Monday marks 11 years since the Upper Big Branch coal mine disaster in Raleigh County, where 29 miners were killed on April 5, 2010.
Federal mine safety investigators determined that a buildup of methane gas and coal dust led to the explosion at the Massey Energy-owned mine. It was the worst mine disaster in 40 years.
Massey CEO Don Blankenship was convicted in December 2015 of conspiracy to violate mine safety and health standards.
Massey was sold to Alpha Natural Resources in 2011. Alpha paid a $210 million settlement with the families of the workers and to address years of safety violations.
The Biden administration released its first set of drug policy priorities Thursday after overdose deaths hit record numbers during the pandemic. Office of National Drug Control Policy Acting Director Regina LaBelle discussed the office’s seven priorities, beginning with expanding access to drug treatment services.
“We’ll do this by expanding access to quality treatment and medications for opioid use disorder,” LaBelle said. “This includes removing unnecessary barriers to buprenorphine prescribing and contingency management interventions, modernizing our methadone treatment, expanding access to evidence based treatment options for people who are incarcerated.”
The American Rescue Plan Act set aside $4 billion to broaden access to behavioral services under the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration.
Another top priority includes addressing racial inequities within addiction treatment.
“So this includes developing a drug budget that reflects the needs of diverse communities, developing priorities for criminal justice reform and identifying culturally appropriate evidence based practices for Black, Indigenous and People of Color across the continuum of care,” LaBelle said. “And that continuum of care includes prevention, harm reduction, treatment and recovery services.”
From August 2019 to August 2020, more than 88,000 people died from drug overdoses, according to provisional data from the Centers for Disease Control and Prevention. West Virginia and Kentucky both reported more overdose deaths than the national average. The Ohio Valley has long been the epicenter of the addiction crisis, and the isolation and stress of the pandemic appears to have worsened the overdose death rates. The overdose death rate increased 43% year-over-year in Kentucky, by 38% in West Virginia, and by 21% in Ohio. In the three states combined, 8,126 people died of overdoses from 2019 to 2020.
President Joe Biden has nominated Gayle Manchin, the wife of West Virginia Sen. Joe Manchin, to co-chair the Appalachian Regional Commission, the White House announced Friday.
The commission was created in 1965 as part of an antipoverty effort under President Lyndon Johnson. It serves 420 Appalachian counties across 13 states from southern New York to northeast Mississippi and has invested $4.5 billion in the region since its creation. All 55 of West Virginia’s counties fall under the commission.
The agency promotes economic development, job training, and investments in infrastructure and the region’s cultural and natural assets.
Joe Manchin is a key Senate Democrat who chairs the Energy and Natural Resources Committee. As a moderate, Manchin’s vote has been critical for Biden’s agenda in an evenly split chamber.
Gayle Manchin is a career educator who was West Virginia’s first lady from 2005 to 2010 and a member of the state board of education from 2007 to 2015.
In 2017, Gov. Jim Justice appointed her as cabinet secretary for the Office of Education and the Arts but fired her in 2018 amid a dispute over the state legislature’s attempts to restructure the department.
Her nomination to the commission will require Senate confirmation.
Doctors hired by coal companies in black lung cases are far less likely to diagnose the disease in X-rays than are independent doctors or those who are hired by coal miners, a new study has concluded, pointing to conflicts of interest in the system that sick miners use to receive assistance.
Doctors hired by coal companies in black lung cases are far less likely to diagnose the disease in X-rays than are independent doctors or those who are hired by coal miners, a new study has concluded, pointing to conflicts of interest in the system that sick miners use to receive assistance.
The doctors who worked for coal companies to read the chest X-rays of miners found an absence of the disease nearly 85% of the time, according to the authors of the study, published Friday by the University of Illinois Chicago School of Public Health’s Division of Environmental and Occupational Health Sciences. In contrast, the doctors whose clients were coal miners found an absence of black lung a little more than 51% of the time.
“The more frequently a physician is hired by the employer/mine-operator to provide a medical opinion related to workers compensation cases for black lung disease, the more likely that physician will not identify black lung disease on a chest X-ray,” the study concluded. “The opposite is true too.”
The study, published in the Annals of the American Thoracic Society, looked at 264 specialists in pulmonology and radiology who reviewed X-rays for more than 37,000 miners from 2000 to 2013. The study examined more than 7,000 court decisions in black lung claims cases from 2002 to 2019 to determine who hired the doctors involved.
