In the second of two reports, NPR looks at the causes of a dramatic spike in progressive massive fibrosis, the most serious stage of the coal miners' disease, black lung. The spike also could stress the federal black lung benefits program, which is already struggling. (Read and listen to the first story here).
ROBERT SIEGEL, HOST:
The deadliest form of the coal miners' disease black lung is far more widespread than previously thought. That's based on a federal report out today and an NPR investigation. Complicated black lung is incurable and fatal. It was believed to be close to extinction 20 years ago, but NPR alone has identified a thousand cases. Here's NPR's Howard Berkes.
DENISE GLASS: OK. We'll do one more. Ready?
HOWARD BERKES, BYLINE: In a black lung clinic in St. Charles, Va., former coal miner Dennis Maggard places a tube in his mouth and tries to exhale hard.
GLASS: Deep breath in. Blow hard. Keep on blowing out. Keep blowing out. Keep blowing out. Keep blowing out. And breathe back in.
BERKES: Respiratory therapist Denise Glass gives Maggard bad news.
GLASS: That one got you. You ended up blowing out 16 percent out of a hundred.
DENNIS MAGGARD: Is that good or bad?
GLASS: Well, it'd be the same if you got a 16 on your report card - pretty bad.
BERKES: When you say bad, what do you mean?
GLASS: Seventy to a hundred is considered normal, 60 and below is disabling.
BERKES: Black lung is stealing Maggard's ability to breathe. He's among hundreds of miners showing up at clinics across Appalachia with severe cases of black lung, far more than federal researchers have reported. Coal mine closures and layoffs have more miners seeking testing and black lung benefits. And the stories they tell explain their disease. Maggard had more tests to undergo so we sat down with Charles Stanley, who inhaled so much mine dust underground, he labeled his mining machine the dust dragon.
CHARLES STANLEY: They kept getting less coal and more rock. So you're cutting 19 inches of coal, you're cutting in 50, 60 inches of rock. And you had to keep cutting more rock, cutting more rock, cutting more rock and cutting more rock. The more rock you cut, the more dust you're going to eat.
BERKES: There's so much rock cut with coal because the big coal seams are just about gone in Appalachia. The thin seams that remain are embedded in rock. And that rock is mostly quartz, containing silica. Mine dust with silica is far more lethal than coal dust alone. There's also the practice of slope mining, where crews cut solid rock to reach coal seams.
BERKES: Mackie Branham did that in Kentucky for six straight months
MACKIE BRANHAM: I worked 14 16-hour shifts until they put another shift on.
BERKES: Was this coal dust or rock dust?
BRANHAM: Pure rock dust.
BERKES: And were you breathing that dust during that time?
BRANHAM: Well, I had my respirators on. And you'd actually have to remove it to help take a breath every once in a while because the dust packed so much around your filters and stuff. You couldn't get no air in. So, yeah, quite a bit.
BERKES: Mine dust is supposed to be controlled - robust ventilation to sweep it away, water sprays to tamp it down and protective masks. But those things don't always work says, Kentucky miner Barney Stanton.
BARNEY STANTON: Companies that I worked for, most of them were really good, I mean, far as giving you things that you needed to try to protect yourself. But they don't work like they should. It's hard to wear a mask and do a physical job. Just trying to do your job, you breathe so hard the dust will come in around the mask.
BERKES: And it was risky, says Mackie Branham, to stop mining machines to make adjustments for excessive dust.
BRANHAM: The mining game is a numbers game. If you don't produce coal, they'll put somebody else in your spot that can. If I've got another man on the other side of the mines, he's cutting more coal than me, it's not going to look good on me. So, I mean, just thought about my family, to be honest with you.
BERKES: There are new and tougher federal limits on mine dust exposure. They just fully took effect in August. They get even tougher when there's excessive silica. And they were vigorously opposed by the National Mining Association. But the group's Bruce Watzman says miners are exposed to less silica now.
BRUCE WATZMAN: I think we're talking about historic exposures and not the exposures that we're seeing today. I think the miners that are working today are better protected because the silica levels have come down.
BERKES: They're down 50 percent since 2009, according to the federal Mine Safety and Health Administration, which is directed by Joe Main.
JOE MAIN: I think if the rules are followed as they are prescribed, we would not have these diseases. I really believe that. Now, the question is, is the strength of the rules that are in place adequate enough to protect miners? I think that's the question of the day.
BERKES: Well, there are some holes in the new rules when it comes to silica. It can take a week or more to detect silica in dust samples, so excessive exposure isn't quickly addressed. And federal data continue to show excessive silica in some mines. It'll also be a decade or more before the effectiveness of the new rules is known because it takes that long to detect the disease in lungs. In the meantime, there are the thousand cases NPR has identified. More are likely uncounted.
EVAN SMITH: We've made some progress towards reducing the dust, but we have these people that it's too late for the new regulations to help them.
BERKES: Evan Smith is an attorney in Whitesburg, Ky., who helps miners file for black lung benefits.
SMITH: You're just putting more people into the system that need compensation. And so the more people we have moving into this system, the more potential burden it places on the taxpayers due to the increase in miners getting severe black lung.
BERKES: And with younger miners diagnosed, black lung benefits payments and health care may be required longer. There may be more demand for expensive lung transplants, which concerns Democratic Congressman Bobby Scott of Virginia.
BOBBY SCOTT: The treatments run from a half million to a million dollars. So if there are cases out there that have not been counted, then we have a lot of expenses that we don't expect to be there will be coming. And so we have to get the numbers straight and to make sure that they're being properly reported.
BERKES: Scott worries about the federal black lung trust fund, which is close to $6 billion in debt. It's taken on a thousand claims that were supposed to be covered by mining companies, but they went bankrupt. The coal tax that supports the fund is set for a 50 percent cut in two years. And if the Affordable Care Act is repealed, miners will lose a specific black lung benefits provision that makes it much easier to qualify. Life without benefits and a paycheck has been tough for Mackie Branham, who is severely sick, seeking a lung transplant and struggling to support five kids.
BRANHAM: I'm in bad shape, man. I mean, I can no longer provide for my family and I can't get out and do nothing around the house like I normally would with them. It tears your nerves up.
BERKES: Just this week, Branham got good news. He was approved for state benefits and is hoping for a quick first check so he'll be able to buy presents for his kids for Christmas. Howard Berkes, NPR News.
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