Mason Adams Published

How A Reporter’s Investigation Of Appalachia’s Black Lung Epidemic Pushed Federal Officials To Respond

Two hands are seen holding a dusky mask that is almost black.
Retired coal miner Danny Johnson holds a protective mask that used to be white, but turned gray and crusted with dust during one working shift in a mine. Johnson was diagnosed with the advanced stage of black lung disease 11 years ago.
Roger May/Mountain State Spotlight

Updated on Oct. 10, 2023 at 11:30 a.m.

This story originally aired in the Oct. 8, 2023 episode of Inside Appalachia.

The coal-producing regions of central Appalachia are at the center of an epidemic of advanced black lung cases among coal miners. New reporting by a retired NPR reporter has shown how federal officials underestimated the sheer number of cases across West Virginia, eastern Kentucky and southwestern Virginia, and now regulators seem to be responding.

Miners are suffering from an advanced version of black lung disease known as progressive massive fibrosis.

It’s the result of digging at increasingly thin coal seams. That means they’re also cutting into quartz, which creates silica dust.

Advanced black lung results from breathing in that blend of silica and coal dust. 

Retired NPR reporter Howard Berkes has been covering this story for years.

He worked with NPR and the PBS series Frontline, and spent more than a year investigating fears that federal regulators and mining companies were failing to protect coal miners from toxic dust.

He and his team obtained documents and data showing federal mine safety officials had evidence of the danger dating back more than 20 years, but never addressed it.

A photo of Howard Berkes from the field. He holds a shotgun mic and wears over the ears headphones.
Howard Berkes spent 38 years as an NPR Correspondent. His investigative reporting exposed an epidemic of advanced black lung disease affecting thousands of coal miners, and decades of failure of federal regulators to take steps to prevent it.

Credit: Wanda Gayle

In 2018, Berkes reported that more than 2,000 miners were dying of illness related to that toxic dust. Since that story aired, at least four of the miners in it who appeared have died, and at least two have received double-lung transplants. Danny Smith, who was prominently featured, is being assessed for a double-lung transplant.

A closeup of a man in a ball cap with an oxygen tank.
Danny Smith spent just 12 years mining coal in eastern Kentucky and was diagnosed with the advanced stage of black lung disease at 39. Both are shocking numbers because it used to take decades of mining for coal miners much older to get as sick as this.

Credit: Elaine McMillion Sheldon/PBS Frontline

Lately, the metallurgical coal industry has been ramping up production to meet global demand, and experts predict even more advanced black lung cases will appear. After years of inaction, though, federal officials are addressing the issue.

Over the summer, the Mine Safety and Health Administration proposed a rule intended to protect coal miners from exposure to silica dust. By the time the comment period closed in September, the draft rule had attracted 157 comments.

Now, Berkes is part of a new investigation into advanced black lung cases that was co-published by Public Health Watch, Louisville Public Media and Mountain State Spotlight. Inside Appalachia Host Mason Adams spoke with Berkes about what his team found.

A wall featuring the photographs of dozens of coal miners.
The New Beginnings Pulmonary Rehab Clinic in South Williamson, Kentucky, features photos of coal miners with advanced black lung disease, including those who have not survived.

Credit: Elaine McMillion Sheldon/PBS Frontline

The transcript below has been lightly edited for clarity.

Adams: So your work in the past, your investigations have in the past have seemed to have resulted in some action. Now MSHA has proposed some new regulations for monitoring silica dust.

Berkes: Yeah, MSHA has taken two very significant steps in this proposed rule. One is to make the exposure limit for silica dust twice as tough as it has been. That was recommended by the National Institute for Occupational Safety and Health back in 1974, and it was recommended again by the Labor Department’s own mine dust advisory committee in 1996.

It’s taken all these years for MSHA to finally adopt what has been long recommended, this tougher limit to exposure to silica dust. That’s a major, major improvement. The second thing that they did is that they decided to regulate overexposure to silica dust directly. In the past, they applied a complicated formula: If a mining company had too much silica dust, then the mining company had to lower the amount of overall mine dust, coal dust and silica dust in the air. That was supposed to bring down the silica dust exposure to an acceptable level. But it’s not a one-to-one relationship.

What we found in our previous investigation was 9,000 overexposures to silica dust, even after the mining companies responded to the regulation that was in effect at the time. So now MSHA is directly regulating silica dust. There can be citations and fines associated with exceeding the silica dust level, that has never happened in the past. So those are two very promising elements of this proposed rule.

A sticker is seen that reads "If it's Silica, It's Not Just Dust." The image on the sticker shows a cartoon coal miner breathing in red dust.
This slogan appeared in a Department of Labor document warning about silica dust exposure in workplaces, including mines, in 1997, 26 years before the Mine Safety and Health Administration proposed tougher restrictions on exposure to silica dust.

