Original subtitles

We have an epidemic here of black luck. These miners are inhaling their

workplace, and it stays with them forever.

In collaboration with NPR, Public Health Watch, and the Appalachia and Mid-South

Newsroom. Do you have a sense of what the rest of your life is going to be

with black lung?

Well, you work your whole life to enjoy the rest of it, and you can't enjoy it.

Drawing on years of reporting, correspondent Howard Berkus

investigates. Why won't you talk to us about this issue?

The numbers are astounding, how many young people are getting this disease.

If we could turn back time, we would do so to prevent this. We can't. We're

dealing with historic exposures. These guys are being treated like disposable

widgets, not human beings, and we're watching them die right before our eyes.

Now on Frontline. This has been going on for decades. It is entirely preventable,

and we aren't preventing it.

Cole's Human Cost.

I started noticing in mid-2023 that it was getting tougher and tougher

breathing-wise, you know, to climb these hills around here.

I love to get my kids into hunting, fishing, stuff like that, but just

having the energy and the wind to do it is almost impossible.

I used to work all day, come home and cut grass till dark.

Now I can come here and sit all day and go home and I'm beat.

I mean, I just ain't got no energy to do nothing.

I mean, I know it's going to get to where I can't get around in the hills to

hunt.

So I'm going to have to give that up eventually, you know.

And it's awkward. You work your whole life to enjoy the rest of it.

And then when you can't enjoy it.

has been investigating the rise of black lung disease for more than a decade.

Even the black lung experts were shocked by this data.

I've been in and out of Appalachia going back 15 years, driving the hills and

coal fields of Kentucky, Virginia, and West Virginia, tracking the resurgence

of an incurable coal mining disease called black lung.

It was tough on all of us. I've interviewed dozens of sick and dying

coal miners.

documented thousands of cases of disease, and exposed failures by federal

regulators and the industry.

And there's evidence it's getting worse.

Jonathan Wright is 44 and worked underground until the mine closed last

year.

I met him in Pike County, Kentucky.

where he now sells overstock and surplus merchandise from a small warehouse.

I worked underground in a coal mine for 25 years.

I've done a little bit of everything, from running a scoop to a shuttle car,

a miner, roof boulder.

I've done a little bit of everything.

Every morning I get up, I cough up grayish-looking flame and stuff, you

know.

between that and just not having the energy, you know, to do what I used to

do.

That's what prompted me to go get checked.

I'm thinking it was in August is when I had that x-ray done.

And I think it took about a month to get it back. And they diagnosed me with

second stage black lung.

How did you react to being told that you had black lung disease? Well, I mean, It

scared me. I mean, I worked in mines for 25 years. You know, I know what it is.

I just, I really didn't think that would happen to me, though. You know, I guess

when you're younger, you don't think it's going to happen.

Why do you think you got black lung?

Just eating too much dust.

Just being exposed to too much dust, without a doubt.

In my earlier part of my career, I was like every other young guy, you know, at

first, just not know much about it. But then later on, just complacency.

You know, you've been in it for so long and there's nothing happened yet.

You know, I believe that's the way a lot of people look at it. You just get

complacent with where you're at and just don't realize what damage it's doing.

One in three veteran underground coal miners tested in central Appalachia now

have black lung.

That's the highest rate since the 1970s.

The disease is devastating families here, where doctors and advocates have

been trying for years to sound the alarm and to get better protections for

miners.

In September, I attended a meeting of the local Black Lung Association in Big

Stone Gap, Virginia.

They're a little bit confused on some of this stuff. Can you answer a couple of

their questions? Sure. It was led by respiratory therapist Marcy Freeman and

radiologist Brandon Crum, who I've been in touch with for years.

We have an epidemic here of black lung, and we see tons.

of coal miners with advanced progressive massive fibrosis.

You know, our clinics, my clinic, Dr. Crum's clinic, Heath, the attorney, West

Addington, Marshall, is at Norton Community.

