Danny Smith spent just 12 years mining coal and was diagnosed with advanced black lung disease at 39. Photo by Elaine McMillion Sheldon/PBS Frontline

The gravesite in Danny Smith’s vast and verdant yard is shaded by hulking trees. His parents’ graves are adjacent and marked by a massive headstone. In summer, crickets chirp, birds sing, and leaves rustle in the breeze. It is a peaceful spot for Smith’s final resting place. And it’s ready.

“I honestly never imagined it would get this bad,” Smith, 51, wrote recently in a text message from his home in the coalfields of eastern Kentucky. His breathing is so labored now, he told me, that he wasn’t sure he could get through a phone call. “I have a hard time just walking to the kitchen without losing breath,” he wrote. “I stay so tired and exhausted.”

Smith’s lungs are riddled with fibrotic tissue. When NPR and PBS Frontline last visited in 2018, he tried to mow his lawn, but a fit of heavy hacking forced him to his knees. Coughing violently, he spit out what looked like moist and crusty bits of dark gray paper with black streaks. That’s dead lung tissue, his respiratory therapist told us later.

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. Photo by Howard Berkes/Public Health Watch

Smith suffers from progressive massive fibrosis (PMF), an incurable, fatal and advanced stage of black lung disease. It plagues thousands of sick and dying coal miners like him. The likely cause, studies conclude, is exposure to clouds of silica dust while mining coal, and digging through solid rock to get to coal seams and prepare them for mining. Silica, one of the most abundant minerals on earth, is 20 times more toxic than coal dust alone. It wreaks havoc on lung tissue when inhaled repeatedly. 

“As bad as I feel now, and I never thought I would say it,” Smith wrote, “I so wish I had never stepped foot inside a mine.”

Smith worked just 12 years underground and was diagnosed with PMF 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.

A crackdown on silica dust. Or is it?

Now, after decades of delay, the federal Mine Safety and Health Administration (MSHA) is finally getting serious about overexposure to silica in the nation’s mines. 

The agency is proposing a silica dust exposure limit twice as tough as it is now. MSHA would also directly regulate excessive silica exposures, something it hasn’t previously done, making citations and fines possible for putting miners at risk. 

“Our current standard as it relates to regulating silica in the nation’s mines…does not adequately protect miners’ health,” Christopher Williamson, the Assistant Secretary of Labor for Mine Safety and Health, acknowledged in an interview.

But there are questions about how effective even these measures will be, beginning with MSHA’s assumptions on potential lives saved and disease avoided.

An investigation by Public Health Watch, Louisville Public Media and Mountain State Spotlight shows that the plan’s purported benefits understate the silica risk to coal miners and the urgent need for immediate action.  The news organizations documented cases of PMF not mentioned in MSHA’s plan or included in the calculation of how many lives the proposed rule could save and how much disease it could prevent. 

The results are staggering: more than 4,000 cases of PMF identified by black lung clinics and the National Institute for Occupational Safety and Health (NIOSH) since 2010; more than 1,500 diagnoses in just the last five years alone.  

Understating the risk potentially weakens MSHA’s case as its proposed rule faces possible challenges from the mining industry.

“The scale of human tragedy is profound,” said Kirsten Almberg, an epidemiologist at the Black Lung Data and Resource Center at the University of Illinois Chicago.  Almberg tracks the occurrence of PMF as reported by federally funded black lung clinics.

Our investigation surveyed both independent and government-supported clinics that test coal miners for black lung disease. We also obtained, through the Freedom of Information Act, unpublished counts of disease from the federally-funded clinics.  

“There’s really no way to quantify…the individual tragedy that happens in each of these cases, with lives cut short, careers cut short, communities reeling and families falling apart,” Almberg said. “It’s just devastating.”

These thousands of cases of disease, suffering and death are not included anywhere in the 168 pages of MSHA’s proposed rule on silica dust exposure. They’re not part of the agency’s prediction of how many lives its new regulation might save (just 63 over 60 years), and how much disease might be avoided (244 cases of black lung over 60 years). 

“The difference in scale is striking,” Almberg added, after comparing the actual count of PMF cases and MSHA’s predictions.

“I don’t have a lot of faith in the modeling,” said Dr. Drew Harris, a University of Virginia pulmonologist who is medical director for black lung clinics operated by Stone Mountain Health Services in southwest Virginia.

 “Not factoring into their risk prediction the amount of disease that is currently happening and had been happening for 10 to 15 years, I think, is not acceptable,” Harris said.   

A fraught history of failure to protect

The proposed crackdown on silica follows a fraught history of MSHA inattention and decades of failure to protect miners from the toxic dust.

A 2018 NPR/PBS Frontline investigation found that MSHA had measured dangerous exposure to silica dust in coal mines for 30 years but did nothing effective in response. There were 21,000 excessive silica dust exposures from 1986 to 2016, according to MSHA’s own data. 

