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On the Disturbing Return of Black Lung

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The push to revive America’s coal industry has generated alarm because it is almost certain to worsen the climate crisis. But the industry also brings an immediate human cost: black lung disease. Black lung is an often fatal condition contracted by miners who breathe in coal and silica dust on the job. Rates of the disease dropped towards the end of the 20th century, thanks in part to federally mandated reductions in the amount of coal dust miners were allowed to breathe in. Now, researchers at the National Institute for Occupational Safety and Health have documented a troubling new trend: Black lung disease cases, particularly among younger miners, have risen sharply since the mid-1990s.

One chart from the group, published by the New York Times earlier in 2018, shows that in 1995 there were “3.7 cases per 1,000 miners.” By 2015, that number had jumped to over 50 cases per 1,000 miners.

Overall, there has been a steady upsurge in the number of cases of black lung, including in its most aggressive forms. A 2018 National Public Radio report identified many reasons for the increase, including the fact that many miners are working longer hours with less time to rest and recover between shifts. Advances in mining technology have also led to the use of more powerful extraction machines that throw more toxic coal dust into the air and into the lungs of coal miners. These factors have made the coal mining regions of Appalachia the “epicenter of one of the worst industrial health disasters in U.S. history,” according to a recent article by Kentucky lawyer, Evan Smith.

Smith advocates on behalf of coal miners through his work at the Appalachian Citizens’ Law Center. Writing for the West Virginia Law Review, Smith calls the uptick in black lung cases evidence of a “gut-wrenching reversal of 20th century progress.” Black lung disease is preventable, Smith insists, and should have gone the way of smallpox long ago. (Black lung is actually not a medical term, Smith points out, and notes that it is just one name for a host of debilitating physical conditions experienced by miners.) Although mining has always been a dangerous occupation, rates of black lung disease did drop from the 1970’s until the beginning of the 21st century, thanks to improved workplace and environmental regulations.

Dangerous working conditions

Looking beyond black lung, recent incidents such as the 2010 Upper Big Branch mining disaster in West Virginia have shown that working conditions for coal miners often remain harrowingly unsafe. Portions of the Upper Big Branch mine exploded in 2010, killing 29 workers. In the aftermath, autopsies were carried out on a majority of the lungs of those killed, revealing that 71 percent of them had black lung disease, including a worker who was just 25 years old when he died. Upper Big Branch was owned then by Massey Energy, whose CEO, Don Blankenship, was sentenced to one year in prison for his role in making the mine an unsafe place to work.

One of the things that made the Upper Big Branch mine so unsafe was the fact that Blankenship had driven out the miners’ union. Blankenship, who is a current  U.S. Senate candidate in West Virginia as a member of the Constitution Party, “made it his personal campaign to break the union at the mine,” according to a 2010 report by Public Radio International. This resulted in workers having to take on 12-hour shifts as one of Massey Energy’s reported cost-cutting measures. What followed was a number of articles arguing, as reporters Taylor Kuykendall and Hira Fawad did in 2015, that union-staffed mines are more productive and less dangerous for workers. One key piece of Farwad and Kuykendall’s evidence for this comes from safety records in 2014, when just one out of 16 work-related mining deaths occurred at a union site.

Despite Kentucky’s history of worker militancy, today there are zero union mines left in the state, which is at the heart of Appalachian coal country. Still, a group called Kentuckians for the Commonwealth continues to advocate on behalf of the thousands of coal miners who work in the state. Acknowledging the rise in black lung disease among miners, the group aims to move away from relying on toxic, fossil fuel industry jobs such as coal mining.

A dying industry

A 30-year-old organization, Kentuckians for the Commonwealth was born out of a late 1970s movement that documented who was benefiting most from Kentucky’s coal-rich land. (Hint: it wasn’t local communities.) The group organizes workers and residents around its vision of a more inclusive, democratic society and cites direct action as one of its key strategies. Right now, a prominent feature of the group’s work is called Appalachian Transition, which is built around the recognition that, despite Trump’s campaign rallies, coal mining is a dying industry. The goal, according to the Kentuckians for the Commonwealth website, is to “support coal communities and workers as we shift away from a fossil fuel economy to one that is more sustainable and equitable.”

The group criticizes the instability and inequity of the coal industry, which often results in large, non-union corporations cutting a destructive path through Kentucky’s rural communities. Kentuckians for the Commonwealth shares stories of people who have reclaimed the land in the Kentucky mountains, in order to reinvest in the environment and learn 21st century skills such as restorative agricultural practices and sustainable forestry—something that has been done in other coal-producing regions in Germany. The ultimate goal is the creation of a base of grassroots power among Kentuckians, even as the state’s legislature continues to align itself with corporate interests.

For proof, one has to look no further than a recent case concerning black lung disease and workers’ rights. Just weeks ago, executives from the now-closed Armstrong Coal company in Owensboro, Kentucky were charged with “falsifying federally mandated coal dust tests designed to protect miners from incurable black lung disease,” as an editorial in the Lexington Courier Journal put it. The case against Armstrong Coal was prompted by two coal miners who went public with their story in 2014, detailing the destructive impact of black lung disease on their lives. Workers felt forced into going along with the company’s deceptive policies, according to news reports—a situation not unlike that in many mines, especially where union protection has been lost.