And the scary thing is none of us really overlap with those patients.

And the fact that we're all seeing such an influx tells me that there's

something going on that is not a good thing in this area.

Yeah, I appreciate y'all having me back here.

If you don't know me, I'm Brandon.

I'm a radiologist over in Kentucky and have a clinic over there.

And we've done a ton of research on black lung, a ton of imaging. So I read

the x-rays and CTs, but we've also took it significantly further and gathered

probably the largest collection of data on central Appalachian minors. So when

you look at it, 70s, 80s, 90s, all the way 2000, 2010s, 2020s,

After billions and billions of dollars has been spent, we're right back to the

same place we was when our grandfathers were mining.

And our great-grandfathers is pretty much where we're at.

So it's been a failure of the entire system

for our miners in central Appalachia is pretty much what you can say about it.

When I talk about Black Lung, you know, I'm always talking about it. I mean, I

live it. My husband has it. My dad has it.

You know, everybody in my family is affected by it because just like you

all, I'm a coal miner's daughter.

And, you know, I see what it's done to them, and I see it firsthand what it's

doing to them.

And I look at Phillip, my husband, who was strong, healthy,

man, invincible, invincible.

And I watched this disease take a little piece of him.

Every few months I see a change.

So, and I've watched my daddy.

And I swear to God, my dad was Superman, right? There's nothing he couldn't do.

Nothing. And now, you know, he can't even breathe and get off the couch.

It's a horrible disease.

Freeman runs respiratory clinics for coal miners in Kentucky and Virginia.

Thank you.

All of the miners I interviewed at her clinics.

have what's known as progressive massive fibrosis, or PMF, the advanced form of

the disease.

That was the diagnosis for Tim Balthus after 35 years as a minor.

128 over 82.

When I went to my pulmonologist in August of 21, he told me what it was.

And I was in denial then.

I was like, there's no way, dude. I can still run miles.

And, you know, went into a denial phase for probably a couple years,

I guess.

And then I just thought, you know, he's not lying to me,

you know. And with the time that I had, the years of service, I guess, in the

mines, I knew it was a possibility.

He just made it real.

Used to work out with your daughters. Yes.

Running track.

Yeah. They ran track and cross country.

So I would run with them through town.

And it wasn't uncommon to run three, four miles with them a day.

Could you keep up with your daughters now?

You have grandkids.

No, I could not run with them. There's no way.

You said you don't like to talk about it because that makes it real.

Yeah.

What's real?

The death is real.

That's going to happen.

If the rest of my body stays in good shape and I don't get killed in a car

accident or something like that, I'm going to die black and blue. I know

that.

I try to put that at the back of my mind.

stay healthy and active and all that kind of stuff.

And hopefully I'll live until I'm in my 70s or 80s, you know, so that would be a

normal life.

Will that happen?

Probably not. With the diagnosis that I have, I'll probably be lucky to live in

the mid-60s. If I'm lucky, if this right here stalls the progression of it, I'll

probably live to be in my mid-60s. How old are you now?

I will be 58 in November.

Mid-60s isn't far off. No. No, it's not.

This is a stack of funeral programs and obituaries for minors who

have

been clients here and who have died and these four i pulled out because

these are guys who i interviewed the last time i was here in 2018

and i remember each of them paul

and jerry and jack

and another jack

They were here struggling to breathe at times, working out, trying to

improve their symptoms as best they could.

But they were joking with each other. They were just so full of life, even

though they had this horrific disease.

And they didn't make it.

And there are 40 more.

of these funeral programs and obituaries here. They keep track of them. They save

them to honor these guys.

When I was here eight years ago for NPR and Frontline,

Federal researchers had just reported that one in five working coal miners in

central Appalachia had black lung.

Basic black lung diagnoses had doubled in a decade.

The advanced disease, PMF, had quadrupled since the 1980s.

And it was clear that miners were getting the advanced disease younger and

more quickly than in the past.

Greg. Hey.

