Black Lung Disease Rises in Appalachia — Coal’s Human Cost (full documentary) — FRONTLINE (PBS)

[00:00:00] Speaker 1: We have an epidemic here of black luck. [00:00:06] Howard Burkus: These miners are inhaling their workplace, and it stays with them forever. In collaboration with NPR, Public Health Watch, and the Appalachia and Mid-South newsroom, [00:00:16] Howard Burkus: do you have a sense of what the rest of your life is going to be with black luck? [00:00:20] Jonathan Wright: Well, you work your whole life to enjoy the rest of it, and you can't enjoy it. [00:00:25] Howard Burkus: Drawing on years of reporting, correspondent Howard Burkus investigates. [00:00:30] Howard Burkus: Why won't you talk to us about this issue? [00:00:31] Howard Burkus: The numbers are astounding, how many young people are getting this disease. [00:00:36] Speaker 5: If we could turn back time, we would do so to prevent this. We can't. We're dealing with historic exposures. [00:00:42] Speaker 6: These guys are being treated like disposable widgets, not human beings, and we're watching them die right before our eyes. [00:00:49] Speaker 7: Now on Frontline. This has been going on for decades. It is entirely preventable, and we aren't preventing it. [00:00:57] Howard Burkus: Coal's human cost. [00:00:58] Speaker 7: Coal's human cost. [00:01:20] Jonathan Wright: I started noticing in mid-2023 that it was getting tougher and tougher breathing-wise, you know, to climb these hills around here. I love to get my kids into hunting, fishing, stuff like that, but just having the energy and, and the, the wind to do it is, it's almost impossible. I used to work all day, come home, and, and cut grass till dark. Now I can come here and sit all day and go home and I'm, I'm beat. I mean, I just, I ain't got no energy to do nothing. I mean, I know it's going to get to where I, I can't get around in the hills to hunt. So I'm going to have to give that up eventually, you know? And it's, it's, it's awful. You work your whole life to enjoy the rest of it. And then when you, you can enjoy it. [00:02:45] Howard Berkus: Howard Berkus has been investigating the rise of black lung disease for more than a decade. [00:02:51] Howard Burkus: Even the black lung experts were shocked by this data. I've been in and out of Appalachia going back 15 years, driving the hills and coal fields of Kentucky, Virginia, and West Virginia, tracking the resurgence of an incurable coal mining disease called black lung. [00:03:10] Speaker 9: It was tough on all of us. [00:03:12] Howard Burkus: I've interviewed dozens of sick and dying coal miners, documented thousands of cases of disease, and exposed failures by federal regulators in the industry, and there's evidence it's getting worse. Jonathan Wright is 44 and worked underground until the mine closed last year. I met him in Pike County, Kentucky, where he now sells overstock and surplus merchandise from a small warehouse. [00:03:47] Jonathan Wright: I worked underground in a coal mine for 25 years. I've done a little bit of everything from running a scoop to a show car, a miner, roof boater. I've done a little bit of everything. Every morning I get up, I cough up grayish looking flame and stuff. You know, between that and just not having the energy to do what I used to do. That's what prompted me to go get checked. I'm thinking it was in August when I had that x-ray done. And I think it took about a month to get it back, and they diagnosed me with a second stage black lung. [00:04:36] Howard Burkus: How did you react to being told that you had black lung disease? [00:04:40] Jonathan Wright: Well, I mean, it scared me. I mean, I worked in mines for 25 years. You know, I know what it is. I just, I really didn't think that would happen to me, though. You know, I guess when you're younger, you don't think it's going to happen. [00:04:57] Howard Burkus: Why do you think you got black lung? [00:05:00] Jonathan Wright: Just eating too much dust. Just being exposed to too much dust, without a doubt. In my earlier part of my career, I was like every other young guy. You know, at first, just not knowing much about it. But then later on, just complacency. You know, you've been in it for so long. And there's nothing happened yet. You know, and I believe that's the way a lot of people look at it. You just get complacent with where you're at and just don't realize what damage it's doing. [00:05:37] Howard Burkus: One in three veteran underground coal miners tested in central Appalachia now have black lung. That's the highest rate since the 1970s. The disease is devastating families here, where doctors and advocates have been trying for years to sound the alarm and to get better protections for minors. In September, I attended a meeting of the local Black Lung Association in Big Stone Gap, Virginia. [00:06:13] Speaker 10: They're a little bit confused on some of this stuff. Can you answer a couple of their questions? Sure. [00:06:19] Howard Burkus: It was led by respiratory therapist, Marcy Freeman, and radiologist, Brandon Crum, who I've been in touch with for years. [00:06:29] Speaker 1: We have an epidemic here of black lung, and we see tons of coal miners with advanced progressive massive fibrosis. You know, our clinics, my clinic, Dr. Crum's clinic, Heath the attorney, Wes Addington, Marshall is at Norton Community. The scary thing is none