The study found that coal companies paid their doctors up to 10 times more compared to doctors hired by miners or their advocates.
“The miners are not paying that much to people reading X-rays on their behalf,” saidRobert Cohen, a pulmonologist at the University of Illinois Chicago and one of the study’s authors.
Cohen said that the general market fee for physicians who read X-rays for black lung runs $75 to $100, while those hired by coal companies can be paid as much as $750 to $1,000.
“It’s just what the market will bear,” he said. “Folks that have a lot of money can pay a lot of money to get the readings that they desire.”
Central Appalachia has seen a resurgence of black lung disease in coal miners in recent years, particularly in Kentucky, West Virginia and Virginia. A 2018 federal study found that 1 in 5 Central Appalachian miners had the disease, versus 1 in 10 miners nationwide.
The study Cohen co-wrote illustrates the difficulty facing coal miners in obtaining federal workers’ compensation benefits for black lung disease, and the absence of a “gold standard” for determining who has it. Its authors recommend a series of changes to eliminate conflicts of interest and make the system fairer.
For example, it concludes that the U.S. Department of Labor should have a more active role in making black lung evaluations more objective. The study shows that doctors who have worked only for the department were less biased in their black lung determinations than those who worked for either coal companies or coal miners.
Researchers also recommend giving the National Institute for Occupational Safety and Health, which certifies the doctors who review black lung cases, more power to weed out those who are proved to be consistently biased or inaccurate in their assessments.
In an unattributed statement from NIOSH, the agency said it has a process in place to decertify doctors who submit inaccurate classifications in black lung cases. The agency declined to say how many doctors it had decertified.
Additionally, Cohen said doctors should be required to disclose how much they were paid to review black lung cases.
NIOSH does not have the authority to regulate the compensation of doctors in black lung cases, the agency said.
A bill introduced in 2015 by members of Congress from Appalachian coal states attempted to address the issue, in part by establishing a pilot program to create an independent medical review panel for black lung cases. It did not become law.
“It’s a tough, adversarial system, and it’s hard to legislate it,” Cohen said. “But we really have to pay attention to that and in every way that we can make it as level a playing field as possible.”
Wes Addington directs the Appalachian Citizens’ Law Center in Whitesburg, Kentucky, which works with coal miners seeking black lung claims. Addington said the study affirms what he and his colleagues see in the claims process.
“This type of bias has real world implications for deserving miners and their survivors,” he said. “That sort of bias that could knock miners out of not only what’s a fairly meager monetary benefit per month, but also health insurance to treat their conditions.”
ReSource reporter Katie Myers at partner station WMMT contributed to this story.
The Blackjewel bankruptcy case has been ongoing since the summer of 2019 when Blackjewel, LLC abruptly collapsed, leaving over 2000 miners in Wyoming, Kentucky and West Virginia without their jobs, their benefits, or their final paychecks. In protest, Kentucky miners spent much of that summer camped on the railroad tracks to the mine, blocking the company’s last load of coal from the market.
Once an economic behemoth, Blackjewel filed for Chapter 11 bankruptcy. On Friday, March 19, Judge Benjamin A. Kahn approved the bankruptcy plan.
This plan will allow Blackjewel to sell its mining permits to other companies. Environmentalists have expressed concern that this would allow Blackjewel to abandon the permits it is unable to sell, leaving old, damaged mine lands unrepaired. Advocacy groups including Appalachian Citizens Law Center, Sierra Club, and Kentuckians for the Commonwealth have all taken an interest in this case.
Appalachian Voices Central Appalachian Senior Program Manager Erin Savage said the case concerns them because of the volume of permits that will now be on the market.The permits — more than 200 total, and more than 30 of them in Kentucky — will now be on the market for a six-month period, in hopes other coal companies will purchase them. Savage says she fears that the coal industry’s economic decline may mean permits go unclaimed, leaving the reclamation of abandoned mine lands an open question.
“I think we’re delaying a lot of inevitable bond forfeitures,” said Savage. If that happens, she added, finding sufficient will and money to properly reclaim these sites will become difficult, leaving community members living near those sites vulnerable to erosion, water pollution, and slope instability as the old mines continue to deteriorate.
Meanwhile, Blackjewel’s former miners are still waiting for full compensation following a settlement with the company in a class action lawsuit based on a violation of the WARN Act. That law requires 60 days of notice before a mass layoff. This settlement grants workers the equivalent of 44 additional days of pay, on top of what they were initially owed by the company. However, it is unclear where their compensation will come from. Ned Pillersdorf, an attorney participating in the case, said the company’s former executive, Jeff Hoops, took advantage of the system, leaving miners and permits in limbo.
