A bipartisan group of U.S. Senators have introduced a provision that aims to boost participation in black lung detection programs.
Virginia Democrat Sen. Mark Warner introduced the amendment Wednesday into the defense, labor, health and education spending package that is being debated on the Senate floor.
If passed, the provision would require the National Institute for Occupational Safety and Health or NIOSH to create a report for Congress within 180 days detailing how to increase participation in black lung screening programs.
The report would specifically focus on NIOSH’s Coal Workers’ Health Surveillance Program, which offers free black lung screenings. Currently, only 35 percent of active miners participate and the percentage of retired miners is even lower.
The report would also aim to identify what barriers deter coal miners with black lung from getting treatment. The amendment does not provide any new funds for the report, but instead directs the agency to use money already appropriated by Congress.
The amendment comes at a time when cases of black lung are at a 25-year high, according to a recent study published in the American Journal of Public Health.
In a statement, Warner said improving outreach efforts would help more miners get screened.
“Black lung is a deadly disease, but the earlier it’s detected, the better the outcomes are,” he said.
A bipartisan group of six lawmakers co-sponsored the amendment, all hailing from Appalachia. They include Sens. Shelley Moore Capito (R-WV), Tim Kaine (D-VA), Joe Manchin (D-WV), Bob Casey (D-PA) and Sherrod Brown (D-OH).
The National Institute for Occupational Safety and Health, or NIOSH, is providing free Black Lung exams in four West Virginia towns.
NIOSH’s Mobile Occupational Safety and Health Units will set up in Ceredo in Wayne County, Delbarton in Mingo County, and Man and Logan in Logan County.
The free screenings will be available next week from Monday, March 26 through Friday, March 30.
The announcement was made in a news release from U.S. Sen. Joe Manchin’s office.
Miners are urged to call 1-888-480-4042 to make an appointment. Walk-ins will be taken as time allows. According to NIOSH, the exam typically takes 30 minutes and includes a short questionnaire, blood pressure screening, a chest x-ray, and a breathing test. Participation is free and the results are confidential.
NIOSH Black Lung Clinic Schedule:
Monday: Ceredo City Hall, 700 B Street, Ceredo, WV 25507 from 8 a.m. to 6 p.m.
Tuesday: Old Burch Elementary School, 1891 Route 65, Delbarton, WV 25670 from 8 a.m. to 7 p.m.
Wednesday: Mountain Mart Village Shopping Center, 80 Huff Creek Highway, Man, WV 25635 from 8 a.m. to 7 p.m.
Thursday & Friday: Walmart – Logan, 77 Norman Morgan Blvd., Fountainplace Plaza, Logan, WV 25601 from 7 a.m. to 7 p.m. both days.
At the age of 38, a coal miner named Mackie Branham Jr. was diagnosed with progressive massive fibrosis, a debilitating and terminal form of an illness that was supposed to be a disease of the past — black lung. But Branham is among many the miners afflicted by a resurgence in the disease, and officials are just beginning to realize the scope of the problem. A review of health clinic records shows roughly a thousand such cases, many times more than federal officials had thought existed.
Credit Benny Becker / Ohio Valley Resource
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Ohio Valley Resource
Mackie Branham, Jr., was diagnosed with the complex form of black lung at age 38.
"The more I talk, the more I get out of breath." – Mackie Branham
Driving into Pike County, Kentucky, the welcome sign tells you that you’ve entered “America’s Energy Capital.” Sheer rock walls line the highway, evidence of a community that’s extremely skilled at cutting through mountains.
Pike County is in the heart of the central Appalachian coalfields, and it’s home to the offices of Dr. James Brandon Crum, a radiologist who often reads the lung X-rays of coal miners. Last July, he reached out the National Institute of Occupational Safety and Health (NIOSH) because he’d noticed a disturbing trend among his patients.
According to a NIOSH study published this month, Crum found the worst form of black lung disease in 60 patients in a period of 20 months. That’s more cases than the NIOSH black lung surveillance program had identified nationwide since 2010.
One of the study’s co-authors, NIOSH epidemiologist Scott Laney, described the rate of severe black lung at Crum’s clinic as “unprecedented by any historical standard.”