I'm Howard Berkus from National Public Radio. Great to meet you.

When I first met Greg Kelly in 2018, he was just 53 years old, still

relatively young for a miner so sick.

That's me, and that's my stepdad. How long did you spend in mining? 31 years.

Years one.

I was in 83.

And what made you stop mining?

My health. I just couldn't. I got sick.

They said, we don't want you to go back to work until you see a lung doctor.

When I did get to see him, he said, you know, you don't need to go back

underground.

Was that the first time you learned that you had black lung? Right. Yeah, that's

the first doctor that ever said, you know, you've got black lung.

I've had two or three x-ray technicians tell me they're the worst set of lungs

they've ever seen.

What kind of reaction did you have when you heard about that?

You can't work.

It's just like a light switch turned on and turned off.

All your plans that you had, you know, hunting

and fishing and doing what you want to do when that day comes, well, all of a

sudden it's here and you can't, you don't have the air to do it.

You know, I still enjoy life. I have a good time. I get to play with my

grandson. Just not like I want to and like I used to be able to, you know.

Catch one.

There he is. I just try to pray and ask the Lord to help me to overcome it and

just go on and be with my family.

You got one, didn't you?

The whole time I've been over, I can't breathe.

And then when you raise up, you got to just stand still to get your breath.

Come on, let's go show Mom what you caught.

The disease that steals the breath of coal miners is back with a vengeance.

I went to see radiologist Brandon Crum at his clinic in Kentucky.

which was overwhelmed with cases of PMF.

So if I show you for comparison, this is a normal X-ray.

And you can see all the dark area, that's the lung because it's filled with

air. And you contrast that to this one.

You see all these big white areas all the way through here.

That's all conglomerate fibrotic mass or PMF.

The biggest concern at that time for me was seeing young men My age, and I'm 43

or younger than I am, with the most severe form of the disease, which is the

complicated black lung disease.

Crum was so concerned, he took his findings to researchers at the National

Institute for Occupational Safety and Health, or NIOSH.

Well, when I told them, you know, we were seeing or I was seeing a lot of

complicated black lung disease, and what was most concerning is I was seeing it

in individuals in their 30s and 40s.

hesitancy on their part. I'm not sure they believe me.

He told us that he was seeing a lot of really advanced disease, and it was

concerning to him.

And I guess my initial thought was, that's probably not true.

The researchers had been officially tracking black lung disease for decades,

but they only tested working minors, not the thousands out of work.

So they hadn't detected the sharp rise in deadly PMF Brandon Crum was finding.

He invited us to show us some of the medical images from his patients, and we

sat there for an entire day, one after another after another, looking at these

chest x-rays, the worst I've ever seen.

What was your reaction to what you saw?

Horror, shock.

I don't know how many other words to use. I was really

taken aback, not only that these cases were legitimate, but just how severe

they were.

It indicated that we had a huge problem, and we realized immediately that it

wasn't going to be isolated to a single clinic.

Researchers at NIOSH had only reported 99 cases of PMF in the previous five

years.

But out-of-work miners had been flooding clinics.

And in calls and visits to 16 clinics across Appalachia, Frontline and NPR

identified close to 2,000 cases in the same time frame.

The Stone Mountain Black Lung Clinics in southwestern Virginia reported more

cases than anyone.

Ron Carson directed the clinics at the time.

We're going to put you in the room. Come on with me.

Well, NIOSH reported maybe 90 or 100 x-rays.

All right, if you'll step up by real close for me. So we came back and we

started doing a study on how many we actually had, pulling x-rays back to

2014 to 2017, three years of x-rays.

We quickly identified 416 during that three-year period.

However, if we had went back to 2010 at a minimum, we could have probably

doubled that.

Breathe in and out deep and fast.

In and out.

And stop.

And I don't know what your test will reveal today, but, and I tell everybody

this for almost 30 years, don't get discouraged.