of us really overlap with those patients, and the fact that we're all seeing in such an influx tells me that there's something going on that is not a good thing in this area. [00:07:01] Speaker 11: Yeah, I appreciate y'all having me back here, and if you don't know me, I'm Brandon Crum. I'm a radiologist over in Kentucky, and I have a clinic over there, and we've done a ton of research on black lung, a ton of imaging. So I read the x-rays and CTs, but we've also took it significantly further and gathered probably the largest collection of data on central Appalachia miners. So when you look at it, 70s, 80s, 90s, all the way to 2000, 2010s, 2020s, after billions and billions of dollars has been spent, we're right back to the same place we was when our grandfathers were mining, and our great-grandfathers is pretty much where we're at. So it's been a failure of the entire system for our miners in central Appalachia. It's pretty much what you can say about it. [00:07:57] Speaker 1: When I talk about black lung, you know, I'm always talking about it. I mean, I live it. My husband has it. My dad has it. You know, everybody in my family is affected by it because, just like you all, I'm a coal miner's daughter. And, you know, I see what it's done to them, and I see it firsthand, what it's doing to them. And I look at Philip, my husband, who was strong, healthy, man, invincible. And I watch this disease take a little piece of him, every few months I see a change. So, and I've watched my daddy, and I swear to God, my daddy was Superman, right? There's nothing he couldn't do, nothing. And now, you know, he can't even breathe and get off the couch. It's a horrible disease. [00:08:46] Howard Burkus: Freeman runs respiratory clinics for coal miners in Kentucky and Virginia. [00:08:53] Speaker ?: What did you get, Gary? [00:08:54] Speaker 12: Just one eight. Thank you. [00:08:58] Howard Burkus: All of the miners I interviewed at her clinics have what's known as progressive massive fibrosis, or PMF, the advanced form of the disease. That was the diagnosis for Tim Balthus after 35 years as a minor. [00:09:14] Speaker 13: 128, over 82. [00:09:20] Speaker 14: When I went to my pulmonologist in August of 21, he told me what it was. And I was in denial then. I was like, there's no way, dude. I can still run miles and, you know, went into denial phase for probably a couple years, I guess. And then I just thought, you know, he's not lying to me, you know. And with the time that I had, the years of service, I guess, in the mines, I knew it was a possibility. He just made it real. You used to work out with your daughters. Yes. [00:10:02] Howard Burkus: Running track. [00:10:03] Speaker 14: Yeah. They ran track and cross country. So, um, I would run with them through town. And it wasn't uncommon to run three, four miles with them a day. [00:10:18] Howard Burkus: Could you keep up with your daughters now? [00:10:20] Speaker 14: Your grandkids? You have grandkids. No, I could not run with them. There's no way. You said you don't like to talk about it because that makes it real. [00:10:30] Howard Burkus: Yeah. What's real? [00:10:34] Speaker 14: Um, the death is real. That's going to happen. If the rest of my body stays in good shape and I don't get killed in a car accident or something like that, I'm going to die black lung. I know that I try to put that at the back of my mind and stay healthy and active and all that kind of stuff and hopefully I'll live until I'm in my 70s or 80s, you know, so that would be a normal life. Will that happen? Probably not. With the diagnosis that I have, I'll probably be lucky to live in the mid-60s. If I'm lucky, if this right here stalls the progression of it, I'll probably live to be in my mid-60s. [00:11:21] Howard Burkus: How old are you now? [00:11:22] Speaker 14: I will be 58 in November. The mid-60s isn't far off. No. No, it's not. [00:11:43] Howard Burkus: This is a stack of funeral programs and obituaries for minors who have been clients here and who have died. And these four I pulled out because these are guys who I interviewed the last time I was here in 2018. I remember each of them as Paul and Jerry and Jack and another Jack. They were here struggling to breathe at times, working out, trying to improve their symptoms as best they could. But they were joking with each other. They were just so full of life, even though they had this horrific disease. And they didn't make it. And there are 40 more of these funeral programs and obituaries here. They keep track of them. They save them to honor these guys. When I was here eight years ago for NPR and Frontline, federal researchers had just reported that one in five working coal miners in central Appalachia had black lung. Basic black lung diagnoses had doubled in a decade. The advanced disease, PMF, had quadrupled since the 1980s. And it was clear that miners were getting the advanced disease younger and more quickly than in the past. Greg. Hey. I'm Howard Berkus from National Public Radio. Great to meet you. Mm-hmm. When I first met Greg Kelly in 2018, he was just 53 years old. Still relatively young for a miner so sick. [00:14:06] Speaker 15: That's me, and that's my step back. How long did you spend in mining? 