Credit: Mine Safety and Health Administration

Adams: There have also been some criticisms of the proposed rule as well.

Berkes: Yeah, mostly on enforcement and oversight. There really is no regular oversight built into the rule. The rule requires mining companies to conduct an enormous amount of sampling of dust, and to record the results of those samples. If they show that there’s overexposure to silica dust, the rule requires that the mining companies then make changes in the way they’re mining so that the silica dust is reduced. There are various things that can be done: they can increase the ventilation, they can make sure that their water sprays on the mining machines are working properly. Those are two key elements in managing dust in coal mines. They can slow down the mining machines and not mine so quickly. They can stop mining a seam that has so much quartz in it. Those are all things that mining companies are required to do once there’s excessive dust. And while they’re doing those things, they’re allowed to continue to mine. 

They’re allowed to let miners continue to work in what are dangerous levels of dust. But miners must wear respirators; that has its own set of problems. We’ve interviewed dozens and dozens of miners since 2016, and they all complain about the dust masks not working properly clogging up, inhibiting their breathing, getting too hot, inhibiting their ability to communicate with fellow miners in a very dangerous environment.

There are new helmets out that are very effective for protecting miners from dust, but they can block vision and can block communication in ways that can become dangerous in a coal mine. The main problem with all of this is that MSHA is not going to be watching all the time. Mine inspectors only go into coal mines four times a year, and they’ll do their own sampling when they’re in there. They can ask to see the results of the sampling the mining companies have done. But what this means is that most of the time, there will be no Mine Safety and Health Administration oversight and enforcement of this new rule. It’ll be up to the mining companies. And as coal miner after coal miner after coal miner who we’ve interviewed over the years will tell you, some mining companies have conducted fraudulent sampling over the years. As recently as last year, there was a criminal prosecution in Kentucky for fraudulent dust sampling.

Two cases are shown with freeze-dried human lungs. The case on the left features a normal looking lung that looks mostly white. The case on the right features a lung that is almost black from black lung disease.
A display at the National Institute for Occupational Safety and Health in Morgantown, West Virginia shows how much damage results from exposure to coal and silica dust.

Credit: Howard Berkes/NPR

Adams: MSHA has been collecting comments on these proposed rules and they’ve been hearing from miners and advocates in the coal industry. By the time this segment airs, that comment period will have come to a close. But in the last few days, Public Health Watch has published a new investigation with Louisville Public Media and Mountain State Spotlight that calls into question some of MSHA’s projections on which it’s basing this rule. Can you tell us a little bit about that investigation and what your team found?

Berkes: Sure. One of the things that really struck me in the very extensive and dense document that MSHA has produced to justify what it wants to do, is they project how many lives will be saved, and how much disease will be avoided if this new rule is permitted to take effect. What really shocked me was that the projection for coal mines was 63 deaths avoided over 60 years — a little more than one a year — and 244 cases of black lung disease avoided over 60 years. That just doesn’t make sense, given how much disease has actually occurred, which MSHA never mentions in its document. And so we calculated how much disease has occurred by continuing our survey of black lung clinics — both independent clinics and clinics that are funded by the federal government.

What we found, which MSHA doesn’t mention, is that in just the last five years, there have been 1,500 new cases of progressive massive fibrosis, the advanced stage of black lung disease, as reported by these clinics. The total since 2010, since that’s as far back as we go in our survey of clinics, is over 4,000 cases of this horrific, fatal disease. There is no cure. We also, by the way, looked at how many excessive exposures there have been in coal mines in recent years. At the new limit — say the new limit was in place since 2016 — we found over 5,000 excessive exposures at the new limit.

A pie chart showing new PMF cases since 2018 by state.

So what these numbers sort of provide is a sense of how serious this situation is, how much over exposure continues to occur, and how much disease continues to occur. That’s not in this proposed rule making. In fact, the numbers presented for silica dust exposure since 2016 by the Mine Safety and Health Administration, they just have numbers from 2016 to 2021. They don’t report how many excessive exposures there were in this document. They report that there were 93 percent of exposures that were within the limit. Well, that sounds like a great number, 93 percent. It sounds like, “Oh, things aren’t so bad.” But that other 7 percent represents more than 5,000 excessive exposures. And because this is such a toxic substance, that’s a lot of potential disease and death. You got to understand that for proposed rule making that this process involves.

A man in a red tie and formal suit holds a microphone. A flag is behind him.
Federal Mine Safety Chief Christopher Williamson addresses a crowd gathered in Arlington, Virginia, on Aug. 3, 2023, for a public hearing on proposed silica dust regulations. Williamson is the first mine safety chief to directly address overexposure to toxic silica dust.

