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Miners still dying from black lung

Death rate remains high in Kentucky despite law


Mark McCowan knew he had inhaled a lot of coal dust during 20 years of operating heavy equipment in underground mines in southwest Virginia.

But at 40 years old, he had no symptoms of disease, and a chest X-ray taken eight years earlier had shown nothing amiss.

Plus, a federal law enacted to eliminate coal workers’ pneumoconiosis – black lung – had been in effect for more than 35 years.

Yet, after McCowan followed a friend’s example and got a second chest X-ray in April 2005, he found he was another example that the nation’s commitment to eliminating black lung has been imperfectly fulfilled.

The 1969 law set the level of coal-mine dust that miners can breathe during an eight-hour shift at 2 milligrams per cubic meter of air. But 38 years later, they’re still dying – more than 20,000 nationwide since 1990.

Black lung death rates in Kentucky rose 38 percent in the six years ending in 2004, even as they dropped in other major coalmining states.

And there are signs that the deaths will continue. Among Kentucky miners getting chest X-rays last year, the number of black lung cases was three to five times higher than expected.

For years, federal officials have talked about eliminating black lung, but there have been obstacles. For example, a federal advisory committee’s key recommendations on how to stamp out the disease still haven’t been implemented almost a decade after they were issued – partly because of a change in focus when President Bush took office, some say. Also, some researchers say the operators of small mines common in Eastern Kentucky may not have the resources or the will to bring dust down to levels that won’t sicken workers.

Fifteen years after the federal law went into effect, McCowan began working in the mines, so he never should have been exposed to dust levels sufficient to scar his lungs, end his career and perhaps consign him to a premature death.

Now 43 and with two grown sons, McCowan is plagued by shortness of breath and fatigue.

He has settled his disabilitybenefits case with Virginia, but a federal claim has been denied and he is appealing. And while his wife works as a secretary, McCowan languishes at home.

Inactivity isn’t something he is used to. He says he worked hard in the mines, but that his labor came at a high price.

“The record production I give ’em has shortened my life on this earth. Legislation was enacted to try to protect us (but) we’re dyin’. Thirty-eight years is too long.”

‘Terribly Wrong’

The federal law’s overall impact has been substantial. The percentage of coal miners with black lung has declined dramatically since the 1970s, from 33 percent to 5 percent or less.

But the deaths continue, and in addition to the human toll, more than $40 billion in federal black-lung benefits has been paid out since 1970, financed by an excise tax on coal and with the cost presumably passed along to consumers.

And Kentucky pays an estimated $77 million annually in state benefits to about 10,000 disabled miners or their surviving dependents. Those benefits are funded by assessments on workers’ compensation insurance premiums paid by coal companies.

Recent analysis by the National Institute for Occupational Safety and Health of miners’ chest X-rays has renewed concern that any are still getting sick from breathing coal dust.

NIOSH sent its van into nine Eastern Kentucky and southwest Virginia counties last spring and summer, offering free chest Xrays to miners.

Although only about 13 percent of the estimated workforce responded – 633 in Virginia and 340 in Kentucky, the results showed that from two to five times as many miners as expected had black lung, 91 in all, including 43 with severe cases.

Because the sample was relatively small, the incidence of miners found to have black lung could have been inflated if those who knew or thought they were ill were more likely to get Xrayed. McCowan, for example, had an X-ray when the NIOSH van came to Tazewell County, Va., even though he’d been already been diagnosed.

Still, the fact that even a few cases of severe black lung were identified, especially in relatively young miners, heightened the sense of urgency for health professionals seeking to eradicate it.

“We are finding people for whom things went terribly wrong,” said Dr. David Weissman, director of the division of respiratory disease studies for NIOSH in Morgantown, W.Va. “And that makes us think there are others for whom things went terribly wrong. … That’s not something that should be happening in 2007.”

Dr. John Dement, a Duke University occupational medicine professor, said: “Isn’t it sad that we’re still talking about this? We know a lot about the disease. It’s a matter of having the will to do what’s needed.”

Celeste Monforton, a minesafety official in the Clinton administration who now teaches and does research at George Washington University, said there is no mystery about what needs to be done.