More than twice that many dust samples (52,000) exceeded silica levels first recommended by NIOSH in 1974 and by the U.S. Department of Labor’s own special advisory committee on black lung back in 1996. That stricter limit has applied to all industries except mining since 2016. 

That long recommended limit (50 micrograms of silica per cubic meter of dust) is precisely the limit MSHA is proposing now. 

Just since 2016, our investigation found, MSHA’s silica dust samples from coal mines exceeded the newly proposed limit more than 5,300 times. Overexposure to silica dust has been and continues to be a persistent threat. 

It’s not like the agency was completely in the dark. As far back as 1996, internal MSHA memos acknowledged the problem, including a cluster of severe black lung disease linked to silica dust exposure. 

MSHA’s Williamson cited the 2018 NPR/PBS Frontline investigation and subsequent studies and reports in proposing tougher limits on silica. 

“The timing was absolutely right to do this,” he said. “The science is solid…What currently exists is not protective enough.”

So many miners dead and dying

That’s evident at black lung clinics like Stone Mountain and pulmonary rehab centers focused on miners with PMF. Marcy Martinez is a respiratory therapist at New Beginnings Pulmonary Rehab, which has two centers in Virginia and Kentucky. She said her caseload alone defies MSHA’s projections for avoided death and disease.

The New Beginnings Pulmonary Rehab clinic in South Williamson, Kentucky, features photos of coal miner clients with advanced black lung disease, including those who have not survived. Photo by Elaine McMillion Sheldon/PBS Frontline

“It’s ridiculous to think that that’s the biggest impact this new rule will have…I don’t think they have a concept of what the reality is out there…” Martinez said, fighting back tears. 

“Just seeing the sick ones, just seeing the severity, just seeing the deaths…We lost 11 men in the last seven months…147 deaths have occurred in my clinics, from black lung, in 10 years. And that is heartbreaking.”

One small clinic alone in eastern Kentucky has identified far more cases of advanced black lung disease in less than a decade then MSHA predicts it will avoid in six decades with the new rule in place.

“As of now, we are almost at 700 cases of complicated black lung,” said Dr. Brandon Crum, a radiologist specializing in black lung X-ray assessments at United Medical Group in Pikeville, Kentucky. That’s Crum’s count of PMF cases at his clinic from 2015 through 2023 so far. 

Dr. Brandon Crum reviews X-rays of coal miners with severe black lung disease at his clinic in Pikeville, Kentucky. Photo by Elaine McMillion Sheldon/PBS Frontline

“I’m surprised that we continue to see that much disease and the severity of the disease,” Crum added. “We’re seeing younger and younger miners get it…Men in their thirties, forties and fifties on a regular basis.”

MSHA deferred questions about its risk analysis, and its failure to include the thousands of cases of disease among American miners, until after the public comment period on the proposed rule ends September 11.

“MSHA encourages all interested parties to provide comments on the proposed rule, including the preliminary risk analysis, and relevant data for the Agency’s consideration,” the agency said in a statement to Public Health Watch.

Almberg, at the University of Illinois Chicago, believes she knows why MSHA would not include in its risk analysis the actual number of PMF cases recorded by clinics and NIOSH since 2010. The analysis depends on knowing precisely how much silica dust exposure sick miners experienced, Almberg said, and that detail is not available for the cases reported by clinics and NIOSH.

“I do think it is an underestimate,” Almberg said.  MSHA said so in its proposal, she added, though there still was no mention of thousands of documented cases of disease in the last decade.

Are proposed protections tough enough?

Mine safety advocates have a list of other concerns about the effectiveness of MSHA’s proposal:

  • Mining companies will be required to sample working areas for silica dust but a history of sampling fraud has some worried about the accuracy and integrity of company dust samples.
  • If samples show excessive silica, mining companies are then required to take corrective measures on their own so that exposure is reduced to safe levels. 
  • MSHA’s proposal does not specify oversight and enforcement of mining company sampling and corrective measures. The samples and corrective measures must be recorded but they are not reported to MSHA unless the agency requests the records.
  • Sampling for silica dust requires offsite laboratory analysis, so a week or more could pass before mining companies know whether excessive exposure has occurred. In the meantime, miners may continue to be exposed to dangerous levels of dust.
  • Even if excessive silica dust is detected, miners can still be required to work “temporarily” in those dangerous conditions while mining companies work to reduce the dust. In those circumstances, miners will be required to wear respirators. But miners often complain about the effectiveness of the devices, citing the difficulty of doing hard and dangerous work in masks that can restrict breathing, become uncomfortably hot, interfere with critical communication, and/or partially block vision. 
  • MSHA’s proposal does not just apply to coal mines but includes metal, sand, and gravel mines. There are 10,000 more of those mines in the United States than there are coal mines, and 144,000 more miners. That creates an enormous new regulatory burden for an agency that is already struggling with staffing and funding.