The count at Stone Mountain rose to nearly 800 with a dozen new cases a

month. My buddy here. God bless you. I just think that

America needs to know that these miners, they have paid a price.

So many years, these miners extracted this coal so that you and I can...

They pay the price.

They have paid the price so that we can have luxury.

And I just feel like America has just forgotten about them.

despite what's going on around us, give us the joy and the peace that the world

cannot give us.

And we thank you for your love that is unconditional.

In Jesus' name we pray.

Amen. Danny Smith was 46 when I met him. He'd mined coal just 12 years but

was desperately sick.

He was getting help with breathing and stamina at a Kentucky pulmonary rehab

clinic run by Marcy Freeman.

Marcy.

Can I drop down today?

Yes, you can.

What's Danny's heart rate?

96.

Let's stop and catch our breath there for a second.

Danny, when he first started with us, he would break out in a cold sweat,

literally drenched, and he would start shallow breathing.

Depression, anxiety, you know, that is as much a part of this disease as their

breathing is.

It

takes

them approximately three to six months to build up when they start this

program.

At six months, they're typically maxed out.

If they're out for two weeks, they lose pretty much everything they gained.

We have a family cemetery.

And when you already got your plot picked out, at my age, it's kind of a

scary thought, you know.

I hope one day you get to see my grandchildren.

I don't want to talk tomorrow, okay?

I'm sorry.

Just give me a minute. I'm all right.

If I can see my babies graduate from college, both of them.

When people get the first stages of the disease, they require oxygen.

Can you turn that oxygen on back there?

Just pull that little green handle.

And then even the oxygen that you're adding to that person so that they can

do more isn't enough.

And so they're essentially suffocating while alive.

Something seemed to change where people were more heavily exposed to perhaps

more toxic dust and were getting this very severe form of the disease that

from my medical school training and from my... past clinical practice was rare.

We didn't see that many cases of PMF, and it was something that we thought had

been relegated to the trash heap of history.

The modern era of coal mine regulation began in the late 1960s, in part because

40,000 coal miners staged a wildcat strike in West Virginia, demanding

government action on black lung.

The greatest heroes are you, the coal miners.

You've taken the future, your future, in your hands, and you proclaim no longer

are we going to live and work and die like animals.

We're free men!

Congress responded with a tough new law that was supposed to protect miners from

the coal mine dust that poisons lungs.

And in the early 70s, a new federal research agency, NIOSH, began to monitor

black lung disease among working miners.

We saw a nice reduction in the rates of disease falling down to very low levels.

And then that, I call it the U-shaped curve of concern, the curve went down

and hit the bottom and then started to go back up again, meaning that something

changed. We took our eye off the ball, something else happened, and the disease

was recurring.

What changed was mining itself.

Big and pure coal seams were mined out.

Thinner seams embedded in rock were left.

Mining machines cut more and more of that rock, producing fine and easily

inhaled particles of silica, toxic dust that the existing mining regulations

didn't directly control.

Somewhere in the late 20th century, there has been a change in the

composition of the dust.

We're seeing more silica, and silica is 20 times more toxic than coal.

When you inhale silica, it's retained in the lung.

These miners are inhaling their workplace, and it stays with them

forever.

By the mid-1990s, federal regulators knew there was a problem.

NIOSH recommended new silica regulation, including an exposure limit twice as

tough. But the proposals didn't go anywhere.

So you worked for the agency back in this time frame.

Celeste Monfortin was a top advisor at the Mine Safety and Health

Administration, or MSHA, at the time.

She says the agency ran into opposition from the mining industry.

Now we see in miners who were, again, working at that period of time and now

are the ones that are seriously ill from that disease.

They're dying. Yeah. Terrible deaths.

Yeah. Had we taken action at that time, I really believe that we would not be

seeing the disease that we're seeing now.

It wasn't until 2014 that the Mine Safety and Health Administration, MSHA,

put in place new restrictions on coal dust.

But they didn't set specific limits on silica dust.