“We never thought this was a legitimate bankruptcy,” Pillersdorf said. “We always thought that Hoops diverted money from Blackjewel and declared bankruptcy to shed debt.”
Judge Kahn is expected to sign the final order this week, after which the ruling will go into effect.
Nathan French signed up for a COVID-19 vaccination and is waiting for an appointment. The 22-year-old Transylvania University senior has had COVID-19 twice.
“The first time it was asymptomatic, and I was thankful,” French said. “But the second time, I was stricken with lung issues, and it felt like my heart rate was faster than normal. I was horrified for my safety because I just didn’t know what was going to happen to me.”
French has a developmental disability, a form of the neuromuscular disease called Charcot-Marie-Tooth disease, which affects his diaphragm and his nerves. French also has a heart condition.
The second coronavirus infection made French feel like he couldn’t breathe, and it landed him in the hospital for a day where he said he didn’t feel like his treatment was a priority.
“They were more concerned with dealing with people who aren’t disabled, so I felt like I was being neglected and not important as a person,” French said.
Courtesy Nathan French
/
Kentucky college student Nathan French is unsure if he is eligible for a COVID vaccine.
French said he doesn’t know if he is currently eligible for a vaccine in Kentucky, but hopes to get one soon. Despite appeals from disability advocates, and studies showing that people with intellectual and developmental disabilities are at an increased risk of dying from COVID-19, Kentucky’s plan for prioritizing vaccinations did not clearly include disabilities in the early phases.
Because French has a developmental disability, he would have already qualified for a vaccination if he lived in some other nearby states, such as Ohio and West Virginia, which prioritize people with disabilities.
Kentucky’s vaccination plans have prioritized medical conditions that are considered “high risk” for severe COVID-19 by the Centers for Disease Control and Prevention. Down Syndrome is listed as a qualifying condition for phase 1C of vaccinations, a broad category which recently got underway in the state, but that is the only such disability on the state’s list, according to disability advocates.
During a press conference March 16, Kentucky Gov. Andy Beshear responded to a question on the issue from the Ohio Valley ReSource and said that the commonwealth’s vaccination plans closely follow the CDC’s guidelines.
“And so the reason it’s not included in Kentucky is it’s not in the CDC prioritizations, but with that said, we should consider it,” Beshear said.
Questioned again on the subject on March 18, Beshear still did not have a firm answer.
“There was even an internal disagreement with whether these individuals are in 1C,” Beshear said. “They certainly need to be prioritized and we’ll be providing clarity on that shortly.”
Crystal Staley, communications director for the governor’s office, said later that night in an email, “yes people with intellectual and developmental disabilities are in 1C.”
However, by the end of the week, even advocates who track the issue closely were left uncertain about just what the state’s policy is for people with intellectual and developmental disabilities, or IDD.
“Those with IDD and their family members don’t know they’re in 1C if, in fact, they are,” Kentucky Protection and Advocacy Legal Director Heidi Schissler said in an email. “It definitely needs to be clarified and the website needs to be updated to clearly explain it, especially now that supply is greatly increasing.”
A Push For Change
In 2017, an estimated 101,535 people with intellectual and developmental disabilities received services in Kentucky. Kentucky Protection and Advocacy is a federally mandated, independent state agency that works to protect the rights of people with disabilities.
The group sent a letter to Gov. Beshear in December requesting priority status for vaccinations for those with IDD. Legal Director Schissler said some concerns have been addressed. For example, people with disabilities who live in congregate housing were prioritized in the state’s first vaccine phase, which also focused on long-term care centers. In early February, the agency met with the Cabinet for Health and Family Services over Zoom.
“They said, you know, ‘We’re still listening. We’ll get back with you,’” Schissler said. Since then the agency sent another letter and drew attention to a recent study published in the New England Journal of Medicine that found that people with intellectual and developmental disabilities were more likely to become infected and were nearly six times more likely to die from COVID-19 compared to the general population.
Corinne Boyer
/
People waiting at the UK HealthCare vaccination site at Kroger field after being vaccinated.
Schissler said she thought that data would get the state’s attention.
“We thought that (study) was truly a game changer — that that was going to make Kentucky officials and the CDC wake up,” she said.