31 years. Here's one. That was in 83. And what made you stop mining? My health. I just couldn't. I got sick, and they said, we don't want you to go back to work until you see a lung doctor. When I did get to see him, he said, you know, you don't need to go back on the ground. [00:14:28] Howard Burkus: Was that the first time you learned that you had black lung? Right. [00:14:31] Speaker 15: Yeah, that's the first doctor that ever said, you know, you've got black lung. I've had two or three x-ray technicians tell me they're the worst set-alongs they've ever seen. [00:14:40] Howard Burkus: What kind of reaction did you have when you heard about that? [00:14:46] Speaker 15: You can't work. It's just like a light switch. It turned on. It turned off. All your plans. That you had, you know, hunting and fishing and doing what you want to do. When that day comes, all of a sudden it's here, and you can't, you don't have the air to do it. You know, I still enjoy life. I have a good time. I get to play with my grandson. It's just not like I want to and like I used to be able to, you know. Did you catch one? [00:15:34] Speaker ?: Yeah. [00:15:36] Speaker 15: There he is. You got it. You know, I just try to pray and ask the Lord to help me to overcome it and just go on and be with my family. You got one, didn't you? You got one, didn't you? The whole time I've been in the order, I can't breathe. And then when you raise up, you got to just stand still to get your breath. Come on, let's go show Mom what you caught. [00:16:11] Speaker 10: The disease that steals the breath of coal miners is back with a vengeance. [00:16:17] Howard Burkus: I went to see radiologist Brandon Crum at his clinic in Kentucky, which was overwhelmed with cases of PMF. [00:16:24] Speaker 11: So if I show you for comparison, this is a normal x-ray and you can see all the dark area. That's the lung because it's filled with air and you contrast that to this one. You see all these big white areas all the way through here. That's all conglomerate fibrotic mass or PMF. The biggest concern at that time for me was seeing young men my age, and I'm 43 or younger than I am, with the most severe form of the disease, which is the complicated black lung disease. [00:16:59] Howard Burkus: Crum was so concerned, he took his findings to researchers at the National Institute for Occupational Safety and Health, or NIOSH. [00:17:08] Speaker 11: Well, when I told them, you know, we were seeing or I was seeing a lot of complicated black lung disease, and what was most concerning is I was seeing it in individuals in their 30s and 40s. I think there was some hesitancy on their part. I'm not sure they believe me. [00:17:23] Speaker 16: He told us that he was seeing a lot of really advanced disease, and it was concerning to him. And I guess my initial thought was, that's probably not true. [00:17:34] Howard Burkus: The researchers had been officially tracking black lung disease for decades, but they only tested working minors, not the thousands out of work. So they hadn't detected the sharp rise in deadly PMF Brandon Crum was finding. [00:17:48] Speaker 16: He invited us to show us some of the medical images from his patients, and we sat there for an entire day, one after another, after another, looking at these chest x-rays, the worst I've ever seen. [00:18:02] Howard Burkus: What was your reaction to what you saw? [00:18:05] Speaker 16: Horror, shock. I don't know how many other words to use. I was really taken aback, not only that these cases were legitimate, but just how severe they were. It indicated that we had a huge problem, and we realized immediately that it wasn't going to be isolated to a single clinic. [00:18:32] Howard Burkus: Researchers at NIOSH had only reported 99 cases of PMF in the previous five years. But out-of-work minors had been flooding clinics, and in calls and visits to 16 clinics across Appalachia, Frontline and NPR identified close to 2,000 cases in the same time frame. The Stone Mountain Black Lung Clinics in southwestern Virginia reported more cases than anyone. Ron Carson directed the clinics at the time. [00:19:06] Speaker 17: We're going to put you in the room. Come on with me. Well, NIOSH reported maybe 90 or 100 x-rays. [00:19:13] Speaker 14: All right, if you'll step up by real close for me. [00:19:15] Speaker 17: So we came back, and we started doing a study on how many we actually had. Pulling x-rays back to 2014 to 2017, three years of x-rays. We quickly identified 416 during that three-year period. However, if we had went back to 2010 at a minimum, we could have probably doubled that. [00:19:41] Speaker 13: The breathing out deep and fast. [00:19:43] Speaker 17: And I don't know what your test will reveal today, but, and I tell everybody this for almost 30 years, don't get discouraged. [00:19:58] Howard Burkus: The count at Stone Mountain rose to nearly 800 with a dozen new cases a month. [00:20:04] Speaker 17: My buddy here. God bless you, my buddy. I just think that America needs to know that these miners, they have paid a price. So many years, these miners extract this coal so that you and I can... ...can tear it out. I'm sorry. [00:20:34] Speaker 18: They pay the price. They have paid a price so that we can have luxury. And I just feel like America has just forgotten about them. [00:21:07] Speaker 7: So let us trust in you and you only. [00:21:13] Speaker ?: Despite what's going on around us, give us the joy and the peace that the world cannot give us. And we thank you for your