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Cabin Creek, an unincorporated community in West Virginia, claims the legacy of the mine wars and labor struggles in the early 1900s. More than a century later, doctors, nurses, and social workers still fight for miners at the Cabin Creek Health Clinic, built in the 1970s as an outgrowth of a miner-led movement to recognize the existence of this occupational disease.
Every few weeks, a handful of former miners get tested at the clinic for signs of black lung. Patients perform breathing exercises as nurse Krista Critchfield instructs. These exercises are meant to exert the lungs to their limits.
“Big deep breathe in… blast it out,” Critchfield yells.
One patient, 74-year-old Roger DeWeese, sits inside a “body box.” It is a clear tube in the shape of a telephone-booth that gauges how much air he inhales and exhales. It’s a tight fit for DeWeese. He’s 6-foot-1.
“I do get short of breath rather quickly,” DeWeese said.
DeWeese lives near Belle, outside of Charleston. He worked in the mines as an electrician for 32 years.
He has been diagnosed with black lung. The state has assessed him at a 10 percent impairment, but DeWeese knows that can worsen over time.
“It’s like sandpaper or sand. It just keeps moving in your lung. And that keeps getting worse and worse,” he said.
He is getting screened to see if he is eligible for federal black lung benefits, which are all or nothing — you are either declared fully disabled, or not.
Dr. Carl Werntz has screened patients like DeWeese for over a decade. First, he asks them about their respiratory health and their mining career.
“A longer time in the mines is more likely to cause black lung,” Werntz said.
Time spent underground is just one factor. Werntz said the kind of dust a miner breathes is also important.
“If they were mining a lot of sandstone or other things with silica in them, then that person’s at much greater risk, and then would get black lung with less exposure,” he said.
Exposure to silica, the dust produced from rock drilling, is even more harmful to the lungs than coal dust, and experts say it is a major factor in the rise in black lung cases in recent years.
A 2018 federal study by the National Institute for Occupational Safety, or NIOSH, found one in five central Appalachian career miners had black lung. This was the highest prevalence ever recorded since the lung-screening program started in 1970.
Werntz never expected to see an increase in black lung patients over the last two decades.
“When I was a resident in 2000, black lung was a disease that was going away. This is going to be gone by the end of your career,” Werntz said. “Currently the rate of advanced black lung is higher now than it was when they passed the Mine Safety Act in 1969. That’s crazy.”
Miners who started their careers in the ‘90s faced a very different work environment than their predecessors. That is when new equipment allowed miners to dig further into rock to access thin seams of coal.
Tapping into these seams of metallurgical coal, used to make steel, can still be profitable, even if it takes some extra digging. In the first quarter of 2021, the price of American metallurgical coal exports was twice that of thermal coal.
“Economically you can afford to mine it. If it was coal to make just electricity, it’s too thin, it’s not worth mining,” Werntz said.
The federal standards regulating dust exposure in the work environment are nearly 40 years old.
“We’ve got a 1980s standard based on one mine dust from the 1980s. And now we’ve changed the nature of the dust in the mine, and we haven’t changed the standard,” Werntz said.
NIOSH says the limit should be reduced by half. The Department of Labor’s inspector general said the same thing. But these officials don’t have the final say. The federal Mine Safety and Health Administration does. While this agency has acknowledged these requests, it has not changed anything yet. Why?
“It’s complicated to go from science to policy,” Werntz said.
Black lung benefits
When Werntz sends his diagnoses off, the Department of Labor takes it from there. Qualifying miners receive a monthly check and lifelong medical coverage for their lungs.
Counselors like Beverly Lawrence help usher miners through what can be a complicated back and forth with the Department of Labor.
“Most of our miners, they either have a limited education, or they just don’t like to deal with paperwork,” Lawrence said. “So we try to tell them don’t get discouraged. Bring us what you got. And we’ll try to explain it as simply as we can. That’s what we’re here for.”
But some miners will need even more help. That is when Lawrence refers them to a lawyer like Sam Petsonk who takes black lung benefits cases. He has represented miners for 15 years, including Blackjewel miners that went on strike in recent years.
“The system is there to provide stability to people,” Petsonk said. “My job as a lawyer is not only to ensure that it does that, but to inspire confidence in the mining public that this system is here to protect you.”
Petsonk has a lot of opinions on how the system could be improved. He and advocacy groups call for higher coal excise taxes to better fund the program, which is billions of dollars in debt.
More miners have qualified for benefits in recent years.
“During the 80s, in the 90s, less than 10 percent of federal black lung claims were awarded. After the Affordable Care Act was enacted, the award rate has jumped up to around 30 percent,” Petsonk said.
Of those awarded benefits, almost half enlist a lawyer. Petsonk can step in when a miner is taken to an appeals court by the feds or coal company.
But he is concerned that even those who are entitled to lifelong free pulmonary care may not be getting it. They might pay out of pocket instead of using their benefit card. Or forgo treatment because they do not realize they are entitled to medical coverage, in addition to cash payments upwards of $700 a month.
Petsonk has heard from some qualifying miners that they never have received their medical cards in the mail. He recently wrote to the federal government asking about these missing cards. It is one way he is pushing the system to live up to its promises.
“Most of us don’t understand how our insurance works. And, you know, frankly everybody could benefit from having a claims advocate when they go to the doctor.”
Legacy of the Black Lung Movement
Elsewhere in Cabin Creek, the Zion Assembly Church of God serves more than the spiritual needs of the community. The Kanawha County Black Lung Association hosts monthly meetings at the church to discuss advocacy opportunities for miners with black lung.
In August, the group held a cookout to thank its dedicated members and encourage more miners to join.
Former miner Gary Hairston, the president of the National Black Lung Association, was assigned to grill duty.
He first got involved through monthly meetings of his local chapter of the Black Lung Association held in Fayette County.
“We talk about black lung and what we can do, how to help people get what they need to get,” Hairston said.
There, he learned how to file for his own black lung claims, find a lawyer, and organize on behalf of others.
Groups like this exist throughout the state because of a grassroots movement in the late 1960s, when miners, doctors, and politicians banded together to pressure the federal government to recognize the existence of black lung, and the need for a compensation program for those it disabled.
“They make it a lot easier for people around in the area. They can go to these places, and not way out of town, when we got them right here,” Hairston said.
Not far away sits a historical marker describing the labor struggles coal miners faced here in Cabin Creek during the mine wars of the early 1900s. Occupational safety in the mines has come a long way since then, but the black lung clinic and the community around it still stand as a testament that the fight for miner safety is never done.
This story was produced by Appalachia Health News, a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.