2 milligrams
per cubic meter of air), which was as little as 1/4 of
the concentrations miners breathed at the time.

The act's passage followed a 23-day unauthorized and
rowdy strike in which 40,000 West Virginia coal miners
demanded government efforts to prevent the disease and
to compensate victims.

By the end of the year, tough dust exposure limits were
in place. Miners were offered free diagnostic chest
X-rays every five years, and federal compensation
became available.

The X-rays showed 4 in 10 miners tested had black lung.
The disease killed 1,800 miners in a single year. But
diagnoses soon plunged more than 90 percent, according
to NIOSH data.

"They anticipated that no one would develop progressive
massive fibrosis," says 84-year-old Donald Rasmussen, a
pulmonologist in Beckley, W.Va., who says he's tested
40,000 coal miners in the last 50 years.

"In 1969, I publicly proclaimed that the disease would
go away before we learned all about it," he adds. "And
I was dead wrong."

Rasmussen first started charting an increase in serious
black lung cases about 15 years ago.

"We began to see the appearance of younger miners who
had worked in the mines only since the dust suppression
following the '69 act that were showing up with
complicated pneumoconiosis or progressive massive
fibrosis," he says.

Since 1970, NIOSH epidemiologists documented test
results for 43 percent of the nation's coal miners. In
1995, the tests began to indicate more and more black
long, rapid disease progression and the unexpected
occurrence among relatively young miners.

"From the patterns and from the severity, from the
prevalence of the disease, this must be a situation in
which the dust in many, many mines is simply not
adequately controlled," says Edward Petsonk, a
pulmonologist at West Virginia University and a
consultant for NIOSH. "There's nothing else that could
possibly cause this."

Increased Dust Exposure

The new era of coal dust controls was followed by more
dust exposure for miners, according to federal data
obtained by CPI and NPR. The average workweek for coal
miners grew 11 hours in the last 30 years, adding about
600 hours of exposure each year.

Why Respirators Are Not A Solution

"By the time I was 40 years old, I mined more coal than
most miners [had] seen in a lifetime," says McCowan.

Production pressure grew with greater demand for coal
and higher prices. By 2000, coal production had jumped
fivefold from the 1970s. In 2010, it was still triple
what it was when the new coal dust limits took effect.

"You can't be exposed to the kind of tonnage that I was
and not get black lung disease," McCowan says.

Actually, Petsonk and Rasmussen say, some miners are
more susceptible to black lung than others. They can't
explain why, but they do say that smoking enhances
susceptibility. Still, neither McCowan nor Gary Wayne
Quarles was a smoker.

Mining machines also became more powerful and
efficient, cutting through coal seams laced with
silica-bearing quartz and sandstone, especially in
Virginia, West Virginia and Kentucky.

"In the process, they release more silicon dioxide, and
the increase in silica is more toxic than just the coal
dust itself," Rasmussen says.

Federal records obtained by CPI and NPR under the
Freedom of Information Act show thousands of coal
miners were exposed to excessive levels of silica in
each of the last 25 years. Since 1987, coal mining
companies and government inspectors turned in more than
113,000 valid mine dust samples. Roughly 52 percent of
those samples exceeded federal standards. In 1998
alone, about 65 percent of the valid silica samples
violated the standard.

Silica exposure prompts a call for something that might
seem unexpected from the National Mining Association
(NMA): more regulation. The industry group wants a
crackdown focused specifically on silica in the
Appalachian region where black lung is resurgent.

"These people are being exposed [to] three to four
times the silica exposures for periods over 20 years.
[They have] a chest full of silica and nothing's been
done about it," says Bob Glenn, a black lung consultant
for NMA.

Excess silica forces mining companies to meet a lower
standard for coal dust. The idea is that less exposure
to coal dust means less exposure to silica. The federal
Mine Safety and Health Administration (MSHA) proposes
toughening the coal dust standard by slashing exposure
limits in half (to 1 milligram per cubic meter of air).

Mine Dust Standards Vs. Protection

Coal dust measurements taken by MSHA and the industry
show that coal mines already meet the lower standard
and have for years. But the industry still opposes the
new standard because it would broadly apply to coal
dust and to all mines everywhere.

In a companion story to the NPR/CPI investigation,
veteran coal industry reporter Ken Ward Jr. of The
Charleston Gazette reviews 40 years of attempts to
strengthen protection for miners.

Mark McCowan, 47, was diagnosed with the worst stage of
black lung only five years after an X-ray showed he had
no sign of the disease.

Ward quotes former MSHA official Celeste Monforton, a
worker safety advocate now at George Washington
University: "We can't get a regulation out to save our
souls." And, as Ward reports, "miners are left with the
same system that experts have agreed hasn't worked for
decades."

Since 1970, when mine dust controls began, black lung
contributed to the deaths of more than 70,000 miners.
The federal government and the industry spent $45
billion compensating the victims, including McCowan,
and their families.

"Now it feels like I've got a heavy wet sack on each
lung," McCowan says, between long, deep breaths.
"Breathing has become a conscious effort. ... It seems
like I give up a little bit of my world each day, that
it gets smaller and smaller."

Simple tasks become enormous challenges -- "a Mount
Everest every day," he calls it -- including holding his
2-year-old grandson.

"I say, 'Little buddy, I got to put you down for a few
minutes,'" McCowan says with a deep sigh. "And he's
learned to run a little bit. He'll say, 'Run, paw-paw,
run.' He wants me to chase him. And I can't."

NPR's Sandra Bartlett and Chris Hamby of the Center for
Public Integrity contributed reporting for this story.
Research by NPR's Barbara Van Woerkom; editing by NPR's
Andrea de Leon and Alicia Cypress.

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