love that is unconditional. In Jesus' name we pray, Amen. [00:21:28] Howard Burkus: Danny Smith was 46 when I met him. He'd mined coal just 12 years, but was desperately sick. He was getting help with breathing and stamina at a Kentucky pulmonary rehab clinic run by Marcy Freeman. [00:21:45] Speaker 19: Marcy, can I drop down today? Yes. Yes, you can, hey. [00:21:49] Speaker 1: I'm going to pour out. What's Danny's heart rate? 96. Let's stop and catch our breath there for a second. Danny, when he first started with us, he would break out in a cold sweat, literally drenched, and he would start shallow breathing. Depression, anxiety, you know, that is as much a part of this disease as their breathing is. [00:22:13] Speaker 19: See ya'll. Oh, oh, oh, oh. I had him at 4:30. [00:22:16] Speaker 13: Oh, oh, oh, oh. Oh, oh, oh, oh, oh, oh. [00:22:20] Speaker 1: Ah. It takes them approximately three to six months to build up when they start this program. At six months, they're typically maxed out. If they're out for two weeks, they lose pretty much everything they gained. Oh, oh, oh. [00:22:40] Speaker 9: We have a family cemetery. And when you already got your plot picked out, at my age, it's kind of a scary thought, you know. [00:22:52] Speaker 20: I hope one day you get to see my grandchildren. I don't want to talk no more, OK? I'm sorry. Just give me a minute. I'm all right. If I can see my babies graduating from college, both of them. [00:23:30] Speaker 21: When people get the first stages of the disease, they require oxygen. [00:23:33] Speaker 19: Can you turn that oxygen back there? Just pull that little green handle. Just pull it, like, towards you. [00:23:40] Speaker 21: And then even the oxygen that you're adding to that person so that they can do more isn't enough. And so they're essentially suffocating while alive. Something seemed to change where people were more heavily exposed to, perhaps, more toxic dust and were getting this very severe form of the disease that, from my medical school training and from my past clinical practice, was rare. We didn't see that many cases of PMF. And it was something that we thought had been relegated to the trash heap of history. [00:24:13] Howard Burkus: The modern era of coal mine regulation began in the late 1960s, in part because 40,000 coal miners staged a wildcat strike in West Virginia, demanding government action on black lung. [00:24:27] Speaker 22: 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! [00:24:48] Howard Burkus: Congress responded with a tough new law that was supposed to protect miners from the coal mine dust that poisons lungs. And in the early '70s, a new federal research agency, NIOSH, began to monitor black lung disease among working miners. [00:25:04] Speaker 21: We saw a nice reduction in the rates of disease falling down to very low levels. And then that, I call it the U-shaped curve of concern. The curve went down and hit the bottom and then started to go back up again, meaning that something changed. We took our eye off the ball, something else happened, and the disease was recurring. [00:25:26] Howard Burkus: What changed was mining itself. Big and pure coal seams were mined out. Thinner seams embedded in rock were left. Mining machines cut more and more of that rock, producing fine and easily inhaled particles of silica, toxic dust that the existing mining regulations didn't directly control. [00:25:48] Speaker 21: Somewhere in the late 20th century, there has been a change in the composition of the dust. We're seeing more silica. And silica is 20 times more toxic than coal. When you inhale silica, it's retained in the lung. These miners are inhaling their workplace, and it stays with them forever. [00:26:06] Howard Burkus: By the mid-1990s, federal regulators knew there was a problem. NIOSH recommended new silica regulation, including an exposure limit, twice as tough. But the proposals didn't go anywhere. So you worked for the agency back in this timeframe? Mm-hmm. Celeste Monforten was a top advisor at the Mine Safety and Health Administration, or MSHA, at the time. She says the agency ran into opposition from the mining industry. [00:26:36] Speaker 23: Now we see in miners who were, again, working at that period of time, and now are the ones that are seriously ill from that disease. [00:26:49] Speaker ?: They're dying. Yeah. Terrible deaths. Yeah. [00:26:53] Speaker 23: Had we taken action at that time, I really believe that we would not be seeing the disease that we're seeing now. [00:27:00] Howard Burkus: It wasn't until 2014 that the Mine Safety and Health Administration, MSHA, put in place new restrictions on coal dust. But they didn't set specific limits on silica dust. Instead, they continued to rely on a flawed formula that they'd used for decades to measure silica exposure. What our data shows, what MSHA's data shows, is that that formula hasn't worked 9,000 times since 1986. We can see it in the data. It's kind of puzzling why they didn't see it in the data and why they don't think this is important enough to have a different kind of regulatory process. At the time, the coal mining industry actually proposed focused regulation of silica. Still, mining companies continue to cut thin seams and create toxic silica dust. [00:28:03] Speaker 5: We sympathize with those individuals, with those families. If we could turn back the