Shining a Light on Black Lung

Vol. 19 • Issue 10 • Page 21

On a sunny August Saturday, David A. Lucas held his 26th annual Coal Miners’ Picnic in Hegins, Pa., the heart of anthracite coal mining country. Lucas and his family made all the food for the crowd of 300 miners, relatives, and friends. Men dressed in old miners’ gear played guitars and banjos. They drank beer from mugs Lucas embossed with the names of co-workers who have died from coal workers’ pneumoconiosis (CWP) – or black lung, as many an old folk song first called it.

“I worked 42 years in the ground,” said Lucas, 59, who followed his grandfather and father into the mines from age 9 until he was forced to retire three years ago due to black lung symptoms. “At the time, you’re thinking of supporting your family, not thinking of what’s going to happen 30 years from now. But it’s like a car running out of gas. Those last two years I started throwing up several times a day in the mine, even on an empty stomach.”

Lucas, who likes to be called David A., has chronic obstructive pulmonary disease and asthma, but most of his disability comes from coal dust inhalation. “Shortness of breath sneaks up on you little by little,” he said. “I’ll walk maybe 50 feet, then have to stop. If the humidity is up, I have to sit on my porch and not do anything.”

Prevalence rising

Mine cave-ins grab the headlines and are unquestionably tragic. But black lung claims far more miners’ lives, covertly, insidiously, without the headlamp of publicity shining on it.

Black lung declined in the 1970s following enactment of the Coal Mine Health and Safety Act, but the caseload has crept up since, according to the Centers for Disease Control and Prevention. Since 1995, prevalence has more than doubled. In the last decade, 10,000 miners have died from it. Of particular concern are younger miners. Some are developing advanced cases by their mid-30s, likely due to inadequate coal mine dust regulations, longer working hours, and lack of early screening.

Another problem is the equipment. Many working miners spurn their protective masks, despite the risk, because they find them so uncomfortable.

“A lot of miners tell me they only wear protection once in a while,” said Michele Cinicola, CRT, patient care coordinator at the black lung clinic at Gnaden Huetten Memorial Hospital, Lehighton, Pa. “It’s cumbersome. They have hard times breathing with it, so they decide not to wear it. Even the younger ones don’t wear them. I don’t know if they are truly aware of the danger. Some drive trucks and feel if they’re above ground, in the cab of a truck, they’re not exposed. But you see them come out of the truck and they’re black. Trucks stir up dirt around a mine.”

Lucas found it almost impossible to breathe while wearing a respirator because it became clogged with coal dust and impaired his vision. “You couldn’t see three feet in front of you,” he said. “You had to stop to clean them out.”

Reduced elasticity

Black lung occurs when repeated inhalation of coal dust coats the lungs and causes scar tissue to form, reducing elasticity, restricting breathing, progressing eventually to lung failure and death.

“When you breathe in coal dust, it may settle in the lungs and create macules, or black spots,” said Christine Bossi, RN, who directs three black lung clinics in central Pennsylvania. “Some miners might have really big spots in one portion of their lungs; others might have more diffuse spots.”

A related form of pneumoconiosis is silicosis, which miners contract when drilling through rock and inhaling quartz dust. “It’s much more diffuse than coal dust and can appear like fine sand and spread everywhere in the lungs,” Bossi said. “The National Institute for Occupational Safety and Health ran an autopsy program. I’ve seen them actually pour sand out of the preserved lungs of dead miners.”

Pennsylvania’s three black lung clinics – at Gnaden Huetten Memorial Hospital, Altoona Hospital, and Windber Medical Center near Johnstown – operate through a federal grant of $258,000 that lasts for three years, after which they must reapply for new funding. Federally funded black lung clinics also operate in designated black lung areas in 14 other states, mostly in the Eastern U.S.

Establishing a good patient history is a valuable part of identifying CWP. This includes asking miners how old they were upon their first exposure to coal dust, their specific job responsibilities, how long they spent underground, the type of coal they mined, and their smoking history.

