By Kari Lydersen
Washington Post Staff Writer
Tuesday, November 28, 2006
CHICAGO -- At 55, Connie Cline looks tanned, fit and trim. But walking only a block leaves him wheezing and winded.
Cline suffers from black lung disease, the legacy of a decade he spent crawling through coal seams and blasting at coal faces in West Virginia. He's sitting in an exam room at the black lung clinic of a public hospital in Chicago, where he comes regularly to try to keep his disease under control.
Though some may view it as a relic of a bygone era, black lung disease is still a serious problem for thousands of miners and former miners nationwide. A study released in August by the Centers for Disease Control and Prevention (CDC) found that younger miners -- in their 30s through 50s -- are developing rapidly progressive, debilitating forms of the disease at a much higher rate than expected. This incidence was especially high in smaller mines such as the ones Cline worked in, including one run by his uncle.
Cline was already feeling symptoms of black lung disease in his early 40s, after a neck and back injury forced him to retire from mining. Pneumoconiosis, or black lung, is caused by coal dust trapped in the lungs, and the disease may worsen even after a miner retires.
"The dust was so thick sometimes you couldn't see your hand in front of you, even with your light," said Cline, who now lives in Akron, Ind. "You just spit it up. You just live in it."
Cline's illness was originally misdiagnosed as cancer by doctors in Akron who were unfamiliar with the large scars that can be formed in complicated black lung disease. After that, Cline found his way to the black lung clinic at John H. Stroger Jr. Hospital of Cook County, which is widely considered the country's top facility for black lung diagnosis and treatment.
Most of the nation's 25 federally funded black lung clinics are in big coal-mining states, such as Kentucky, West Virginia and Wyoming. Illinois, in particular Chicago, is associated with burning coal to forge steel or produce electricity, not with coal mining.
But when many Appalachian mines closed or laid off workers starting in the 1950s, scores of miners migrated to Chicago for work in steel mills and other industrial jobs.
Cline's father, a West Virginia miner, was part of this migration. Cline was raised in Chicago but headed back to his Appalachian mining roots after serving in the Vietnam War.
Broady Moorer, a patient in the room next to Cline's, also moved to Chicago to work in factories after mining in Kentucky. "Once the mines went down, there wasn't anything else to do there," said Moorer, 76, whose father and seven brothers were miners. "I was ready to leave."
Coal is a component of the country's future energy plan, with more than 100 coal-burning power plants now in the permit stages or under construction. With modern technology and a shift toward strip mines, many miners and doctors thought black lung disease might vanish.
But it is still a serious occupational risk, as indicated by studies that include a CDC report identifying black lung hot spots in 22 counties in Kentucky, Pennsylvania, Virginia and West Virginia.
"If you didn't have dust exposure, you wouldn't have the disease," said Vinicius Antao, a medical officer at the National Institute for Occupational Safety and Health (NIOSH), which carries out black lung studies. "There is not enough dust control."
In 1995, NIOSH recommended reducing the allowable level of coal mine dust from two milligrams to one milligram per cubic meter of air, but the recommendation was not adopted.
Bruce Watzman, vice president of safety and health for the National Mining Association, a national trade group, said industry officials were surprised by the NIOSH study.
"These results caught us off guard," he said. "We want to learn more about it."
He said the industry plans to use personal dust monitors -- devices each miner wears to immediately log dust levels -- once research is complete and the devices are commercially available. He said that development and testing of the devices, which will cost about $7,000 each, has taken "longer than anyone expected."
"We continue to work and explore new technology to reduce dust levels in the mines," Watzman said. "We have a twofold approach: the development of personal dust monitors and the refinement of existing tools to reduce dust exposure underground."
He said the group does not support lowering the legal dust limit.
Miners' advocates say that along with stricter limits, better enforcement is needed.
"It's one thing to have dust control measures in place, it's another to monitor them," said Mary Natkin, a law professor at Washington and Lee University in Lexington, Va., whose students help miners in black lung benefits cases. She said current dust control enforcement, which relies largely on companies' self-reporting, is like "putting the fox in charge of the henhouse."
There's no doubt that black lung has been drastically reduced since the Federal Coal Mine Health and Safety Act of 1969 established dust limits. Recent surveys indicate about a 3 percent overall rate of disease, compared with 10 percent or more in the 1960s. But with coal production increasing, mostly in smaller, nonunion mines, Robert Cohen, director of the black lung clinic in Chicago, worries about what the future will bring.
"Unfortunately, black lung disease is not likely to disappear. Rather, we're likely to see more cases if health and safety regulations are weakened or go unenforced," he said. "Unlike the Sago mine explosion, this will be the hidden disaster. These deaths won't hit the headlines and will take place quietly decades from now."