hands of time, we would do so to prevent this. But, you know, we can't. We're dealing with historic exposures. And from our perspective, what we need to be focused on today is, how do we prevent a reoccurrence of this? [00:28:24] Howard Burkus: You can slow down the mining machines. You can maybe cut production a little bit so that you're not generating as much dust. Or maybe you decide that you don't cut so much rock and you don't cut those thinner seams. Aren't those things that mining companies could have done? You don't need regulation to do that. [00:28:44] Speaker 5: Sure, they could have done that. But again, Howard, I'm not going to speculate on why they did or didn't do what they chose. You know, our focus here is forward-looking. How do we prevent this in the future? I can't answer for those what occurred in the past. Were we really focusing on the right thing? You know, MSHA had a mantra, "end black lung." And we support that. But coal dust might not have really been where the focus should have been at that time. It might have been silica rather than coal dust. [00:29:22] Howard Burkus: In 2018, we tried for months to interview the head of MSHA about the PMF epidemic and the agency's decision to not directly address silica. [00:29:33] Speaker 24: The MSHA mission is to prevent death, illness, and injury from mining and promote safe and healthful workplaces for U.S. miners. A very honorable mission. [00:29:43] Howard Burkus: David Sateslow is a former mining company executive who was the head of MSHA at the time. We found him at a rare public appearance at West Virginia University. [00:29:53] Speaker 24: Silica is toxic to your body. You hear the phrase in health circles over progressive, massive, fibrosis, these sorts of things. To me, I believe those are all clearly silica problems. Silica is something that has to be controlled. [00:30:17] Howard Burkus: I was surprised that Tesla was so clearly connecting PMF to silica and wanted to know why this hadn't translated into direct action. Mr. Tesla, I'm Howard Berkus from National Public Radio and PBS Frontline. We've been interested in talking to you about progressive massive fibrosis and the epidemic of disease. I'm wondering why you're unwilling to speak with us about that. We've had multiple requests for interviews, ready to talk to you today, next week, in the past. [00:30:48] Speaker 24: I don't think the science is that well defined on it yet, Howard. [00:30:52] Howard Burkus: You have 2,000 miners right now. [00:30:55] Speaker 24: I don't think that the science of the causation is that well defined. [00:31:00] Speaker ?: I don't know. [00:31:01] Howard Burkus: You said yourself that silica was... [00:31:03] Speaker 24: No, I said I suspect silica. [00:31:05] Howard Burkus: We've interviewed dozens of coal miners and they've told us about their experiences. They all have progressive massive fibrosis. They're all dying from these diseases. So they've talked about their experiences. [00:31:15] Speaker 24: I'm supposed to go up here to this picture. [00:31:17] Howard Burkus: Why won't you talk to us about this issue? [00:31:19] Speaker 24: Because I don't think the science is settled on it. [00:31:22] Howard Burkus: What has that got to do with it? You have so much experience in this field as you just described. And you've described all these deaths that are occurring. [00:31:31] Speaker 24: Okay, let me put this right. I won't talk to you about it because I'm supposed to go be in a picture right now. [00:31:35] Speaker 25: I'm not accused of the students are waiting for sacrifice. [00:31:38] Speaker ?: Okay, we're finished there. All right, I'm pushed to the final three. One, two, three. [00:31:48] Howard Burkus: It would be another six years before regulators took action on silica dust. In 2024, the Biden administration put in place strict limits on exposure to silica dust in mines, and to every other industry. Violations could trigger fines and even shutting down mine sections with excessive dust. [00:32:12] Speaker 25: I, you know, took another look at some of the investigative reporting that you and others had done, Howard. And, you know, I knew that I wanted my signature issue and the thing that I wanted the agency to focus on while I was there leading it was improving the protections for miners, all miners, not just coal miners, from exposure to silica dust. [00:32:34] Howard Burkus: Christopher Williamson led MSHA in the Biden administration. He's the great grandson of a coal miner who had black lung. [00:32:42] Speaker 25: For me, it was just a great injustice that coal miners, metal non-metal miners, every miner in this country, the thousands of them that get up and go to work and do things that we wouldn't do for our benefit, did not have at least the same level of protection that every other worker in this country had. And I was going to try to do something about that. And I knew that it was going to be hard, but I knew that it was also going to take channeling the agency's entire focus and energy to do that. And that's exactly what we did. [00:33:14] Howard Burkus: But the new silica dust limits have never been enforced. The mining industry sued and a federal court suspended enforcement indefinitely as the Trump administration said it would consider changing the silica regulation. The administration has been focused on boosting coal mining with a pledge of nearly $700 million to keep coal-fired power plants running and coal exports flowing. At the same time, 2,000 new cases of black lung were reported by clinics last year alone. 