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. Credit: PBS Frontline/Elaine McMillion Sheldon

Public Health Watch reporting on shortcomings in a proposed rule to protect coal miners from toxic silica dust has federal regulators considering a tougher approach.

Our joint investigation with Louisville Public Media and Mountain State Spotlight showed that the long-delayed government response to a deadly epidemic of severe black lung disease lacked any mention of the extent of the disease, perhaps downplaying the urgent need  for action.

Our investigation documented more than 4,000 cases of advanced black lung diagnosed since 2010 — more than 1,500 in just the last five years.

This advanced stage of disease, known as progressive massive fibrosis, is incurable and fatal. It saps the ability to breathe, leading to suffocation or other organ failure.

Given the number of cases we documented, the Mine Safety and Health Administration, or MSHA, seemed to severely understate the impact of its proposed crackdown on exposure to silica dust, which can trigger advanced black lung.

MSHA predicted its proposed rule would prevent 244 cases of disease and 63 deaths over 60 years.

Our investigation documented far more cases of disease and death in a fraction of the time.

Our reporting attracted the attention of mine safety advocates and Democratic leadership on the House Committee on Education and the Workforce, who quoted from it in comments filed in response to MSHA’s proposed rule.

“MSHA should reevaluate whether it has made maximum use of the information available to the agency to inform the public about the necessity and value of this Proposed Rule,” Reps. Bobby Scott (D-Va.) and Alma Adams (D-N.C.) wrote, citing the Public Health Watch investigation.

Appalachian Voices, an activist group in the region, cited our investigation as well in its comments on MSHA’s proposal. 

“This epidemic has worsened in Central Appalachia, and we are concerned that the modeling conducted for this rule doesn’t incorporate data that medical clinics in Appalachia have reported since 2010,” the group wrote.

“We encourage MSHA to review data from black lung clinics in Central Appalachia to ensure a more realistic accounting of current morbidity and set a higher goal for future morbidity.”

Now, MSHA tells Public Health Watch it is considering “suggestions that the [proposed rule] underestimates the benefit” as it develops a final rule.

“The final rule will communicate key decisions and what was considered in reaching them,” the agency said in a statement.

The statement said that Christopher Williamson, the assistant secretary of labor for mine safety and health, “heard the latest updates from health experts, NIOSH [the National Institute for Occupational Safety and Health], the network of black lung clinics, and spoke directly with coal miners about their health” at a recent national conference of black lung clinics.

NIOSH, the clinics and some of those health experts were primary sources for the Public Health Watch investigation.

Williamson “is deeply troubled by the amount of disease – including the most advanced forms – that health experts continue to report in Appalachia,” the MSHA statement said.

Our reporting also underscored a major complaint about the proposed rule:  – its failure to clearly define MSHA’s oversight and enforcement, and a system of sampling mine air for excessive silica dust that is left almost entirely to mining companies. The proposal doesn’t require mining companies to report excessive exposures to MSHA, even though they can put miners at risk and trigger citations and fines.

MSHA addressed this problem in its statement to Public Health Watch, saying it is considering requiring coal mine operators to report overexposures to MSHA district managers.

“This would allow MSHA to take appropriate enforcement action and provide any necessary compliance assistance to operators,” the agency told us.

A timeline for a final rule will be announced this month, MSHA said, when it releases its Fall 2023 Regulatory Agenda, a list of regulatory actions in the works. A final version of the rule must be approved by the Department of Labor and the Office of Management and Budget, so it is still likely months away.

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.