“We do PFTs, arterial blood gases, chest X-rays, urinalysis, complete blood count, electrolytes, EKG, and a basic metabolic profile,” Cinicola said. “When miners return, our clinic pulmonologist goes over their results with them and does a complete physical. If all looks well, they’ll come back next year. If not, he’ll order further testing or meds. A lot of them need oxygen therapy. Some need inhalers for breathing and pulmonary rehab.”

Miners also get flu shots at the clinics because they are more prone to upper respiratory diseases and viral illnesses. “We get 1,600 doses every year free from the state for all three clinics to provide to miners and their wives or widows,” Bossi said.

However, with three clinics servicing 21 counties throughout Pennsylvania, geography becomes a problem for retired miners on fixed incomes. “A lot of miners don’t want to travel two hours to get tested and treated,” said Renee Henry, RRT, CPFT, patient care coordinator at the Altoona clinic.

Most miners also do not heed physicians’ recommendations to consider an alternative career. Coal miners’ pride goes as deep as the veins of coal they covet.

Lucas never quit mining all those years, even when his father died of black lung at age 58. “It’s a special breed of people who do what we do,” he said. “You have to be hardcore to work in the ground. I’m a survivor. I would have liked to work to the day I died.”

Fight for disability benefits

Lucas’ knuckles, emblazoned with bluish black scars from the caves, testify to many sunless, hard-working years. He and other disabled miners have had to dig through another long, dark tunnel – a legal one – to win workers’ compensation benefits.

Tucked away in the recent health care reform legislation are two provisions penned by the late Sen. Robert Byrd of the coal-mining state of West Virginia. The provisions reverse decades of rules limiting the ability of coal miners and their widows to collect disability benefits for CWP.

Even so, a miner with black lung faces an arduous legal path to obtain disability compensation. Many never see a dime.

Mining companies often contest the diagnosis of black lung, especially if a miner smokes. “When they come down with lung impairment, mining companies often say it’s COPD from smoking,” Bossi said. “Which came first, the chicken or the egg?”

Helen Koschoff, Esq., has represented miners for more than 30 years from her office in Wilburton, in central Pennsylvania, an active anthracite coal mining region.

“Most of my clients are in their 70s and 80s at this point,” Koschoff said. “I’ve had miners waiting for benefits for 20 years.”

Limited witnesses, evidence

After filling out numerous forms detailing his work history, a miner must have a physical exam from a physician authorized by the Department of Labor. Department officials then assess the evidence brought by the miner and his company and make a determination. Most cases are denied.

Usually, the case then proceeds to a formal hearing before a judge. One factor working against miners is the caliber of their medical witnesses. Suppose, for example, a mining company contends that a miner’s cardiac condition may be causing his lower pulmonary incapacity.

“Miners in rural areas don’t have access to pulmonologists,” Koschoff noted. “Most are treated by local family practitioners. So they go up against board-certified pulmonologists hired by the companies who will have greater paper credentials than a family physician. Qualifications of doctors become an integral part of these decisions.”

Miners also are handicapped by the rules governing admission of evidence. In 2001, legislators revised the law to limit the amount of evidence both parties could admit. The intent was to level the playing field, as mining companies have far deeper pockets than miners. But it backfired.

“The law requires a miner to prove his case by a preponderance of the evidence,” Koschoff said. “Then it limits that evidence to an amount equal to what the opposition presents.”

Miners are limited to two physical exams, two X-rays, and two PFTs. “Let’s say you’ve been examined by a family physician and a pulmonologist,” the attorney said. “If the other side then has a physician who says the miner’s heart function is to blame, the miner can’t get a third physician, such as a cardiologist, to refute that claim.”

A miner can keep his case active so long as he submits additional evidence or otherwise contests the adverse ruling within a year of it. Widows of black lung victims are not so lucky. “If her husband couldn’t win benefits while he was alive – and if she can’t provide any new evidence within one year after she is denied – then she’s out forever,” Koschoff said.

Contact Michael Gibbons at [email protected].