1,700 black lung deaths were reported from 2020 to 2023. Jonathan Wright was diagnosed in 2023. He was x-rayed as part of a NIOSH black lung program. The agency used five years of x-rays like that for a study on the most up-to-date rates of disease. Last summer, with our partners at Public Health Watch, NPR, and the Appalachia Mid-South Newsroom, we obtained their latest findings before publication. They showed that the rate of disease in miners like Wright hasn't been this high since 1978. There is this new rate of disease that's being reported for miners exactly like you last year. Still working 25-plus years underground here in central Appalachia. And at the beginning of your career, that percentage was way down to like 1 in 10. Now it's 1 in 3. I'm just wondering what you think about that. [00:35:07] Jonathan Wright: I think a lot of it is just because of exposure of how much rock these mines are taking now. But it is crazy to think that they've just let it go. It seems like I've just not cared about it, you know, for the last 25 years to really do anything about it. [00:35:31] Speaker 6: Well, I have to say that I'm disgusted. But unfortunately, I'm not particularly surprised. [00:35:50] Howard Burkus: Scott Laney was the lead author of the NIOSH study. We filmed him back in 2018. This time, he wasn't allowed to go on camera. But we had already recorded a radio interview about the study. [00:36:05] Speaker 6: The reporting that we've done in the scientific literature, the reporting that you've done in the media predicted this was going to happen. And it's arrived. And what I'm reporting now or predicting now is that this is not going to get better because of all of the disease that's already in the pipeline. You know, these guys are being treated like disposable widgets, not human beings. And we're watching them die right before our eyes. [00:36:40] Howard Burkus: Ron Carson is now retired from running the Stone Mountain Black Lung Clinics. He still helps coal miners seeking federal black lung benefits. And he was stunned by the NIOSH findings when I saw him again in Virginia last summer. [00:36:54] Speaker 17: It just still amazed me after all these years that these conditions have not been improved. No one should have this lung problem from something that can be controlled. It just shouldn't be happening this way. [00:37:11] Howard Burkus: We were in kind of the same position in 2018 when we last, you know, talked to you and filmed you. Does it feel like deja vu to something? Absolutely. [00:37:21] Speaker 17: That's why a few minutes ago, I said, "Oh, my word." I'm reminiscing what it was like eight years ago. And for us to be sitting here discussing what we are talking about over the past eight years and nothing's been done, it just-- It's horrifying. It's horrifying. It's horrifying. Because we put the data out there. We put the facts out there. And something should have been done on a higher level to make sure that we wouldn't be here today talking about this. That's what's disturbing to me right now. [00:38:01] Howard Burkus: I repeatedly tried to get officials from MSHA to talk about the new reported rates of disease and the hold on enforcement of the silica rules, but they wouldn't agree to an interview or answer written questions. The leading mining industry trade group was willing to talk. The National Mining Association says it does not oppose the new limit on silica dust exposure, which is set at 50 micrograms per cubic meter of dust. [00:38:30] Speaker 13: They were getting ready for that 50, and they're headed in that direction. We didn't oppose the 50. That number, the industry has agreed to. It's how we get there. [00:38:40] Howard Burkus: Michael Peelish is a consultant for the association, and he told me the industry challenged the silica dust regulation in court because it wanted more flexibility with compliance. [00:38:52] Speaker 13: Michael Peelish: This is a sad excuse for a rule, in my opinion. It does not give the miners what they need. It doesn't give the operators the opportunity to comply in an efficient, effective way. Period. Okay? And if we had that ability to do that, that rule, I think, would be much more effective. [00:39:12] Howard Burkus: Peelish says the industry has done a lot already to protect miners. What's needed now, he says, is the ability to require miners to use dust masks or respirators when the other protections fail to keep dust controlled. [00:39:27] Speaker 13: Michael Peelish: Respiratory protection is critical. Respiratory protection, many industries, you've heard this before, who doesn't wear respiratory protection in industry if you're in a factory? Whether it's a respirator, whether it's hearing protection, whatever it might be. That's what we need to focus on at this point. [00:39:45] Howard Burkus: Michael Peelish: I have interviewed dozens and dozens of coal miners, probably more than 60, and have asked them specifically about dust masks and respirators. And almost every single one of them had a complaint. Too hot to work in. Filters don't filter out the finer stuff. They can interfere with their ability to communicate in an environment in which failure to communicate