“It’s just getting people in industry to say: `You shouldn’t accept any exposure to dust any more. If the controls aren’t in place, you don’t operate.'”

But Monforton and others agree that methods of detecting and controlling dust are flawed, and that proposals to strengthen them have fallen through again and again.

Danny Hall, 56 – a retired Knott County miner, whose disease required a lung transplant – said laws are useless if they aren’t enforced.

“If it cuts down on production, it’s a hardship for the companies,” he said. Inspectors “aren’t going to… shut down a big company.”

Setting The Standard

Some federal health officials and others also have raised questions about whether the current coal-dust standard needs to be tightened further.

In 1995 NIOSH concluded that the dust limit needed to be cut in half, to 1 milligram per cubic meter of air, to eliminate severe cases of black lung.

That recommendation, consistently opposed by the mining industry – and now also by the federal Mine Safety and Health Administration – has never been implemented. Legislation introduced in Congress last week, however, would cut coal dust levels to those recommended by NIOSH.

In 1996, U.S. Labor Secretary Robert Reich appointed a ninemember federal advisory committee to formulate recommendations that would “lead to the elimination of black lung.”

In 11 months, the committee produced a 154-page report that contained 20 recommendations for eradicating the disease.

The committee cited “substantial evidence” that either a “significant number of miners” were being exposed to levels of dust that exceeded the federal standard, or else that the standard was insufficient. The panel recommended consideration of a lower standard.

It also proposed that the federal government take over dust testing, now largely the responsibility of the industry and supplemented by periodic MSHA samplings.

A Courier-Journal investigation in 1998 disclosed widespread cheating by mine operators and miners on dust samples, despite repeated warnings to MSHA by independent experts and government auditors that reported dust levels often were improbably low.

Although Reich’s committee included academics and representatives from labor and industry, who often are at odds over mine safety, most recommendations were unanimous.

Yet more than nine years after its report was issued, virtually all of its key proposals have come to naught, and at least 7,600 more miners have died of black lung.

“It is never fun to sit on a commission and have nothing result from your work,” said Carol Rice, one of its members and a professor of environmental health at the University of Cincinnati. “It’s frustrating.”

In 2003, MSHA proposed a regulation that would have had the effect of actually increasing as much as four-fold the legal concentrations of coal dust.

Rice and two other committee members responded by firing off a letter to Labor Secretary Elaine Chao.

“We are appalled that MSHA leadership would propose this change,” the letter said. Attached to it was a copy of the committee report’s cover page, which the letter pointedly told Chao was an effort “to facilitate your efforts to identify this report and review our findings.”

The letter also urged that the report be “read completely.” The word “read” was underlined for emphasis.

Committee Chairman David Wegman, a dean at the University of Massachusetts-Lowell, said recently that as best he could recall, the letter either went unanswered or else the response was boilerplate.

Chao’s representatives said they could not find the letter, but did not comment further.

New Administration

The problem, Wegman said, was that the committee was created during the Clinton administration, and efforts to implement its recommendations stalled after Bush took office in 2001.

“The key recommendations we had were ignored,” Wegman said, adding most were unanimous.

J. Davitt McAteer, who was in charge of MSHA under President Bill Clinton and strongly supported the committee report, agreed that the recommendations “foundered on the shoals of politics.”

“We came up with a very strong set of regulations,” he said. “They had industry and labor support. They had the benefit of reviewing European and Australian models, where they have essentially eliminated the disease. But we didn’t eliminate it. The miner is still exposed. The disease still exists, and it doesn’t need to. We know what to do, and it’s a damn shame we haven’t done it.”

Melinda Pon, MSHA’s acting deputy administrator for coalmine safety and health, said the agency’s current emphasis is on enforcing operator compliance with existing regulations.

“We feel that the 2.0 standard is sufficient, and with operator compliance and enforcement, will continue to limit exposure to dust,” Pon said.

In defense of that position, Pon also cited statistics suggesting that workers in some regions of the country, particularly southern Appalachia, are more susceptible to disease from coal dust than their counterparts elsewhere.

Compliance At Issue

Some scientists think those differences may be attributable at least in part to variations in the toxicity of coal dust by region, and on the size of the mining operation.