Mackie Branham Jr. is one of the 60. An X-ray of his lungs shows that they’re littered with dark splotches, the scar tissue that’s built up around deposits of coal and rock dust. With his diagnosis, Branham was told he couldn’t go back to working in the coal mines. That meant no more paychecks and the beginning of an extremely difficult period for Branham’s family.
Credit Benny Becker / Ohio Valley ReSource
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Ohio Valley ReSource
The Branham family.
"I can no longer provide for my family." – Mackie Branham
Branham’s work-history lines up with many of the reasons the NIOSH study suggests could be causing the uptick in severe black lung in younger miners. As a self-described “company man,” Branham did whatever the company asked, and that often meant extremely long hours. He often missed birthdays and holidays to pick up extra shifts. He’d sometimes work more than 24 hours straight. Longer hours likely go part of the way to explaining how a 38-year-old can have lungs worse than many retired miners.
The NIOSH report suggests another piece of the puzzle could be the popularity of a technique called slope mining, which involves making a long cut through rock in order to reach a coal seam. In central Appalachia, this usually means cutting through sandstone. Sandstone breaks down into silica dust, which can be much more harmful than coal dust. Branham said he once spent six straight months making this kind of cut, regularly working shifts as long as 16 hours.
The report also suggests that the recent downsizing of the Appalachian coal industry could be playing a major role in this new spike of diagnoses. In today’s coal landscape, laid-off miners have little hope of getting rehired, and that’s created a new incentive for miners to get tested and apply for benefits.
Branham’s black lung is so severe that he wouldn’t be able to work even if there were mines hiring. But he said he’s also affected by the continuing layoffs. As he sees it, laid-off miners have few options besides applying for black lung benefits, and that flood of claims has put him further down the list, forcing him to wait longer before he can hope to receive benefits.
Credit Benny Becker / Ohio Valley Resource
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Ohio Valley Resource
Amber and Mackie Branham.
'I make in a week what he made in two days.' – Amber Branham
Mackie Branham Jr. lives with his wife Amber and their five children. The family has a lawyer, and has been fighting for benefits since March, but they’ve not yet seen a dime. Branham says that his former employer, Alpha Natural Resources, has been fighting him every step of the way.
Coal companies have long been notoriously aggressive in fighting black lung claims. Branham’s condition is pretty clear-cut since he’s disabled and isn’t a smoker. But he still had to get opinions from seven doctors to make it through the process. In the meantime, it’s been hard for his family to get by. He tried to get government benefits, but was turned down for both unemployment and disability. His wife has been working over 60 hours a week as a waitress, and yet Branham said he’d likely be homeless if not for help from his family and a very kind landlord.
"We're having a lot more severe black lung than even our worst nightmares." – Attorney Evan Smith
The NIOSH study found 60 cases of the worst form of black lung diagnosed at Dr. Crum’s clinic since 2015, and characterized that as a “resurgence.” With help from the ReSource, NPR found 392 additional cases in the same period at clinics across the region. Clinics noted over a thousand cases since 2010, which is more than double the number of cases that NIOSH’s black lung surveillance programs have found in the last forty years.
A growing number of miners with the worst form of black lung is likely to create challenges for families, communities, and the region as the whole. Coal companies responsible for paying benefits could face a growing cost in an already difficult market. Taxpayers and the federal government could end up bearing more of the burden.
Credit Howard Berkes / NPR
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NPR
Mackie Branham views a lung X-ray with Dr. James Brandon Crum, who was among the first physicians to note an uptick in black lung diagnoses
Branham’s former employer, Alpha, recently emerged from bankruptcy, and is still responsible for his benefits. In the recent wave of coal bankruptcies, some companies have shed their liabilities to pay black lung benefits. When that happens, any black lung claims that company would have been responsible for are transferred to the federal black lung benefit fund. That’s what happened when Patriot Coal, once a major employer in the region, shifted about $62 million in liabilities onto the black lung benefits fund.
Credit Alexandra Kanik / Ohio Valley Resource
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Ohio Valley Resource
Benefits in Question
The federal government started paying black lung benefits in 1969 after thousands of striking miners demanded that black lung be recognized as a condition that deserved worker’s compensation.
