MELISSA BLOCK, HOST:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block. And we begin this hour with disturbing news from a joint NPR investigation with the Center for Public Integrity. The disease that steals the breath of coal miners is back with a vengeance, especially in Virginia, West Virginia and Kentucky. Black Lung is afflicting younger miners and advancing more quickly to the worst stage of disease.
Mine safety advocates have warned for years of a resurgence. Still, as NPR's Howard Berkes reports, federal regulators and the coal industry failed to protect miners from the dust that causes Black Lung.
HOWARD BERKES, BYLINE: The freshest indications of the resurgence of Black Lung are found in 24 autopsy reports, like the one on a coffee table in a gray house outside Naoma, West Virginia. Each of its eight stiff and stapled pages list one name in bold black letters. Quarles, Gary Wayne, age 33, cause of death, smoke, soot and blast injury in the explosion two years ago at the Upper Big Branch coal mine.
The details draw soft sobs from Gary Wayne's mother, Patty, who's pant leg hides a tattooed image of her son. But it's an entry on page 6 under significant findings that shocks the lost miner's dad.
GARY QUARLES: He had black lung. Being in the mines for 13 to 15 years and already considered having black lung nowadays, it's unbelievable.
BERKES: Gary Quarles is 55 and spent twice as many years underground. His chest x-rays are negative for black lung, so his son's post-mortem diagnosis is troubling.
QUARLES: And he never smoked. He never smoked a cigarette in a day of his life. And not only him, there's quite a few other younger guys, you know. And being that young, that's uncalled for.
BERKES: Seventy percent of the tested Upper Big Branch miners showed signs of black lung. That's 10 times the miners' rate in southern West Virginia and 20 times the national rate. At least two were in their 20s and some had less than 10 years underground. This defies the change that began in 1969 when 40,000 West Virginia miners walked off the job due to misery and death from black lung.
Some marched raucously on the state capital in Charleston and others cheered Congressman Ken Hechler at a rally.
CONGRESSMAN KEN HECHLER: The greatest heroes are you, the coal miners. You've taken the future, your future, in your hands and you've proclaimed no longer are we gonna live and work and die like animals. We're free men.
BERKES: Charleston cardiologist Isadore Buff called for state and federal action.
ISADORE BUFF: Will the coal miners of West Virginia get compensation for black lung and will the coal mines be cleaned up so that they won't die of this horrible disease? That's the problem. That's what we're trying to do.
BERKES: And by the end of the year, Congress acted, establishing tough limits on coal dust underground. A national compensation program kicked in, along with free chest x-rays. They found that four in 10 coal miners suffered black lung, 1,800 died from it in a single year. But by the mid-1990s, the new coal dust limit seemed to be working. Diagnoses plummeted by more than 90 percent.
DONALD RASMUSSEN: The way the law was intended and the way the program was set up, they anticipated that no one would develop progressive massive fibrosis.
BERKES: That's the worst stage of black lung and pulmonologist Donald Rasmussen has seen it many times in his clinic in Beckley, West Virginia, where he says he's tested 40,000 coal miners in the last 50 years. He's 84 and thought he'd be out of the testing business and retired by now.
RASMUSSEN: Well, in 1969, I publically proclaimed that the disease would go away before we learned all about it and I was dead wrong.
BERKES: So, 43 years later, the testing continues at Rasmussen's clinic.
UNIDENTIFIED WOMAN: Suck in real deep. Blow. Keep blowing, keep pushing.
BERKES: In this breath test, a retired miner forcefully exhales into a white tube, his nostrils clipped closed, his face beet red as he strains to push the last gasp of air from his lungs.
UNIDENTIFIED WOMAN: Big, deep breath in, breathe normal. Okay, take a break, let me look at what we got so far.
RASMUSSEN: I guess about 15 years ago, we began to see the appearance of younger miners who had worked in the mines only since the dust suppression following the '69 act that were showing up with complicated pneumoconiosis or progressive massive fibrosis.
BERKES: Coal worker's pneumoconiosis is the formal name for black lung and the new trend was also evident at Debbie Wills' clinic in Cedar Grove, West Virginia.
DEBBIE WILLS: The first 10 years or so that I worked here, I had four patients with complicated black lung. We knew them all intimately because there were so few of them. Now we have at least 50 diagnosed with complicated black lung.
BERKES: And in coal mining towns from Pennsylvania to Utah, federal epidemiologists track breath tests and chest x-rays for tens of thousands of miners. They have test results for 40 percent of the nation's coal workers and the findings are dramatic. Basic black lung diagnoses doubled in the last decade. Advanced disease quadrupled since the 1980s in Virginia, West Virginia and Kentucky.
Scott Laney is an epidemiologist at the National Institute for Occupational Safety and Health, or NIOSH.
SCOTT LANEY: Any reasonable epidemiologist would have to consider this an epidemic. I mean, this is a rare disease that should not be occurring. It's occurring at a high proportion of individuals who are being exposed. This is clearly a public health epidemic.