The Armstrong Coal case prompted another Kentucky newspaper’s editorial board to declare that “coal miners’ lives still matter,” yet it might be hard for those seeking medical help for black lung disease in Kentucky to believe this. In July, new state laws went into effect that not only make it harder for workers hurt on the job to qualify for workers compensation, but also “excludes the most qualified physicians from being heard in black lung claims.” When the laws were passed, Smith, of the Appalachian Citizens’ Law Center, told National Public Radio that this move “keeps Kentucky coal miners from using highly qualified and reliable experts to prove their state black lung claims [and] looks like just another step in the race to the bottom to gut worker protections.”

So, when Donald Trump and his allies wax poetic about bringing “clean, beautiful coal” jobs back to places like Kentucky, it seems fair to ask a simple question: at what cost?

This article was originally published at In These Times on July 27, 2018. Reprinted with permission.

About the Author: Sarah Lahm is a Minneapolis-based writer and former English Instructor. She is a 2015 Progressive magazine Education Fellow and blogs about education at brightlightsmallcity.com.


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Kentucky lawmakers put decisions on black lung treatments in hands of industry-paid doctors

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The political assault on science in the age of Trump has reached a point where even medical specialties are rising up in protest. Radiologists are fighting back against a new Kentucky law that excludes them from the black lung claims process for coal miners in the state.

Under the new legislation, if a miner files a black lung claim with the state, only a federally licensed pulmonologist can review the X-rays and ultimately make a diagnosis. Previously, radiologists could offer a diagnosis as well.

The legislation, part of a larger workers’ compensation bill signed into law by Kentucky Gov. Matt Bevin (R) on March 30, is expected to make it more difficult for coal miners stricken with black lung disease to receive benefits for treating their disease and living with black lung. The workers’ compensation bill was supported by the Kentucky Chamber of Commerce and the Kentucky Coal Association. Labor groups strongly opposed it.

The American College of Radiology, a national organization representing more than 38,000 radiologists, said it is troubled that Kentucky lawmakers stepped in to determine who is qualified to read the X-rays of coal miners seeking compensation for black lung disease. A process is already in place to determine whether a physician is qualified to review black lung cases, the group said.

“To have that established process superseded by legislators and a political process is inappropriate,” American College of Radiology Chief Executive Officer William Thorwarth Jr. M.D., said in a statement emailed to ThinkProgress on Monday.

Thorwarth emphasized that politics should be left out of the black lung claims process. “We hope that the Kentucky legislature will rescind this new law and work with medical providers to save more lives,” he said.

Phillip Wheeler, an attorney in Pikeville, Kentucky who represents coal miners seeking state black lung benefits, said it’s possible the new law could be overturned on appeal. The law applies the rule only to workers who file claims for black lung and not workers in other industries who file benefit claims, Wheeler said Monday in an interview with ThinkProgress.

An appeals court could find that the law violates the constitutional guarantee of equal protection under the law by limiting the type of doctors who can be used in black lung cases, while workers in other occupations aren’t subjected to the same limits when they apply for worker’s compensation benefits.

The new law also could prove problematic because it drastically reduces the number of physicians in Kentucky permitted to read the chest X-rays when coal miners file a black lung claim, Wheeler said. Six doctors in Kentucky will now be eligible to conduct the exams, according to an NPR review of federal black lung cases. At least half of them “have collected hundreds of thousands if not millions of dollars form the coal industry over the last 25 to 30 years,” Wheeler said.

“The three primary doctors that will be doing most of these exams have shown a distinct bias against coal miners through the years,” he said.

Physicians who read chest X-rays for work-related diseases like black lung — also called coal workers’ pneumoconiosis — are known as “B readers” and are certified by National Institute for Occupational Safety and Health for both federal and state compensation claims. B readers do not specifically have to be pulmonologists or radiologists, though they can be both.

Black lung is common term for several respiratory diseases that share a single cause: breathing in coal mine dust. Over time, black lung disease causes a person’s lungs to become coated in the black particulates that miners inhaled during their time in the mines. Their passageways are marked by dark scars and hard nodules.

The Kentucky Coal Association “basically drafted the legislation,” Wheeler said, explaining why the new law will likely make it more difficult for miners to win black lung claims cases.

The new Kentucky law coincides with the Trump administration’s decision to examine whether it should weaken rules aimed at fighting black lung among coal miners, a move the administration says could create a “less burdensome” regulatory environment for coal companies.

President Donald Trump pledged to end the so-called war on coal but has thus far done nothing to help coal miners who have spent years working in mines win black lung benefits.

Likewise, Kentucky lawmakers are showing a preference for industry profits over occupational health. Evan Smith, an attorney at the Appalachian Citizens’ Law Center in Kentucky, said in a tweet that the new law will keep the state’s coal miners from using “highly qualified and reliable experts to prove their state black lung claims.”

The law “looks like just another step in the race to the bottom to gut worker protections,” Smith said.

Black lung has made a comeback in recent years. The disease now sickens about one in 14 underground miners with more than 25 years’ experience who submit to voluntary checkups, according to a recent study, a rate nearly double that from the disease’s lowest point from 1995 to 1999.

Kentucky is one of the states that has witnessed the resurgence in the most advanced form of black lung disease, which is debilitating and deadly.

Lawmakers included the provision in the new worker compensation law even though radiologists are considered to be the most qualified among doctors certified to diagnose black lung disease.

State Rep. Adam Koenig, a Republican who represents a district in northern Kentucky, sponsored the legislation. He told NPR that, when writing the law, he relied on the expertise of those who understand the issue — “the industry, coal companies and attorneys.”

This article was originally published at ThinkProgress on April 9, 2018. Reprinted with permission. 

About the Author: Mark Hand is a climate and environment reporter at ThinkProgress. Send him tips at [email protected]


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