“Devastating Impact”
On March 5, the New England Journal of Medicine published a commentary with a blunt warning about the “devastating impact” COVID-19 was having on people with IDD. The study found that people with intellectual disabilities “are at substantially increased risk of dying from Covid-19.”
One of the study’s authors, Dr. Wendy Ross, is a developmental and behavioral pediatrician who directs the Center for Autism & Neurodiversity at Jefferson Health in Philadelphia. Since the study’s publication, she said about six states have changed vaccine plans to include intellectual disabilities.
“I think the big differentiator about this study that made it so impactful is that it wasn’t saying that intellectual disability is one of many things that can make you more likely to get COVID and die from COVID,” Ross said. “It said it is literally the top independent risk factor for getting COVID. And second, only to age for dying from COVID.”
The CDC’s vaccination guidelines for people with disabilities state that “disability alone does not put you at higher risk for getting COVID-19.” The agency updates the list of medical conditions regularly, but has not added intellectual or developmental disabilities.
Ross said the data from the study was presented to the CDC.
“They did not question the quality of our data, but they did not change the recommendations, and I honestly cannot explain that,” she said.
Challenges Elsewhere
Ohio listed intellectual and developmental disabilities in phase 1B of its vaccine plan that was slated for distribution on Jan. 25. For people who also have certain medical conditions, county developmental disability boards are in charge of helping them to coordinate a vaccine. People with IDD who do not use county board services should reach out to those boards to plan to get their vaccine.
“Ohio’s decision to vaccinate those with developmental or intellectual disabilities and certain medical conditions was based on the potential severe outcomes these individuals could face if infected with COVID-19, in line with Ohio’s goal to save lives,” Alicia Shoults with the Ohio Department of Health said in an email.
Shoults added that local health departments are vaccinating people who aren’t able to leave their homes.
West Virginia’s vaccine plan lists intellectual and developmental disabilities and care takers in phase 2-A. The state expanded eligibility in phase 2A on March 15.
Anne McDaniel, executive director of the West Virginia Statewide Independent Living Council, said advocates and disability groups have been pushing to make people with disabilities a higher priority within the state’s plans.
“People with disabilities (were) included in phase 2-A all along, but we’ve been in phase one, since vaccination started until just the last week or so,” she said.
McDaniel said it was especially important to focus on people with disabilities living in group settings.
“Because the whole phase structure started with people in nursing homes, people in assisted living, people in prisons,” McDaniel said. “But people with disabilities who are living in group homes, larger group homes, other congregate settings, were not included in that.”
McDaniel said the groups’ continual push for the inclusion of people with disabilities “may have sped up that move to phase two a little bit.”
To ensure people have access to vaccines, ongoing efforts have focused on vaccine registration and pop-up clinics have been set up to reach people who cannot get to vaccination sites.
McDaniel said strategies to have nurses vaccinate people in their homes and in congregate settings are also underway.
“The new vaccine from Johnson & Johnson, I think, is really going to help with that,” she said. ”You don’t have that time frame, from the time it’s thawed, until the time it has to go into an arm,” she said.
Still, identifying people who can’t leave their homes or don’t have access to transportation to reach a vaccine clinic has been a challenge in West Virginia.
Maj. Gen. James A. Hoyer, the Adjutant General of West Virginia, said there isn’t a single way to identify someone who can’t get to a vaccine clinic. Health departments, regional clinics and programs that focus on vaccinating people with disabilities have helped identify about 2,400 individuals so far.
But Hoyer said he’s not sure how many of those 2,400 have been vaccinated in their homes or at health departments.
“It’s probably not something that we have tracked,” Hoyer said.
Hoyer said university health and science programs and pharmacy programs have volunteered to administer shots. “The other group that’s been really exceptionally good is the independent pharmacy folks, because, you know, in some of these small rural communities, it’s not uncommon for pharmacists to go still make a house call for a vaccine.”
A New Advocate
When Nathan French learned that people with IDD weren’t listed as eligible for vaccines in Kentucky, he said he was disappointed.
“I have learned to expect to be disappointed,” he said.
But French wants things to change. He plans to become an advocate for people with disabilities.
“I hope that later in my life I can go into politics to represent people with disabilities and make changes at the state and national scale.”
June Leffler, West Virginia Public Broadcasting’s Appalachian Health News reporter, contributed to this story.
The Ohio Valley ReSource gets support from the Corporation for Public Broadcasting and our partner stations.