Instead, they continued to rely on a flawed formula that they'd used for

decades to measure silica exposure.

What our data shows, what MSHA's data shows, is that that formula hasn't

worked 9,000 times since 1986.

We can see it in the data.

It's kind of puzzling why they didn't see it in the data and why they don't

think this is important enough to have a different kind of regulatory process.

At the time, the coal mining industry actually proposed focused regulation of

silica. Still, mining companies continue to cut thin seams and create toxic

silica dust.

We sympathize with those individuals, with those families. If we could turn

back the hands of time, we would do so to prevent this.

But, you know, we can't. We're dealing with historic exposures.

And from our perspective, what we need to be focused on today is how do we

prevent a reoccurrence of this?

You can slow down the mining machines. You can maybe cut production a little

bit so that you're not generating as much dust.

Or maybe you decide that you don't cut so much rock and you don't cut those

thinner seams.

Aren't those things that mining companies could have done?

You don't need regulation to do that. Sure, they could have done that. But

again, Howard.

I'm not going to speculate on why they did or didn't do what they chose.

You know, our focus here is forward-looking. How do we prevent this

in the future? I can't answer for those what occurred in the past. Were we

really focusing on the right thing?

You know, MSHA had a mantra, end black lung, and we support that.

But coal dust might not have really been where the focus should have been at that

time. it might have been silica rather than coal dust.

In 2018, we tried for months to interview the head of MSHA about the PMF

epidemic and the agency's decision to not directly address silica.

The MSHA mission is to prevent death, illness, and injury from mining and

promote safe and healthful workplaces for U.S. miners, a very honorable

mission. David Ceteslo is a former mining company executive who was the

head of MSHA at the time.

We found him at a rare public appearance at West Virginia University.

Silica is toxic to your body. You hear the phrase in health circles over

progressive, massive fibrosis, these sorts of things.

To me, I believe those are all clearly silica problems.

Silica is something that has to be controlled.

I was surprised that Tesla was so clearly connecting PMF to silica and

wanted to know why this hadn't translated into direct action.

Mr. Tesla, I'm Howard Berkus from National Public Radio and PBS Frontline.

We've been interested in talking to you about progressive massive fibrosis and

the epidemic of disease.

I'm wondering why you're unwilling to speak with us about that. We've had

multiple requests for interviews.

Ready to talk to you today, next week, in the past.

I don't think the science is that well-defined on it yet, Howard.

You have 2,000 miners right now.

I don't think that the science of the causation is that well-defined.

You said yourself that silica was... No, I said I suspect silica.

We've interviewed dozens of coal miners, and they've told us about their

experiences. They all have progressive massive fibrosis. They're all dying from

this disease.

So they've talked about their experiences. I'm supposed to go up here

to this picture. Why won't you talk to us about this issue?

Because I don't think the science is settled on it. What does that got to do

with it? You have so much experience in this field, as you just described, and

you've described all these deaths that are occurring. Okay, let me put this

right. I won't talk to you about it because I'm supposed to go be in a

picture right now.

Excuse me, students are waiting for security, please.

It would be another six years before regulators took action on silica dust.

In 2024, the Biden administration put in place strict limits on exposure to

silica dust in mines, which already governed every other industry.

Violations could trigger fines and even shutting down mine sections with

excessive dust.

I, you know...

took another look at some of the investigative reporting that you and

others had done, Howard. And, you know, I knew that I wanted my signature issue

and the thing that I wanted the agency to focus on while I was there leading it

was improving the protections for miners, all miners, not just coal

miners, from exposure to silica dust.

Christopher Williamson led MSHA in the Biden administration.

He's the great-grandson of a coal miner who had black lung.

For me, it was just a great injustice that coal miners, metal non-metal

miners, every miner in this country, the thousands of them that get up and go to

work and do things that we wouldn't do for our benefit, did not have at least

the same level of protection that every other worker in this country had.

