Silica Dust and Complicated Black Lung Disease: How long before miners are protected?

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85% of miners eligible for NIOSH Part 90 free lung screenings don’t participate…

…there are 273 cases of progressive massive fibrosis (PMF) in this clinic alone…30 cases have been diagnosed in just the last three months…

Even after miners are taken out of the mines, their disease is rapidly progressing…some miners with PMF have progressed from no disease showing up on a radiograph to PMF in 10 years or less…

Every lung transplant costs 1.2 to 1.6 million dollars and that doesn’t factor in the post-operative care…

If you had attended the National Coalition of Black Lung & Respiratory Disease Clinics conference in Gatlinburg, TN last week – a conference for health care workers, lawyers, miners, and other advocates that are trying to work together to treat and prevent black lung disease – your notes might have looked something like mine (shown above). Though being a part of the community of advocates coming together to combat black lung disease is certainly encouraging, being reminded of the disease incidence rate and its severity certainly is not.

ACLC has been representing miners with black lung disease since 2002. During the first five years that our doors were open, we represented one miner whose case was proved complicated. In the past five years, the number of complicated cases has exploded. We know that our experience is not isolated. An epidemic of complicated black lung disease has emerged in Central Appalachia. Incidence of disease is occurring at an unprecedented rate (Blackley et al., 2018a). This increase in disease severity is also reflected in the claimants of the Federal Black Lung Disability Trust Fund. In 1988, there were only 18 claimants with complicated lung disease, otherwise referred to as Progressive Massive Fibrosis (PMF), whereas in 2014 there were 350 (Almberg et al., 2018). Most of these miners last mined in West Virginia, Kentucky, Virginia, or Pennsylvania. 

These cases of PMF are being diagnosed in miners with as little as 8 years of experience, who are as young as 38, and even in those that have only worked in surface mines (Blackley et al, 2018b). Miners are getting sicker more rapidly and at a younger age. These miners have young families and struggle to provide for their families when they are disabled by this disease. This resurgence of black lung disease is being driven in large part by miners’ increased exposure to silica dust as changes in mining practices require miners to cut through more rock for longer periods of time (Kreiss & Boguang, 1996; Cohen et al, 2016; Laney et al., 2010; Boyles, 2018).

In 1995 the National Institute for Occupational Safety and Health (NIOSH) looked at MSHA’s 2.0 mg/m³ coal dust standard and determined that it was not sufficiently protective of miners and that the level should be reduced by half. NIOSH also found that crystalline silica constituted a particular lung hazard to coal miners and recommended that the exposure limit be reduced from 100µg/m³ to 50µg/m³. In 1996, the Secretary of Labor’s Advisory Committee on the Elimination of Pneumoconiosis (Black Lung) Among Coal Miners likewise determined that the current regulatory standard was insufficient to prevent Black Lung and recommended that MSHA consider reducing the permissible level.

The Mine Act under which MSHA operates requires the agency to regulate dust so that “no miner will suffer material impairment of health or functional capacity,” even if that miner were to spend his/her entire working life in the mines. This mission has not been upheld. This month marks a decade since the Appalachian Citizens’ Law Center (ACLC) petitioned the Mine Safety and Health Administration (MSHA) to revise its regulations on respirable coal mine dust to better protect miners from black lung and other respiratory diseases. In 2010, MSHA granted ACLC’s petition and committed to commence a rulemaking process for both a coal dust standard as well as a separate standard for silica dust. 

In 2014, MSHA reduced the coal dust standard from 2.0 to 1.5mg/m³. Though the 2014 coal dust rule was some progress, the silica standard for miners has not been updated since 1985. MSHA did commence a rulemaking process for a separate silica standard, but it was not completed. In spring 2016, the silica standard was listed as a “proposed rule” on the agency’s rule list. However, in the spring 2019 list, the silica standard was no longer listed as a “proposed rule,” but as in the “prerule stage” – the earliest stage of a rulemaking process. 

A new standard is far overdue, and MSHA is sitting on this rulemaking process while miners are dying of Black Lung disease.

As a prerule, MSHA has opened a request for information (RFI) period during which they are requesting information from the public to inform how they can protect miners from exposure to silica, despite the fact that workplace dust control practices have already been established as part of the 2014 coal dust rule and despite available research and evidence on the danger of respirable silica dust that was compiled by the Occupational Safety and Health Administration (OSHA) for its 2016 rule that created a permissible exposure limit to silica dust. OSHA found that an exposure limit of 50µg/m3 substantially reduces worker risk of silicosis mortality. Though we will defer to medical experts, it is clear that an exposure limit of 100 µg/m3 per shift is not sufficient for protecting workers’ lungs.

