CHARLESTON, W.Va. — Black lung diagnoses have doubled in the last decade, and a new investigation blames a combination of factors, including operators who cheat the system and lax enforcement by regulators.
Experts have warned of the resurgence since 1995, but an investigation by National Public Radio, the Center for Public Integrity and the Charleston Gazette concludes that all the systems designed to protect coal miners have failed. That includes federal lawmakers, who haven't passed regulations to toughen 1969 standards for coal dust.
The number of people with advanced stages of the disease has quadrupled since the 1980s in the region stretching from Eastern Kentucky through southern West Virginia, into southwestern Virginia.
"This is clearly a public health epidemic," said epidemiologist Scott Laney of the National Institute for Occupational Safety and Health. "This is a rare disease that should not be occurring."
And younger miners are being hit hard.
After the Upper Big Branch disaster, which killed 29 West Virginia miners in April 2010, autopsies revealed that nearly two-thirds of those who had enough lung tissue for testing had signs of black lung. That includes miners who had worked underground less than a decade, and two who were in their 20s.
The Mine Health and Safety Act of 1969 was supposed to reduce exposure, limiting coal dust to 2 milligrams per cubic feet of air. Miners were offered free chest X-rays every five years, and the government began compensating victims.
The number of reported cases plummeted, and Beckley, W.Va., pulmonologist Donald Rasmussen proclaimed that the disease would be eradicated.
"And I was dead wrong," he said.
Since 1970, black lung has contributed to the deaths of more than 70,000 miners. Compensation has hit $45 billion.
There are several reasons for the spike. Even as new dust controls were put in place, for example, the average work week for coal miners grew. That increased exposure by an average of 600 hours a year.
The federal Mine Safety and Health Administration wants to slash the coal dust standard in half, but industry opposes it as being too broad. Some Republican legislators have objected, too, calling it an overreach of federal authority that would cost operators too much.
MSHA had estimated compliance costs at $72.4 million to $93.2 million for the first year, and $40 million to $44.5 million each subsequent year.
The estimated annual health savings is $99 million to $197 million a year.
Rep. Larry Bucshon, R-Ind., meanwhile, blamed miners for putting themselves at risk by failing to wear safety equipment.
The investigation suggests there is some truth to that.
Kentucky miner Donald Marcum acknowledged that he seldom wore a device to collect coal dust for eight hours as required. Typically, he'd hang it in cleaner air, near the mine's entrance. Sometimes the devices sat in offices or lunchboxes.
"We just done what we was told because we needed to feed our families and really didn't look at what it might be doing to our health," said Marcum, 51, who now has the most severe form of the disease.
Bruce Watzman, a vice president with the National Mining Association, said he doesn't know if that kind of manipulation occurs regularly.
"I hope not," he said. "We encourage our members to fulfill their obligations under the law."
Cheating aside, the investigation concludes, the system for monitoring dust is flawed, and MSHA seldom enforces violations.
Between 2000 and 2011, MSHA received more than 53,000 samples showing miners had been exposed to more dust than allowed, yet it issued fewer than 2,400 violations.
That's partly attributable to the way the rules are written, allowing some samples to be over the limit. And sampling pumps run for only eight hours, even if a miner works 10 or 12.
Even when samples are too high, the regulations let a company negate them by taking five more that are compliant. And because of extensions granted by MSHA, dust violations often go uncorrected for weeks or months, increasing miners' exposure.
MSHA said most extensions "are for good reasons, such as getting approved dust controls implemented or allowing the operator time to collect additional samples."
But in the meantime, miners like Mark McCowan continue to develop the disease.
McCowan, 47, of Pounding Mill, Va., went from a clean X-ray to an advanced stage in 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," he said. "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."