BERKES: Laney says miners are now diagnosed younger and the disease is getting worse quicker.
MARK MCCOWAN: My name's Mark McCowan. I was diagnosed with a complicated form of black lung disease in 2005 when I was 40 years old. Fourteen months later, I took another x-ray and it progressed. After I quit work, the disease has progressed further to the worst kind now.
BERKES: Mark McCowan is 47 now and he looks healthy just sitting there on his living room couch in Pounding Mill, Virginia, but walking his hilly yard, he says, or trying to mow the lawn or simply holding his two-year-old grandson leaves him gasping for air.
MCCOWAN: I say, well, buddy, I got to put you down for a few minutes. And he squirms around a little bit. He'll say, run, papa, run. He wants me to chase him. And I can't. I say, give papa a minute. I might be able to in a minute. And I face Mount Everest every day. Sometimes I make it to the top and sometimes I don't.
BERKES: And like Gary Wayne Quarles, the young victim of the Upper Big Branch explosion, McCowan never smoked. Both worked right at the coal face in the dustiest jobs and both operated gigantic rotating shearers on massive long wall mining machines. But both also worked in an era with strict limits on dust exposure. So what went wrong?
Edward Petsonk is a pulmonologist focused on black lung at NIOSH and West Virginia University.
EDWARD PETSONK: From the patterns and from the severity, from the prevalence of the disease, this must be a situation in which the dust in many, many mines is simply not adequately controlled. There's nothing else that could possibly cause this.
BERKES: Miners are exposed to that coal dust longer because they're spending more time underground, according to federal data. The average work year for coal miners grew 600 hours in the last 30 years.
MCCOWAN: By the time I was 40 years old, I had mined more coal than most miners seen in a lifetime.
BERKES: And as Mark McCowan discovered at one job, more hours came with more efficient mining machines and more pressure to produce.
MCCOWAN: The first year I worked for them was in 1997. They had a record year that year. And since then, they've broken that record. You can't be exposed to the kind of tonnage that I was and not get black lung disease.
BERKES: In fact, the rate of production in coal mines climbed fivefold through the end of the century. Pulmonologists say some miners are more susceptible to black lung and smoking increases susceptibility. But veteran black lung specialist Donald Rasmussen cites something else that makes coal dust more dangerous and black lung more severe.
RASMUSSEN: The mining equipment has grown more and more powerful. They can chew rock. They are now able to mine narrow seams or a seam of coal where there's a strip of rock between, and send that to the cleaning plants and get clean coal out of it. But in the process, they release more silicon dioxide, and the increase in silica is more toxic than just the coal dust itself.
BERKES: Silica is in the quartz and sandstone that is especially prevalent in coal seams in Virginia, West Virginia, and Kentucky, where the resurgence of black lung is greatest. And the average coalminer was exposed to excessive levels of silica in each of the last 25 years, according to federal data. That prompts something a bit unexpected from the coal industry, a call for more enforcement specifically focused on silica.
Bob Glenn is a consultant for the National Mining Association.
BOB GLENN: What needs to be done is an enforcement of the silica standard in those regions there. This is serious. These people are being exposed three to four times the silica exposures for periods over 20 years. So these people - a chest full of silica and nothing's been done about it.
BERKES: The National Mining Association doesn't challenge the notion that black lung is back. But the group opposes tougher limits for coal dust that would affect all coal mines everywhere. Target the problem mines in problem regions, the group says, and smaller mines that present the biggest threats. Still, some large operations also have coal and silica dust issues.
Mark McCowan worked at one of the biggest coal mines in Virginia, where the coal seam coursed through rock.
MARK MCCOWAN: Sometimes the coal was reduced to a two-inch thickness and you have to stay with that two inches because you know that's your coal seam. But the rest of what you need to mine may be solid rock.
BERKES: Federal regulators want to toughen the coal dust standard by cutting the exposure limit in half. They say that will also cut exposure to silica. But here's the thing, federal and industry data show coal mines on average already meet the lower standard for coal dust. So something is not right with the standard or the data, because black lung continues to ruin more lives.
MCCOWAN: Now it feels like I've got a heavy wet sack on each lung. Breathing has become a conscious effort. Some days, I'm consciously feeling how heavy my lungs are and that it's not getting no better. It seems like I give a little bit up of my world each day, that it gets smaller and smaller.
BERKES: Since 1970, black lung killed or helped kill 70,000 coalminers. Tomorrow on NPR's MORNING EDITION: how government failed to control coal dust, how the exposure limits were weak from the very beginning, and how industry gamed the system that was supposed to protect Mark McCowan, Gary Wayne Quarles and thousands of others.
Howard Berkes, NPR News.
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BLOCK: At NPR.org, you can see the working life of coalminers as captured by photojournalist Earl Dotter. And there are links to more reporting from the Charleston Gazette on failed efforts to toughen mine dust regulations.