Harold Sturgill was disabled by black lung disease when he was 58 years old. Now he advocates for disabled miners.

“When it comes to the mining companies, and it comes to the worker, it’s still all about production,” Sturgill said. “They could care less about me, how much dust I suck in, or how long I’m going to live, because somebody else is there to take my place.”

Sturgill worries that without meaningful action to protect miners, his son, who is also a miner, will contract the same illness. “A man’s gonna feed his family whether it kills him or not,” he said.

Sturgill shared his story at the West Virginia Black Lung Association conference the first week of June. It was the first such meeting since an NPR investigation and PBS Frontline film put the spotlight on central Appalachia’s growing epidemic of black lung disease and the failure of regulators to meaningfully address it.

As many as one in five experienced coal miners in the region has some form of black lung, which is progressive, debilitating, deadly, and preventable. At the conference, researchers presented more evidence of the growing number of cases, and specific practices likely putting mine workers at risk, and the head of the mine workers’ union issued a rousing call for action.

Congressional leaders have scheduled hearings later this month to investigate. But federal mine safety regulators show little indication of making any meaningful change to policies meant to protect miners from harmful dust exposure.

Sydney Boles

Radiologist Brandon Crum delivers grim findings from his clinic in eastern KY.

A Growing Epidemic

An investigation by NPR and the Ohio Valley ReSource beginning in 2016 found that far more miners had progressive massive fibrosis, a more serious type of black lung disease, than had been recognized in government reports. More than 2,000 miners have PMF, and rates of the disease are significantly higher in central Appalachia than in other coal-producing regions.

Forehand Lung with opacities outlined (1)Adelina Lancianese, NPR

An X-ray image of an Appalachian coal miner with black lung lesions.

Brandon Crum, a radiologist in Pikeville, Kentucky, was among the first caregivers to sound the alarm about the remarkable number of sick miners he encountered. He says the last 12 months have been the worst of his career as more cases added up.

“I started out with 60,” he told the conference audience in Pipestem, West Virginia. “As of last week, I had 246 cases of complicated black lung in my clinic alone.”

Crum says there are even more cases of simple black lung, chronic bronchitis, and other forms of lung disease that result from dust exposure in coal mining.

Crum has seen younger miners disabled by black lung, and a surge in a new form of the disease called diffuse dust fibrosis, or DDF.

“This is something I’ve been picking up over the last six to 12 months, and it’s increasing in frequency and it’s also increasing in severity,” Crum said.

DDF can quickly make it hard for miners to breathe, and Crum said an increasing share of lung transplant surgeries are for miners with DDF. The condition is likely attributable to increased exposure to silica dust.

Silica dust is formed when mining equipment cuts into surrounding rock layers and it is far more toxic than coal dust alone. The rock in central Appalachian coalfields is higher in silica than the rock in other mining regions, and miners are drilling thinner coal seams, requiring them to cut through more rock to gain access to coal.

Researchers at the National Institute for Occupational Safety and Health, or NIOSH, say they are finding more evidence of silica dust exposure in the images of the lungs of sick miners.

“There’s a specific type of abnormality that’s associated with silicosis,” NIOSH researcher Scott Laney said. “And what we’ve seen is a six-fold increase in the time that we’ve been looking at it, since the 80s, in these silicotic nodules on the X-rays.”

According to a 2019 NIOSH research paper, the prevalence of silicotic nodules has remained steady in non-Appalachian coal mining regions but it has skyrocketed within central Appalachia.

Fellow NIOSH researcher David Blackley said his team had also found an increase in lung transplants in recent years.

“We think there have probably been between 60 or 80 transplants done for coal worker’s pneumoconiosis since the 90s,” Blackley said. “And then just over the last couple of years we’ve seen 10, 12, 15 per year.”

Blackley said the registry that tracks lung transplants likely undercounts the number of transplants for black lung, also known as coal worker’s pneumoconiosis, because the condition can be misdiagnosed.

The transplants are risky and can cost upwards of $1 million, but as a last resort, the surgery can add a few years to a sick miner’s life.

Stalled Regulation

The mining community has known since the 1970s that silica is far more toxic than coal dust alone, and federal researchers and miner advocates have fought for decades to implement more stringent coal dust standards. But those efforts have stalled, often because of pressure from industry.

In 2014 the Mine Safety and Health Administration, or MSHA, approved a rule further limiting coal dust exposure, and fully applied the rule to industry practice in 2016. It was hailed as an important and overdue move to protect miners but that rule did not specifically address silica dust exposure.

black-lung-feature-v4Adelina Lancianese, photos; Alexandra Kanik, illustration.

Read more about living with black lung >>

Currently, when a mine exceeds coal dust or silica exposure limits, the portion of the mine with elevated levels is placed on a reduced exposure standard for coal dust overall, but not for silica specifically. Regulators say measuring silica dust is difficult and they essentially use coal dust measures as a proxy indicator of silica dust exposure. However, the NPR investigation and a new NIOSH study found thousands of instances where lowering overall dust levels did not reduce silica dust to safe levels.

Despite the mounting evidence of silica’s role in the epidemic, there is little sign that regulators are planning to do anything differently to control dust exposure. Under the Trump administration, legislators and regulators have made moves to change some health and safety controls and raised concerns among health advocates that the changes would weaken protections in order to reduce costs for the mining industry.

David Zatezelo, a former mining executive President Trump appointed to lead MSHA, said in a speech at West Virginia University in September that silica must be controlled. But in an interview immediately afterward, he told NPR “the science isn’t in” yet on a link between silica exposure and severe black lung disease.

092018MSHA_Zatezalo9Jesse Wright, WVPB

Former mining executive David Zatezalo leads the U.S. Mine Safety and Health Administration.

The ReSource caught up with Zatezelo at a reception following the formal events at the conference in West Virginia. As bluegrass played in the background, Zatezelo pulled up MSHA’s latest regulatory agenda on his phone.

Zatezelo said that because black lung disease can take 10 to 15 years to manifest after dust exposure, it’s too soon to say whether the 2014 rule is working or not. “We’ve put out an RFI on it,” he said, referencing the agency’s request for information from stakeholders. “We’re soliciting feedback.”

Calls for Change

Speaking at the West Virginia conference, United Mine Workers president Cecil Roberts called for increased regulation of silica dust.

“You could draw a circle around southeast Kentucky, southwest Virginia, and southern West Virginia. That’s where it is,” Roberts said, referring to the alarming rise in cases in central Appalachia. “That’s where miners are getting sick. That’s where miners are dying. And anybody who tells you, ‘We need more information.’ They’re lying.”

Roberts called on Congress to step in if regulators would not, and he may get his wish. Democratic Congressman Bobby Scott of Virginia, who chairs the House Committee on Education and Labor, pledged to conduct hearings in response to NPR’s 2018 investigation.

“Despite the stronger mining safety standards adopted during the Obama administration, the long-standing failure to meaningfully limit mine workers’ exposure to crystalline silica—which is 20 times more toxic than coal dust–has resulted in a surge of the most lethal form of black lung disease,” Scott said in a statement. “Congress has no choice but to step in and direct MSHA and the mining industry to take timely action.”

A committee staffer confirmed on background that those hearings are scheduled for June 20.

Sydney Boles is the ReSource reporter covering the economic transition in the heart of Appalachia’s coal country.