The system has gone through a lot of changes in the years since, including changes to the requirements to receive benefits and how the costs are spread between taxpayers and coal companies. But since the 1980s, there had been one steady trend from year to year: a decrease in the number of living beneficiaries, and the amount of benefits getting paid out each year. That’s what you’d expect given the number of regulations intended to limit exposure to coal dust.
But in the last few years, the number of black lung claims has been increasing.
Credit Alexandra Kanik / Ohio Valley Resource
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Ohio Valley Resource
The new surge in the worst forms of black lung is more evidence that these regulations haven’t been working as well as they were intended to. Coal mines can be an extremely cost-conscious and productivity-oriented environment, and for years there have been widespread and well-documented cases of mine operators cutting corners and ignoring safety regulations.
A new dust rule may finally address some of the issues causing the current uptick, but because black lung is contracted through years of exposure, it’ll be at least a decade before anyone can tell if things have improved.
In the meantime, some in the region are concerned about the future of the federal black lung benefits fund. Among them is Evan Smith, an attorney at the Appalachian Citizen’s Law Center in Whitesburg, Kentucky, and the man behind blacklungblog.com. Smith said the recent bankruptcies and the increase in black lung claims could put the fund at risk.
That’s especially worrying since the fund will also be losing income as the per-ton tax on coal that supports the fund will fall along with declining production. A temporary increase in the tax is also set to expire in December, 2018. Members of Congress have asked for an updated report on the fund’s viability.
Federal black lung benefits have been been a major income source in the Ohio Valley region. Since 2009, Ohioans have received more than $95 million in federal black lung benefits. In Kentucky, the amount is over $230 million. And in West Virginia, federal black lung benefits have paid out more than $300 million. This money goes straight into the pockets of black lung beneficiaries and is one of the biggest cash streams that’s still flowing into some coalfield communities.
A New Barrier
Credit Alexandra Kanik / Ohio Valley Resource
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Ohio Valley Resource
Click to view a flow chart on how to apply for black lung benefits.
Another possible change in the federal black lung program could come if the Republican Congress repeals the Affordable Care Act (also known as Obamacare). One section of the Act, known as the Byrd Amendment, made it easier for miners with at least 15 years of experience to file for black lung benefits, essentially shifting the burden of proving the cause of the disease from the miner to the mining company.
If the Affordable Care Act is repealed and the Byrd Amendment gets struck along with it, it could open a new set of challenges and delays that miners like Mackie Branham Jr. would have to face in trying to claim their black lung benefits.
Hope for Christmas
The benefits process is adversarial and difficult to get through even with the help of a lawyer. Both Mackie and Amber Branham’s fathers have form of black lung, but neither was able to get benefits, and that seems to be a common story.
It looks like Branham’s story is going to be different. On December 13th, the Branhams got some good news. After Branham submitted a diagnosis from seven doctors— including a final one chosen by Alpha Natural Resources— a Kentucky judge awarded Branham his worker’s compensation benefits, and Branham has hope that he’ll get a benefits payment in time for Christmas.
The week a healthcare worker in West Virginia completes his 21-day monitoring period after a month in Liberia.
Scott Laney – Epidemiologist (NIOSH)
Epidemiologist Scott Laney works for the National Institute for Occupational Safety and Health in Morgantown. NIOSH is a branch of the Centers for Disease Control and Prevention and sends people all over the world to investigate diseases.
Scott Laney came to Morgantown six years ago to investigate the respiratory health of coal miners, but as things continued to escalate with the Ebola epidemic in Africa, he felt duty-bound to volunteer in relief efforts.
Laney has a background in infectious diseases, and molecular epidemiology and tumor virology. Before being recruited to NIOSH in 2008, he was part of then joined the Epidemic Intelligence Service in 2006, a CDC-program.
He volunteered in August. Two weeks later, he was on a plane to Liberia.
Credit Scott Laney / CDC
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CDC
Laney putting together chlorine handwashing buckets for affected communities.
Liberia
Laney spent the first three or four days in the capital city of Monrovia designing case-control studies for healthcare workers—to help figure out how exactly so many healthcare workers are falling ill. Then he spent much of October in the rural western county of Bong.