Small mines, such as those with 50 or fewer employees that are common in Eastern Kentucky, historically have had higher rates of workers’ lung disease. Some researchers hypothesize that operators of those mines may lack the knowledge, resources or resolve to control dust.

Until geographic discrepancies are understood, Pon said, “no decision can be made regarding the adequacy” of the current dust standard.

McAteer, however, expressed frustration with a continued waitand see approach. “The means are there now to prevent the disease,” he said.

Pon also noted that nationwide testing figures show miners being exposed to average levels of dust well below the current 2.0 standard during an eighthour shift – and often at or below the 1.0 level recommended by NIOSH. But those results can be misleading:

Many miners work shifts longer than eight hours, so their dust exposure may be greater than the samples suggest.

The statistics also show dusttest results – between 10 percent and 25 percent of the total – exceeding the 2.0 standard. In Kentucky’s Pike County, for example, nearly 32,000 samples taken between 1970 and 2005, 13 percent of the total, exceeded the limit.

Dust-test results are averages of multiple samples over several shifts. So a miner could be exposed to levels of dust above the limit on one or more days but the violations would not show up in the average.

Said McAteer, the former MSHA official, “By averaging the samples, you are ‘dumbing them down.'”

Ed Thimons, chief of the NIOSH respiratory hazards control branch in Pittsburgh, said, “I don’t know, and I don’t think anybody can tell you, miners’ true exposure to respirable dust over a year, or over a career.”

In an attempt to respond to such concerns, MSHA in May 1998 began issuing citations for dust violations based on a single inspector sample rather than the average of multiple samples. But the National Mining Association and the Alabama Coal Association quickly contested the change, and it was voided a few months later by the 11th U.S. Circuit Court of Appeals.

The veracity of sampling done by operators and by MSHA is widely discounted by miners and safety advocates.

Miners claim, for example, that their bosses often take extraordinary steps to reduce dust before their testing is done, and alert miners when MSHA inspectors are to arrive so conditions underground can be cleaned up before those tests.

McCowan, the Virginia miner, said: “You can eat all (the dust) you want until it comes time for a dust sample.”

Pon said MSHA accepts dustsampling results as valid “unless we have evidence to show otherwise.”

Gary Gibson, 59, of Jenkins, a former miner who is now a federal inspector for MSHA on disability for heart problems, said that in his experience, mine operators wouldn’t always work to reduce dust to acceptable levels. “Some did,” he said, “but most didn’t.”

He acknowledged that they did more – hanging curtains to increase ventilation, for example – when he was around.

“If people like me wasn’t around, they didn’t,” he said, adding that miners would contact him frequently. “They would talk to me if they weren’t getting air.”

Joseph Lamonica, a retired MSHA official who now works as a consultant to the coal industry, said that while some cheating on dust sampling unquestionably has occurred, it is unfair “if all mines are painted with that brush.”

Most coal operators, he said, attempt to comply with the law.

MSHA Takeover?

One way to strengthen belief in the integrity of dust sampling is for MSHA to take full responsibility, said Bruce Watzman, vice president of safety, health and human resources for the National Mining Association.

“There are those who, when a sample is in compliance, allege that the industry has cheated. And when a sample is out of compliance, the operator is cited for a violation,” he said.

For its part, MSHA’s official stand is that it is premature to comment on taking over dust sampling until new monitoring technology is widely available.

While some health and safety advocates argue that better technology, monitoring and compliance can effectively eliminate black lung, Dr. John Parker isn’t so sure.

Parker, a former NIOSH official who now is chief of pulmonary and critical-care medicine at West Virginia University, said, black lung has been more formidable than expected.

“I’m really not certain that lowering the dust standard to 1.0 would actually eliminate” all serious cases, he said. “I hate to admit that there is a human lung cost of doing business, but it’s possible that’s what we may have to accept.”

That’s of little consolation to miners such as McCowan.

“Production is what corporate people want. … Production is achieved only through shortcuts on miners’ health.”

R.G. Dunlop and Laura Ungar are reporters for The Courier- Journal in Louisville, where this article appeared June 24 as part of a special project on black lung.

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