clearly could end up being killed. All kinds of complaints. So that would seem to make it problematic to require masks. [00:40:27] Speaker 13: Michael Peelish: Well, we don't stop at things that are difficult to do. We don't stop there. We are ways to get, you know, to make that occur. So I think it is a solution. And I think it is a workable solution. And I think it has to be enforced like any other regulation that requires it to be enforced. [00:40:48] Speaker 7: Michael Peelish: The bottom line for me is you cannot rely on respirators to protect coal miners. It is not going to be effective. It is not practical. And you worked as a roof bolter, shuttle car operator, scoop operator. [00:41:03] Howard Burkus: Drew Harris is a pulmonologist and medical director at Black Lung Clinics. A couple deep there. He's worked with hundreds of sick miners over the years. Does that sound okay? [00:41:13] Speaker 7: Yeah. All right. Whenever you're ready, you can start pedaling. You can slow down. We can ease off the resistance there. Every workplace should be providing for their workers a safe environment. And that requires, in coal mining, to have the right ventilation and have the right safety equipment and water sprays on the machines to keep the dust levels down. And we should not be relying on coal miners to wear respirators in any way, shape, or form as a primary means of protection. Because it is impractical for coal miners to wear these respirators. [00:41:52] Speaker 26: Now I'm going to have you finish this breath here in. Blow out a little more. And now big, deep breath in. Suck in, suck in. And blast it out hard. Keep pushing. Keep pushing. Keep pushing. Keep pushing. Keep pushing. All right. We've gone. [00:42:07] Speaker 7: You can't imagine a school teacher rate of one out of three getting this disease. The public would put their arms up and scream and stop whatever exposure it was until this got better. But this has been going on for decades. And we know why this is happening. And it is entirely preventable. And we aren't preventing it. [00:42:26] Howard Burkus: Why do you think there isn't more of an outcry? [00:42:29] Speaker 7: I think there's a lot of reasons why. The disease is entirely concentrated in central Appalachia. The vast majority of this disease is seen in eastern Kentucky, southwestern Virginia, and southern West Virginia. In central Appalachia, which is rural, where there are not a lot of advocates for the people who are living in these communities. There are very few people that stick up for these folks who are suffering. That is a big reason why that this disease continues to devastate this community. [00:43:05] Howard Burkus: At the end of September, miners and their advocates headed to Washington to try to appeal to members of Congress. [00:43:15] Speaker 27: And we have 25 seconds. So we're good. [00:43:19] Speaker ?: We're good. [00:43:20] Speaker 27: We're at this door. We have a big day ahead of us. If this is your first time going to the Capitol, raise your hand. Cool. Wow. [00:43:30] Speaker ?: Half. [00:43:31] Speaker 27: We were able to get over 30 people in the Black Lung Association from the four states to D.C. for one day of, you know, action. Usually we do this in smaller batches. So it was really great that we were able to get people to take time out of their work days, out of their lives to come here. [00:43:48] Speaker 1: I'm Congresswoman Summerlee's Policy Advisor. And I do want to say the Congresswoman really wishes she could meet with you all today. As you may have heard, the House is not in session. [00:43:56] Howard Berkus: The rules need to be strengthened to control Sylaga. [00:44:00] Speaker 27: We could better fund the clinic so they can hire more counselors to help people. We're making it. We're surviving. But we need help. You know. [00:44:09] Howard Burkus: The group then gathered in a Senate hearing room for a forum on Black Lung. [00:44:14] Howard Berkus: And I'm telling you, the epidemic we got now, we're going to see younger and younger to be dying. They're going to leave young children behind. Young children. They're not going to be able to see graduate, get married, go to college. And we have got to do something in every co-state in the United States and say, we got a voice, we're going to do it, and we're not stopping. We're going to have to stop it. [00:44:40] Speaker ?: We're going to have to stop it. [00:44:56] Howard Burkus: On my most recent reporting trips to Central Appalachia. [00:44:59] Speaker 11: Hey. Hey, Howard. Good to see you again. Good to see you. [00:45:03] Howard Burkus: I stopped in to see radiologist Brandon Crum again. He's continued to test coal miners and collect detailed data. Wow. [00:45:14] Speaker 11: What do we have here? What does this tell us? So I think this tells us more about Black Lung and Central Appalachia miners probably than any data collection in the world. I think it's the most complete data collection on Central Appalachia miners that we have currently. [00:45:32] Howard Burkus: It seems that the numbers that you're showing here, which you're getting to with your latest data over here, you're talking, what's the total number over 1,000? [00:45:42] Speaker 11: It's going to be about, altogether when we get, it's probably going to be about 1,300 guys total. And then out of those 1,300, we're looking at about 238 