Eastern Kentucky radiologist sees spike in black lung, federal report says

Roger Cook of Letcher County at his home in 2013. Cook was an underground coal miner for 32 years, but he had to retire in 2010, when he was diagnosed with black lung. Cook died in September at age 61.
Roger Cook of Letcher County at his home in 2013. Cook was an underground coal miner for 32 years, but he had to retire in 2010, when he was diagnosed with black lung. Cook died in September at age 61. Herald-Leader staff file photo

A spike in serious black-lung cases in Eastern Kentucky cited in a new report provides further evidence of the resurgence of a disease that federal lawmakers and mine-safety advocates hoped to eradicate long ago.

The report released Thursday by the National Institute for Occupational Safety and Health said 60 current or former coal miners — all patients of a single radiologist — were diagnosed with the most severe form of black lung between January 2015 and last August.

Nearly all the miners, who had progressive massive fibrosis, were from Pike, Floyd, Letcher and Knott counties.

In comparison, there were 31 cases of progressive massive fibrosis identified nationwide from 1990 to 1999, according to the report.

Black lung is caused from breathing dust churned up during coal mining. The torturous disease chokes off a person’s ability to breathe and often leads to premature death.

It has been the cause of about 78,000 deaths since 1968, Joe Main, head of the federal Mine Safety and Health Administration, said in a conference call this week.

Congress approved a law in 1969 that set limits on miners’ exposure to breathable dust. Companies are required to use ventilation and other measures to keep down dust in mines.

The goal was to wipe out progressive massive fibrosis, according to the NIOSH report released Thursday. The incidence of black lung fell sharply after the 1969 mine act, but then began rebounding after 2000. Eastern Kentucky has been a hot spot, with 9 percent of all miners screened in one NIOSH program from 2005 through 2009 having the disease.

The report issued Thursday provides more evidence that the disease continues to afflict miners, said Dr. David Blackley, one of the authors.

NIOSH got involved in the study after a radiologist in Pike County contacted the agency to report seeing a sharp increase in patients with progressive massive fibrosis, also called complicated black lung.

The radiologist, whom the report did not identify, asked for help investigating the problem and figuring out ways to reduce the prevalence of the disease in the area.

The findings in the report were consistent with other NIOSH studies that have shown miners getting black lung earlier in their careers and the disease progressing more quickly.

The youngest miner among the 60 in the study was just under 45, and at least one miner with only 15 years on the job had complicated black lung, according to data cited in the study.

Researchers have identified a number of possible factors in the resurgence of black lung, including miners working longer shifts and therefore having longer exposure to dust; more mining of thinner coal seams, which requires cutting through more rock; inadequate dust-control rules; and failure by coal companies to comply with the rules.

The report released Thursday did not identify the mining practices that led to the 60 miners having black lung. In talking to patients, however, the doctor who called NIOSH identified a practice called slope mining as a potential way they were exposed.

That method involves using a continuous mining machine to cut through hundreds of feet of sandstone to reach coal seams, the report said.

Sandstone in Eastern Kentucky contains a high level of quartz, so slope mining could expose miners to hazardous dust with a high concentration of breathable crystalline silica, the report said.

“If that’s the case it would be a major concern,” Blackley said.

The report said the economy could be a factor in the sharp increase in black-lung cases being seen.

It’s possible many miners didn’t seek examinations for the disease early in their careers for fear of losing a job or not being able to get a job, but have come forward more recently because the region has lost thousands of coal jobs and the miners are getting tested in order to seek benefits.

Participation by Kentucky miners in a NIOSH program to provide X-ray screening has been low historically — just 17 percent between 2011 and 2016. That raises the potential that there are many more current and former miners with black lung who haven’t been tested.

One goal of the report published Thursday is to document and draw attention to the problem in hopes that more miners will get screened.

Evan Smith, an attorney at the Appalachian Citizens’ Law Center in Whitesburg who helps handle cases for miners seeking black-lung benefits, said the findings in the report mirror a huge increase in cases the non-profit firm has seen.

Smith said it is staggering to think of the number of miners who worked their entire careers under rules limiting dust exposure but still got complicated black lung. It’s an indication that the limits and enforcement were not stringent enough until a few years ago, Smith said.

With Main, a former miner and union official, at the helm, MSHA put new dust standards in place beginning in 2014.

The changes included a lower limit on exposure to dust, more comprehensive sampling and the use of personal monitors for miners in the dustiest jobs, which can provide them with quick information on their exposure, and a chance to make changes.

Some in the industry argued coal companies could not comply with the standards, but more than 99 percent of the air samples collected by MSHA and companies have been in compliance, proving the standards are workable, Main said.

Any regulator who wants to back away from the rule will have to explain to miners “in good conscience how they can unravel that,” given the tens of thousands of black-lung deaths, Main said.