MSHA responds to most of these concerns by saying they are likely to be raised during the public comment period and will be considered before a final rule is imposed

MSHA chief Williamson did respond to some of the issues in his interview with Public Health Watch and Louisville Public Media.

He pointed out that regular quarterly inspections will continue at coal mines after the rule is in place, with MSHA inspectors sampling for both coal and silica dust. In between those inspections, he said, the agency will respond to any whistleblower complaints about companies’ failure to sample dust accurately and respond to overexposure effectively. 

A makeshift billboard depicting a miner working in a “low coal” mine shaft greets drivers leaving Fleming-Neon, Kentucky. Photo by Justin Hicks/Louisville Public Media

Federal law is “very clear that the ultimate responsibility for miners’ safety and health lies with the mine operator,” Williamson said.  

“Operators have legal obligations and you start out from the premise that people are going to comply with the law… And then if they don’t, there are consequences for that.”

Harris, the medical director at the Stone Mountain black lung clinics, is not convinced, noting that responsible companies will do what MSHA expects. But not all companies are responsible, he said. They need to know that MSHA’s watching them more than four times a year.

“Without enforcement of the rule…it’s essentially useless,” Harris said. “You can impose anything, but if people don’t follow the rule or there’s no incentive to follow the rule, it’s not going to have effect. And I’m not convinced that as it is written there’s enough incentive to do the right thing.”

Williamson also addressed the concern, expressed by some safety advocates, that including metal, sand and gravel mines in the proposal escalates the regulatory burden for the agency, making it more difficult to fully protect coal miners, who are already suffering by the thousands. 

“MSHA has responsibilities to protect all miners’ safety and health,” Williamson told Public Health Watch and Louisville Public Media. “So how can I say that these protections should be in place for a coal miner that are not in place for a metal and nonmetal miner?”

Federal mine safety chief Christopher Williamson has made controlling silica dust in the nation’s mines one of his top priorities. He’s a West Virginia native and the black helmet in the case behind him was used by his great grandfather, who mined coal for more than 30 years. Photo by Justin Hicks/Louisville Public Media

During that interview, Williamson pulled out a highlighted copy of the agency’s fiscal year 2024 budget request, which seeks an increase of more than $50 million in overall funding. Of that, more than $20 million would go toward expanded enforcement, $7 million specifically toward silica dust enforcement, and more than $2 million to increase the capacity of MSHA’s labs to accommodate an expected increase in dust samples collected by agency inspectors. 

Pointing to those numbers, Williamson said, “We’ve demonstrated that this is a priority. And we’ve asked for more money to be able to do it.”

This is merely a budget request, however. It must still be approved by the White House and Congress.   

The urgency to act

More than 50,000 American coal miners have lost their jobs since 2011 amid cutbacks in the burning of coal for electric power and the need to respond to global warming. But nearly 40,000 are still working. And, given foreign demand for American coal — especially the high-value metallurgical coal used to make steel — tens of thousands of workers will likely continue to mine coal for years to come.

That “met coal,” as it’s called, is so valuable that mining companies will cut thinner and thinner coal seams to retrieve it. This, in turn, disturbs more of the rock that produces silica dust. The threat to coal miners’ lungs will continue as a result. 

“We don’t have as many miners as we used to, say 20 years ago,” said radiologist Crum, “but I think the percentage of miners that are going to contract black lung will probably be higher, and the percentage of severe disease will be significantly higher.”

Crum already sees the trend in the X-rays he reviews as he sits in the dark in his office in Kentucky. X-ray after X-ray after X-ray. More and more miners getting very sick, and getting sicker younger, even with fewer years mining coal. 

Just in the last seven years, according to our review of MSHA’s own data, silica dust samples exceeded the proposed limit more than 5,300 times. Those were periodic samples taken by MSHA inspectors during quarterly inspections, so they didn’t account for exposures when inspectors weren’t present, which was most of the time. 

Prosperity and regret

Back in eastern Kentucky, Danny Smith typed out more messages on his cell phone, an oxygen tube clipped to his nostrils. He’s on oxygen all the time now, he wrote. He can’t get enough air without it. He’s  being assessed for a double-lung transplant.

“I totally agree that something has to be done,” Smith wrote, happy to see that MSHA plans to do more to protect miners from the silica dust that made his life so difficult at such a young age. 

He’s also wistful about what he calls the “billion-dollar coal fields” in his corner of Appalachia and the prosperity mining jobs made possible. 

“Coal mining made it what it was at one time. People had very comfortable lives here.” 

There was a pause in his typing. Then these words appeared:

“I would rather be poor and [have] no home as to feel what I’ve been feeling lately and knowing it will only get worse.”

Howard Berkes is a member of the Public Health Watch board of directors. Berkes is a former NPR investigations correspondent who collaborated with PBS Frontline on a landmark 2018 investigation exposing an epidemic of advanced black lung disease and the failure of federal regulators to prevent it. Justin Hicks is the data reporter for Louisville Public Media. Mountain State Spotlight reporter Allen Siegler contributed to this story.