And I was going to try to do something about that. And I knew that it was going

to be hard, but I knew that it was also going to take channeling the agency's

entire focus and energy to do that.

And that's exactly what we did.

But the new silica dust limits have never been enforced.

The mining industry sued, and a federal court suspended enforcement indefinitely

as the Trump administration said it would consider changing the silica

regulation.

The administration has been focused on boosting coal mining.

With a pledge of nearly $700 million to keep coal-fired power plants running,

and coal exports flowing.

At the same time, 2,000 new cases of black lung were reported by clinics last

year alone.

1,700 black lung deaths were reported from 2020 to 2023.

Jonathan Wright was diagnosed in 2023.

He was X-rayed as part of a NIOSH black lung program.

The agency used five years of X-rays like that for a study on the most up-to

-date rates of disease.

Last summer, with our partners at Public Healthwatch, NPR, and the Appalachia Mid

-South Newsroom, we obtained their latest findings before publication.

They showed that the rate of disease in minors like Wright hasn't been this high

since 1978.

There is this new rate of disease that's being reported for minors exactly

like you last year.

Still working, 25 plus years underground here in central Appalachia.

And at the beginning of your career, that percentage was way down to like 1

in 10.

Now it's 1 in 3.

I'm just wondering what you think about that.

I think a lot of it is just to cause the exposure of how much rock these mines

are taking now.

But it is crazy to think that they've just let it go. It seems like they've

just not cared about it for the last 25 years to really

do anything about it.

say that I'm disgusted, but unfortunately I'm not particularly

surprised.

Scott Laney was the lead author of the NIOSH study.

We filmed him back in 2018.

This time he wasn't allowed to go on camera, but we had already recorded a

radio interview about the study.

The reporting that we've done in the scientific literature, the reporting

that... you've done in the media predicted this was going to happen and

and it's arrived and what i'm reporting now or predicting now is that this is

not going to get better because of all of the disease that's already in the

pipeline you know these guys are being treated like disposable widgets

not human beings and we're watching them die right before our eyes

Ron Carson is now retired from running the Stone Mountain Black Lung Clinics.

He still helps coal miners seeking federal black lung benefits.

And he was stunned by the NIOSH findings when I saw him again in Virginia last

summer. It just still amazes me after all these years that these conditions

have not been improved.

No one should have this lung problem from something that can be controlled.

Just...

It shouldn't be happening this way.

We were in kind of the same position in 2018 when we last talked to you and

filmed you.

Does it feel like deja vu to some degree? Absolutely. That's why a few

minutes ago I said, oh my word, I'm reminiscing what it was like eight years

ago. And for us to be sitting here discussing what we are talking about

over the past eight years and nothing's been done, it just...

It's horrifying.

It's just horrifying.

Because we put the data out there, we put the facts out there, and something

should have been done on a higher level to make sure that we wouldn't be here

today talking about this.

That's what's disturbing to me right now.

I repeatedly tried to get officials from MSHA to talk about the new reported

rates of disease.

and the hold on enforcement of the silica rules, but they wouldn't agree to

an interview or answer written questions.

The leading mining industry trade group was willing to talk.

The National Mining Association says it does not oppose the new limit on silica

dust exposure, which is set at 50 micrograms per cubic meter of dust.

They were getting ready for that 50, and they're headed in that direction. We

didn't oppose the 50.

That number...

the industry has agreed to. It's how we get there.

Michael Peelish is a consultant for the association, and he told me the industry

challenged the silica dust regulation in court because it wanted more flexibility

with compliance.

This is a sad excuse for a rule, in my opinion. It does not give the miners

what they need. It doesn't give the operators the opportunity to comply in

an efficient, effective way, period, okay?

And if we had that ability to do that, that rule, I think, would be much more

effective.

Peelish says the industry has done a lot already to protect miners.

What's needed now, he says, is the ability to require miners to use dust

masks or respirators when the other protections fail to keep dust

controlled.

Respiratory protection is critical.