cases of complicated. So these are miners who are all sick with this disease. Some of them are already at the advanced stage. Others will likely get to the advanced stage, right? Oh, yeah. Even if they didn't mine another lump of coal tomorrow, you would be dealing with this. problem for decades to come. [00:46:12] Howard Burkus: I also wanted to visit miner Danny Smith. But he was too sick for an interview, he told me. He was too sick to even get through a phone call. The last thing he told me eight years ago was that he wanted to live long enough to see his two daughters graduate from college. And they both have. Greg Kelly was in much better shape. Hi. [00:46:45] Speaker ?: Hi. How are you? Great to see you. [00:46:48] Howard Burkus: Good to see you. [00:46:49] Speaker 15: You look great, man. I feel great. Man, you look so much better. [00:46:52] Howard Burkus: I like your shirt. Yeah. [00:46:54] Speaker ?: My lungs are Vanderbilt. [00:46:54] Howard Burkus: He's got the data on one guy. Installed 8/10/2021. He had a double lung transplant in 2021, something very few coal miners have had. [00:47:13] Speaker 15: The surgeon, when he talked to me, he said, I had to scrape your lungs out. He said, I couldn't even pick them up. He said, that's how bad it was. He said, you coal miners are extremely tough to do lung transplants off. He had to scrape your lungs out? Yeah. He said, he couldn't just pick them up, you know, and move them out. They take them out one at a time. But when they did this one, they scraped it up, replaced it, and had to scrape those up because he couldn't pick it up. So what have you got here? It's the medication I have to take every day. It's like 38 pills a day that I have to take. That's the morning dose right there. There's a lot of vitamins and the rejection medicine. Every morning you've got to get up, write down your vitals, your blood pressure, what your sugar level is. Of course, it messes with your sugar. What my sprung tree is, I have to blow and see what my, whatever I'm putting out with this right here. Put it on and it reads it. And then you have to take your pulse off. I just, I've been doing that for five years. When I get out of bed, that's one of the first things I do. [00:48:16] Howard Burkus: How is it different now in terms of your ability to breathe and do things? [00:48:20] Speaker 15: Oh, it's, it's entirely, it's like daylight and dark. Just like it happened to me, then when I got new lungs, it was, I got, I got a new life. I was able to do the things that I wanted to do when, you know, when I said, well, I'm going to, I'm going to be able to retire, you know, then I could go fishing and I do my gardening and stuff like that. And I get to play with my grandkids, you know, that's, I got, you see, kids that I might [00:48:49] Speaker 12: not have. If I hadn't got these lungs, I wouldn't be here. [00:48:57] Howard Burkus: You know, what's amazing to me is you lived to see this, to have another grandson. Here we go. [00:49:06] Speaker ?: Here we go. Here we go. Here we go. Here we go. Here we go. [00:49:11] Speaker 22: Here we go. Here we go. [00:49:13] Speaker ?: Here we go. Here we go. Here we go. Here we go. Here we go. Here we go. [00:49:19] Speaker 15: Here we go. Here we go. Run. Run around the base. [00:49:23] Speaker ?: This way. [00:49:24] Howard Burkus: He's had five more years so far, but he knows the median life expectancy for coal miners with new lungs is just six and a half years. [00:49:37] Speaker 12: I mean, I ain't got a lot of money, but I'm the richest man on this house. Because I got a family that loves me and grandbabies that enjoy me and I enjoy them. And, I mean, what more could you want? How much more could you want? [00:50:23] Howard Burkus: Forgive me for asking this question this way. I've talked to dozens of coal miners who have black lung disease, started out some of them, you know, with simple, developed into complicated. It got a lot worse and a lot worse than what you've described that you're thinking about. Yeah. And they have a pretty fearful picture of their future. Because they've seen relatives die from black lung and it can be pretty grim. I mean, you know that, right? [00:50:58] Jonathan Wright: I don't like to think about it, but I do know, I do know that. Like I said, I don't want to get to where I'm a burden on everybody else, you know, because I can't do for myself. You know, it'd be tough to get to that point after you've tried to do for yourself your whole life, you know. But I do know what the end cause is going to be. I mean, I know it's coming. I don't like to think about it. But I do know that's the end result. I do know that. [00:52:08] Speaker ?: I do know that. [00:52:14] Speaker 28: Corporate support for Frontline was provided by The Economist. Go to PBS.org/Frontline for a Q&A with correspondent Howard Burkus. I've been in and out of Appalachic going back 15 years. And for more reporting with our partners. [00:52:39] Speaker 7: We know why this is happening and it is entirely preventable and we aren't preventing it. [00:52:46] Speaker 28: Connect with Frontline on Facebook and Instagram and stream anytime on the PBS app, YouTube, or PBS.org/Frontline. Frontline Online's Kohl's Human Cost is available on Amazon Prime Video. [00:53:03] Speaker 18: And we'll see you next week. [00:53:04] Speaker ?: We'll see you next week.