Inside HRSA, November - December 2008, Health Resources and Services Administration
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HRSA-funded Black Lung Clinic Helps Younger Miners Cope


Miner cutting coal at the face of the mine.
Miner cutting coal at the face of the mine, with machine called a ‘continuous arc miner’ or cutting machine. The average height of the coal is 36 to 42 inches.

Miners having lunch.
Miners having lunch.

Roof support boards have been bolted to support ceiling from falling in.
Roof support boards have been bolted to support ceiling from falling in. Most of these miners are now disabled or retired and patients at the Black Lung Clinic in St. Charles, VA.

Miner taking a break on an old car seat.
Miner taking a break on an old car seat. Curtain hanging in background is for dust control.

St. Charles Black Lung Program
St. Charles (VA) Black Lung Program
(left to right)
Back row: Melissa Muse, Jackie Laws, Cindy Viers, Carlena Mutter, Brenda Yates, and Dr. Bickley Craven.
Middle row: Kisten Davis, Ann Livesay, Connie Short, and Karen Cox.
Sitting: Jerry Murphree, Mark Davis, Ron Carson (Program Director), and Bradley Johnson.


HRSA’s Black Lung Clinics Program is life-sustaining for those in the coal mining industry stricken with lung disorders. Now, increasing numbers of young miners are entering the program, with ailments that previously went undiagnosed until a prior generation of miners were well into their fifties.

With a yearly budget of about $5.6 million, the program funds 15 grantees that treat working and retired miners in11 states. The program aims to get miners to realize they’re at risk for black lung disease — which results from breathing in coal dust over a long period of time — and to encourage them to get screened, get care, and apply for benefits.

According to Ron Carson, hired to start up the Respiratory Care Black Lung Program in St. Charles, Va., “the average ‘active’ coal miner — in fact, anyone with a respiratory impairment — won’t go see a doctor. But once we tell miners about the benefits. . . they actually want to become part of our program.”

“But the younger miners that come to us are really sick,” reports Carson. “They’re on multiple inhalers and oxygen, and they have to quit working. Back in the late 90s, we had just five or 10 active miners in the program. Last year, we had more than 100.”

“They’re coming to us in their 30s or 40s with large opacities of the lung — progressive massive fibrosis — which is what we used to see back in the ‘90s after miners had worked for 20, 30 or 40 years.”

Turns out, the southwest corner of Virginia and parts of the Appalachian coalfields in neighboring Kentucky, Tennessee and West Virginia have become “hot spots” for numbers of miners getting sick at a younger age.

To help these young miners, Carson and his staff show them how to develop medical documentation — by making sure they get chest x-rays and pulmonary tests every year. That way, they’re more likely to receive their black lung medical benefits card, which covers all medical visits and all the medication, oxygen and inhalers they’ll need for the rest of their lives, at no cost.

Despite this recent and troubling trend, Carson remains optimistic, recalling a time not so long ago when he had difficulty even making miners aware of the program.

“When we first got the program in 1991,” he recalls, “I talked to miners at union meetings, sent letters to local physicians and to attorneys that dealt with black lung claims. I went into the community and spoke to many different organizations, even set up a sub-office in our Congressperson’s local headquarters, where I’d counsel patients.”

His passion for helping miners is rooted in personal history. Carson comes from a mining family and might have become a fourth-generation coal miner himself had he not gotten lost in a mine a mile-and-a-half underground when he was just 18. He was alone, and his helmet battery went out.

The experience galvanized his intentions of going to college in Massachusetts and returning to help those whose stories he knew so well.

The St. Charles clinic — part of the HRSA-supported Stone Mountain Health Center — has served more than 10,000 miners and their families overall, and treated 2,400 patients in 2007 and 2,687 so far this year.

More than 400 Social Security and 700 Federal black lung claims were awarded since the program began, with millions of dollars in revenue back-payments (not including medical benefits) made to mining families.

The clinic’s second site is in Oakwood Va., about 100 miles away.

For Carson, program results are not always measurable: “When a miner comes in and says that his quality of life has improved — that he can walk and breathe more easily — and we’re a part of it, there’s the real success story.”


Did You Know...
HRSA-supported clinic ranks “Best in the Nation”

The Miners Clinic of Colorado is located at National Jewish Health in Denver, a pulmonary care facility that got its start as a tuberculosis hospital in the late 1800s and that has been named the number one respiratory hospital by U.S. News and World Report since 1998.

The Clinic coordinates care with other hospitals in Colorado and Arizona that are closer to western mining communities.

In response to HRSA’s new initiative to demonstrate health outcomes for patients served by black lung clinics — and because so many miners live in remote rural areas — the clinic developed a home-based pulmonary rehabilitation program. The program includes a self-instruction booklet on good nutrition and hydration, starting a walking program, and simple strength-building and breathing exercises, which can be incorporated into daily living.

Meredith Towle, program coordinator, says: “Our patients are excited about this take-home, which we hope helps other grantees develop similar programs.”

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