Respiratory protection...

Many industries, you've heard this before, who doesn't wear a respiratory

protection in industry if you're in a factory or whether it's a respirator,

whether it's hearing protection, whatever it might be.

That's what we need to focus on at this point.

I have interviewed dozens and dozens of coal miners, probably more than 60,

and I've asked them specifically about dust masks and respirators.

Almost every single one of them had a complaint.

Too hot to work in.

Filters don't filter out the finer stuff.

They can interfere with their ability to communicate in an environment in which

failure to communicate clearly could end up being killed.

All kinds of complaints.

So that would seem to make it problematic to require masks.

Well, we don't stop at things that are...

are difficult to do we don't stop there we are ways to get you know to make that

occur so i think it is a solution and i think it is a workable solution and i

think it has to be enforced like any other regulation that requires it to be

enforced the bottom line for me is you cannot rely

on respirators to protect coal miners it is not going to be effective it is not

practical

And you worked as a roof bolter, shuttle car operator, scoop operator.

Drew Harris is a pulmonologist and medical director at Black Lung Clinics.

He's worked with hundreds of sick miners over the years.

That sound okay?

Yeah. All right. Whenever you're ready, you can start pedaling.

You can slow down. We can ease off the resistance there.

Every... workplace should be providing for their workers a safe environment.

And that requires in coal mining to have the right ventilation and have the right

safety equipment and water sprays on the machines to keep the dust levels down.

And we should not be relying on coal miners to wear respirators in any way,

shape or form as a primary means of protection because it is impractical for

coal miners to wear these respirators.

have you finish this breath you're in blow out a little more and now big deep

breath in suck in suck in and bless it out hard keep pushing keep pushing keep

pushing all right we've gone

You can't imagine a school teacher rate of one out of three getting this

disease. The public would put their arms up and scream and stop whatever exposure

it was until this got better. But this has been going on for decades, and we

know why this is happening.

And it is entirely preventable, and we aren't preventing it.

Why do you think there isn't more of an outcry?

I think there's a lot of reasons why. The disease is entirely concentrated in

central Appalachia. The vast majority of this disease is seen in eastern

Kentucky, southwestern Virginia, and southern West Virginia.

In central Appalachia, which is rural, where there are not a lot of advocates

for the people who are living in these communities, there are very few people

that stick up for these folks who are suffering.

That is a big reason why that this disease continues to devastate this

community.

At the end of September, miners and their advocates headed to Washington to

try to appeal to members of Congress.

And we have 25 seconds, so we're good. We're good.

We're at this door.

We have a big day ahead of us.

If this is your first time going to the Capitol, raise your hand.

Cool, wow, half.

We were able to get over 30 people in the Black Lung Association from four

states to D.C.

for one day of action.

Usually we do this in smaller batches, so it was really great that we were able

to get people to take time out of their work days, out of their lives to come

here.

I'm Congresswoman Summerlee's policy advisor, and I do want to say the

Congresswoman really wishes she could meet with you all today. As you may have

heard, the House is not in session.

The rules need to be strengthened to control silicate.

We could better fund the clinic so they can hire more counselors to help people.

We're making it. We're surviving, but we need help, you know.

The group then gathered in a Senate hearing room for a forum on black lung.

And I'm telling you, the epidemic we got now...

We're going to see younger and younger to be dying.

They're going to leave young children behind.

Young children. They're not going to be able to see graduate, get married, go to

college. And we have got to do something in every co-state in the United States

and say, we got a voice, we're going to do it, and we're not stopping.

On my most recent reporting trips to Central Appalachia, I

stopped in to see radiologist Brandon Crum again.

He's continued to test coal miners and collect detailed data.

Wow.

What do we have here?

What does this tell us?

So I think this tells us more about Black Lung and Central Appalachia miners

probably than any data collection.

in the world. I think it's the most complete data collection on Central

Appalachian miners that we have currently.