In the RFI, MSHA states that it is seeking “information and data to determine if existing engineering and environmental controls can continuously protect miners and ensure that they do not suffer material impairment of health or functional capacity over their working lives from working in areas with high levels of quartz.” We urge MSHA to focus on improved enforcement of engineering, administrative, and environmental controls which includes better practices for validating whether or not samples are representative of daily conditions in the mine as well as create a stricter, separately enforceable silica dust standard.  No controls are effective if they are inadequately validated and enforced.

In addition, in this RFI MSHA articulates interest in the use of personal protective equipment, particularly respiratory protective equipment, to protect against respirable quartz. In reference to 30 CFR 56/57.5005 the RFI states, “…where accepted engineering control measures have not been developed or when necessary by nature of work involved, miners may work for reasonable periods of time in a location where concentrations of respirable quartz exceed permissible levels only if they are protected by appropriate respiratory equipment…” Though we recognize that personal protective equipment may provide further protection for miners, similar to the coal dust standard, respiratory protection should not be considered a means through which to achieve compliance to a respirable quartz standard. The burden of protection should not fall on miners and their access to respirators but, instead, the environment in which they work should be made safe. 

On October 13th, 2019 the Southeastern Kentucky Black Lung Association is dedicating a memorial stone to loved ones from their community that have died and been affected by black lung disease. There will be over 250 names will be on that stone. In preparing for and planning this memorial stone, it has come up in conversation again and again that families will be able to place more names on the stone after it is set in the ground and that they might be able to engrave names on the sides of the stone once the front and back are filled up. I wish we didn’t need to find more space for names. I wish the disease was a part of history, of memory, isolated to grandfathers and grandmothers, and memorialized on a stone. But it is not. The disease is very much a part of the present and will be a part of the future unless we act. This is a health emergency. Enough is enough. We need protection for our miners. Let’s put our voices together for people who no longer have breath. Help us tell MSHA that we need a stronger silica standard for our miners.

Comments on the silica RFI are due October 28, 2019. We encourage those who care about preventing this disease to place a comment on the public record. You can do so by submitting a comment directly on the federal register (link below) or contact Rebecca Shelton at ACLC for more information (rshelton@aclc.org).


References:

Almberg, K.S. et al. (2018) Progressive massive fibrosis resurgence identified in U.S. coal miners filing for black lung benefits, 1970-2016. Annals ATS. 15(12): 1420-1426.

Blackley, D.J. et al. (2018a) Continued Increase in Prevalence of Coal Workers’ Pneumoconiosis in the United States, 1970–2017. Am J Public Health. 108:1220-1222.

Blackley, D.J. et al. (2018b) Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia. JAMA. 319(5):500–501.

Boyles, S. (2018). CDC: Coal Workers With Black Lung Disease Are Dying Earlier. Available from: www.medpagetoday.com/pulmonology/generalpulmonary/74405.

Cohen, R.A. et al. (2016). Lung Pathology in U.S. Coal Workers with Rapidly Progressing Pneumoconiosis Implicates Silica and Silicates, Am J Resp Crit Care. 193(6): 673-680

Kreiss, K. & Boguang, Z. (1996). Risk of Silicosis in a Colorado Mining Community. Am Journal Ind Med, 30: 529-539

Laney, A.S. et al. (2010). Pneumoconiosis among underground bituminous coal miners in the United States: is silicosis becoming more frequent?, Occup Environ Med. 67:652-656








3 Responses to “Silica Dust and Complicated Black Lung Disease: How long before miners are protected?”

  2. Larry Miller

    In my opinion, the only way to even begin to address this BL silica proliferation is better and more strictly enforced safety laws. more time away from the dust for recovery and the #1 way to solve this is to take the responsibility for sending MSHA dust samples out of the hands of coal companies with better and tougher remedies for default. I believe that any time safety and profit go head to head in a production environment, profit always wins. Change will not be easy in mining, it never has.

    • Rebecca Shelton

      Hi Larry,

      Thanks for your comment. Have you considered putting together a comment to submit to MSHA that reflects your thoughts on how to protect miners from silica?

Comments are closed.