A letter home: “… I am currently working in one of the most impacted areas in Western Africa where prior to my arrival no one had yet visited. My focus has been centered around the village of Mawah in Bong county – an isolated community that is far off the beaten path and virtually inaccessible. This village of 850 people housed a traveler from Monrovia some time back for one evening as he was passing through by foot. This individual had Ebola and an incredible outbreak occurred as a result. In the last month numerous people have died and I have arranged transport by ambulance of 25 more in the last 10 days…”
Laney’s work was part of the effort to get a real idea of how many people are being affected by the disease.
QUICK FACT: In March of this year, the first Ebola infection was recorded in Liberia. To date, the CDC reports, over 6,000 cases and over 2,000 deaths.
Laney would go out to visit communities and log records of all of his experiences—everything from cultural interactions and observations, to observing burial techniques.
Laney Log: 10-7-14 … The stories I heard to today are too countless to tell but this village is hypervigilant. They have been strictly instructed not to accept any outsiders into the village. There are multiple road blocks and men at these locations making sure that does not happen. I asked Dr. Freeman what would happen if a visibly sick individual approached the village and he said the guards were instructed to tell them to go away by any means necessary. At night a family of 6 from the bush – two of which were ill – were taken in by a community member in Bong mines. The community threatened to burn his house down if he did not send them away. Fortunately, ambulances were in route and these two patients were taken to an ETU. The father and children were sent back to the bush. …At the river we heard a rumor that a party of individuals were suggesting that someone should go to Mawah and poison the water to kill the villagers so no one from there could enter into other communities…
Credit Scott Laney / CDC
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CDC
From Laney Log: …We returned to observe the burial of the body. I witnessed the removal of the body and burial and the donning and doffing of PPE by the burial team. It was no where near as elegant as the IMC teams response at the stadium but the few breaches were addressed and I provided guidance on the issues moving forward….
Laney says he encountered a culture steeped in a terrifying epidemic with all the tragedy and discord that comes with it. But the only thing about his experience that surprised him was discovering, upon his return home 21-days ago, how the American public and politicians were responding to people like him, healthcare workers returning home.
A Return Home
Laney returned home October 17th.
He was screened before he left Liberia, then upon entering the U.S., then again at the CDC. Finally he made his way home to his young family in Preston County. He didn’t have too difficult a time. But the story is different for many colleagues.
The CDC just released recommendations detailing appropriate measures to take to monitor health workers who have worked around Ebola. For the past 21 days, Laney has been recording and reporting daily temperature and symptom assessments.
An email from CDC: Dear Anthony "Scott" Laney, Thank you for taking the time today to discuss the CDC active monitoring protocol and for your recent service to the CDC Ebola Response. This email confirms the 21-day monitoring activities and documentation we discussed on the phone. Your monitoring timeframe ends on 11/8/14. We ask that you: • Monitor and record your temperature twice a day (morning and evening). • Monitor yourself for unexplained fatigue, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain or unexplained bleeding or bruising. We request that you also send your temperature and your symptom assessment to the CDC IMS Employee Active Monitoring email box by completing the information in the boxes below and replying to this email by noon each day until your end date of 11/8/14….
Another email from the CDC: Dear CDC staff, Thank you for your service to the Ebola response. We have received feedback that some employees and family members of employees have encountered difficulty going to school or work due to restrictions imposed upon them based upon fear. In order to ease your transition back to your home and workplace and to alleviate employer and school fears, we have drafted three letters for CDC employees returning from Ebola-related deployments: 1. A letter for family and close contacts; 2. A letter for persons determined to be at no identifiable risk, to be distributed to all employees determined to be at no identifiable risk after completion of the post-deployment risk assessment; (most of you are not in this category.) 3. A letter for persons determine to be at low (but not zero) risk, to be distributed to all employees determined to be at low (but not zero) risk – typically, these would be employees deployed to Liberia, Sierra Leone, or Guinea. …
In West Virginia:
Laney also points out that his community in West Virginia, especially in Preston County, has been a reliable source of comfort and encouragement. He says he hopes that attitude persists for other West Virginian healthcare workers who will soon also be returning home.
As to whether or not Laney will return to continue public health efforts in Africa—he says it’s possible he’ll go back the spring.