It seems that the numbers that you're showing here, which you're getting to

with your latest data over here, you're talking, what's the total number over a

thousand? It's going to be about all together when we get, it's probably

going to be about 1300 guys total. And then out of those 1300, we're looking at

about 238 cases of complicated.

So these are miners who are all sick with this disease. Some of them are

already at the advanced stage. Others will likely get to the advanced stage,

right? Oh, yeah. Even if they didn't mine another lump of coal tomorrow, you

would be dealing with this problem for decades to come.

I also wanted to visit miner Danny Smith.

But he was too sick for an interview, he told me.

He was too sick to even get through a phone call.

The last thing he told me eight years ago was that he wanted to live long

enough to see his two daughters graduate from college, and they both have.

Greg Kelly was in much better shape.

Hi. Hi.

How are you?

Great to see you. Good to see you. You look great, man.

I feel great.

Man, you look so much better.

I like your shirt. My lungs are Vanderbilt.

Installed 8-pan 2021.

He had a double lung transplant in 2021, something very few coal miners have had.

The surgeon, when he talked to me, he said, I had the scrappy lungs out. He

said I couldn't even pick them up.

He said, that's how bad it was. He said, you coal miners are extremely tough to

do lung transplants on.

He had to scrape your lungs out?

He said he couldn't just pick them up, you know, and move them out. They'd take

them out one at a time, but when they did this one, they scraped it up,

replaced it, and then had to scrape the other one up because he couldn't pick it

up. So what have you got here?

This is a medication I have to take every day.

It's like 38 pills a day that I have to take.

That's the morning dose right there.

There's a lot of vitamins and the rejection medicine.

Every morning, you've got to get up, write down your vitals, your blood

pressure, what your sugar level is, because it messes with your sugar.

What my sperm is, I have to blow and see what I'm putting out with this right

here.

You put it on and it reads it, and then you have to take your pulse off.

I've been doing that for five years. When I get out of bed, that's one of the

first things I do.

How is it different now in terms of your ability to breathe and do things?

Oh, it's entirely like daylight and dark. Just like it happened to me, then

when I got new lungs, I got a new life.

I was able to do the things that I wanted to do when I said, well, I'm

going to be able to retire. Then I could go fishing, and I do my gardening, stuff

like that.

And I get to play with my grandkids.

To see kids that I might not have.

Because if I hadn't got these moms, I wouldn't be here.

You know what's amazing to me?

Is you lived to see this.

To have another grandson.

Here it

comes.

You got it.

Run.

Run around the base.

This way.

He's had five more years so far, but he knows the median life expectancy for

coal miners with new lungs is just six and a half years.

I mean, I ain't got a lot of money, but I'm the richest man on this holler.

Because I got a family that loves me.

and grandbabies that enjoy me and I enjoy them.

And I mean, what more could you want?

Forgive me for asking this question this way.

I've talked to dozens of coal miners who have black lung disease.

Started out, some of them, you know, with simple, developed into complicated.

It got a lot worse and a lot worse than what you've described that you're

thinking about.

Yeah.

And they have a pretty fearful picture of their future because they've seen

relatives die.

from black lung and it can be pretty grim i mean you know that right i don't

like to think about it but i do know i do know that uh like i said uh

i i don't want to get to where i'm a burden on everybody else you know

because i i can't do for myself you know it'd be tough

to to get to that point after you've

tried to do for yourself your whole life, you know.

But I do know what the end cause is going to be.

I mean, I know it's coming. I don't like to think about it.

But I do know that's the end result. I do know that.

Go to pbs.org slash frontline for a Q&A with correspondent Howard Berkus.

I've been in and out of Appalachia going back 15 years.

And for more reporting with our partners.

We know why this is happening, and it is entirely preventable, and we aren't

preventing it.

Connect with Frontline on Facebook and Instagram, and stream anytime on the PBS

app, YouTube, or pbs.org slash frontline.

Frontline's Kohl's Human Cost is available on Amazon Prime Video.