Credit: Justin Hicks/Louisville Public Media

So right now, it’s proposed, you mentioned that there’s this comment period that has taken place, that the industry and the public and mine safety advocates and miners get to comment on it. Before there’s a final rule, the Department of Labor has to approve whatever the final rule might be. The Office of Management and Budget has to approve this final rule. We’ve got an election year coming up. There’s often sensitivity from the White House and the Office of Management and Budget on anything that might make voters not vote for candidates that the administration supports or might not vote for the president again, if there’s something in this that offends them.

I’ve seen this happen in the past, where regulatory action was stalled in order to hold off until after an election. There may be other reasons that there could be concerns or objections, budget-wise or otherwise, from the impact on the industry. So it’s important, if you’re going to state your case, to state it as strongly as possible. This rule making does not state that case as strongly as possible. There may be lawsuits from the mining industry over this. So it’s puzzling to me why they didn’t do that. When we asked the Mine Safety Administration, they said, “The comment period exists so that people can tell us what we might need to do better. And this will be one of the things that we consider if people comment on this.

A map of the United States with several dots showing coal mines with silica dust from August 2021 to August 2023.

Adams: It’s mind-blowing to think that this represents thousands of people. And behind each of these numbers is a human being. You’ve interviewed dozens of these miners. What have you taken away from those interviews that’s not necessarily reflected in the data?

Berkes: I want to point out that every one of those miners had progressive massive fibrosis. We interviewed miners who had the worst stage of disease. One of the things they all talked about was what their prospects were for the future. Many of them watched fathers, brothers, uncles, grandfathers die of black lung disease, and so they know what they face. This is a tragedy that strikes generations and families: Fathers that won’t see their kids grow up. Fathers that won’t see their daughters at their weddings, won’t see high school graduations. And actually, it’s not just men, there are women miners with this disease as well.

The tragic nature of this is just so astounding and moving and deep. When you talk to a miner with severe disease at advanced stages, they can hardly get a sentence out without coughing or without having to pause for very deep breaths. A miner in my story, Danny Smith, who was diagnosed at 39, he’s 51. Now, he has his grave site picked out. I tried to call him in the last couple of weeks, and his breathing is so labored, he said he can’t get through a phone call. So we were communicating by text message.

Several lung x-rays are shown on a screen.
Lungs riddled with fibrotic tissue from complicated black lung disease are displayed in the office of radiologist Dr. Brandon Crum in Pikeville, Kentucky.

Credit: Elaine McMillion Sheldon/PBS Frontline

Danny was featured in our 2018 story. We’ve been in communication since then. And he’s in terrible shape, and it’s so bad. He loved coal mining, but it’s so bad. He said now he wishes he never stepped foot in the mine. And this was a job he loved. It was a job that made a good life for him and his daughters. He’s a single parent. And there’s an enormous amount of regret, of buying into this bargain of a great life for mining coal. You know, part of what I don’t understand is, in any other workplace in our country, if you had thousands and thousands of people who were sick and dying from a disease, there would be outreach, and there would be response, and there would be response quicker than what has come.

I don’t know why people don’t seem to care about coal miners. There are 40,000 coal miners still working today. I don’t know what it takes to get a response that gets this going in a way that really protects and helps coal miners. But they are people like you and me who have done a job to make lives better for their families. They’re caught up in this whole thing and it’s killing a lot of them.

A coal miner sits in a booth and takes a breathing test.
Retired coal miner Roy Keith undergoes a spirometry test at the New River Health Clinic in Oak Hill, West Virginia as part of the process of measuring lung capacity and diagnosing the onset of black lung disease.

Credit: Allen Siegler/Mountain State Spotlight

Adams: Howard Berkes, thank you for your important work on this topic. This is an important subject that has such a deep, deep impact here in central Appalachia. Thanks for coming on Inside Appalachia and speaking with us about it. 

Berkes: Always a pleasure to be with you.

A statue of a coal miner.
A statue at the courthouse in Grundy, Virginia, honors the coal miners of Buchanan County.

Credit: Howard Berkes/NPR


After the Public Health Watch/Louisville Public Media/Mountain State Spotlight investigation documenting thousands of advanced black lung cases was published in August, mine safety advocates and Congress members cited it in comments to MSHA about its proposed silica dust rule.

MSHA responded with a statement that said the agency was considering “suggestions that the [proposed rule] underestimates the benefit” as it develops a final version of the rule.

***Editor’s Note: The U.S. Mine Safety and Health Administration collected 157 comments on its proposed silica dust rule. A previous version of this story misstated the number of comments the agency received.