“There’s a variety of reminiscences right here, some good, some unhealthy,” stated Danny Smith, reflecting on his years working on the now-defunct Strong Power mine in Pike County, Ky. Smith, 51, suffers from a complicated and incurable stage of black lung illness.
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Wealthy-Joseph Facun for NPR
“There’s a variety of reminiscences right here, some good, some unhealthy,” stated Danny Smith, reflecting on his years working on the now-defunct Strong Power mine in Pike County, Ky. Smith, 51, suffers from a complicated and incurable stage of black lung illness.
Wealthy-Joseph Facun for NPR
The gravesite in Danny Smith’s huge and verdant yard is shaded by hulking bushes. His mother and father’ graves are adjoining and marked by an enormous gravestone. In summer season, crickets chirp, birds sing, and leaves rustle within the breeze.
It’s a peaceable spot for Smith’s remaining resting place. And it is prepared.
“I actually by no means imagined it could get this unhealthy,” Smith, 51, wrote in a textual content message from his house within the coalfields of japanese Kentucky. His respiratory is so labored at instances, he wrote, that he wasn’t certain he may get via a telephone name.
“I’ve a tough time simply strolling to the kitchen with out dropping breath,” he wrote. “I keep so drained and exhausted.”
Smith’s lungs are riddled with fibrotic tissue. When NPR and PBS’s Frontline final visited in 2018, he tried to mow his garden, however a match of heavy hacking pressured him to his knees. Coughing violently, he spit out what regarded like moist and crusty bits of darkish grey paper with black streaks — useless lung tissue, his respiratory therapist advised us.
Smith suffers from progressive huge fibrosis, or sophisticated black lung, a complicated, incurable and deadly stage of black lung illness. It is induced by the inhalation of coal mine mud, particularly publicity to extremely harmful silica mud.
Silica is considered one of Earth’s most considerable minerals, and it is about 20 instances extra poisonous than coal mud. It is typical within the quartz that surrounds coal seams, particularly in central Appalachia. Mining machines lower via the rock to achieve and to mine coal seams, grinding rock into high quality, sharp and simply inhaled silica particles.
Publicity to silica mud seemingly explains Smith’s sophisticated black lung prognosis on the comparatively younger age of 39 and after simply 12 years of reducing rock and coal underground.
“As unhealthy as I really feel now, and I by no means thought I’d say it,” Smith texted, “I so want I had by no means stepped foot inside a mine.”
Danny Smith spent simply 12 years mining coal earlier than he was recognized with sophisticated black lung illness at 39.
Elaine McMillion Sheldon for PBS Frontline
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Elaine McMillion Sheldon for PBS Frontline
Danny Smith spent simply 12 years mining coal earlier than he was recognized with sophisticated black lung illness at 39.
Elaine McMillion Sheldon for PBS Frontline
The size of a profound human tragedy
Concern over silica’s function in black lung has been rising for many years, and mine security advocates have urged regulators to behave since 1974. And this summer season, the federal Mine Security and Well being Administration (MSHA) lastly issued a proposed new regulation to restrict miners’ silica mud publicity.
The draft rule would set up a silica mud publicity restrict twice as robust as it’s now. It additionally creates a framework for the company to instantly regulate extreme silica exposures, one thing it hasn’t beforehand finished, making citations and fines doable for placing miners in danger.
“Our present normal because it pertains to regulating silica within the nation’s mines … doesn’t adequately defend miners’ well being,” stated Christopher Williamson, assistant secretary of labor for mine security and well being.
Mine security advocates welcome the brand new publicity restrict — 50 micrograms of silica per cubic meter of mud. It is what they have been looking for for many years.
But when the rule is adopted, the company predicts it could save solely 63 coal miner lives and keep away from 244 circumstances of black lung illness over 60 years. An investigation by Public Well being Watch, NPR, Louisville Public Media and Mountain State Highlight suggests this can be a gross underestimate of the rule’s potential upside.
The investigation sought to doc a extra full image of the present prevalence of the illness than beforehand reported. It discovered greater than 4,000 circumstances of sophisticated black lung since 2010 and greater than 1,500 diagnoses in simply the final 5 years alone.
The company’s failure to account for the 1000’s of sick and dying miners now affected by the illness appears to undercut the urgency for a proposed regulation that mine security advocates think about important to saving lives.
“The size of human tragedy is profound,” stated Kirsten Almberg, an epidemiologist on the Black Lung Knowledge and Useful resource Middle on the College of Illinois Chicago. “There’s actually no approach to quantify … the person tragedy that occurs in every of those circumstances, with lives lower brief, careers lower brief, communities reeling and households falling aside. It is simply devastating.”
When evaluating the precise depend of sophisticated black lung circumstances documented on this investigation with MSHA’s predictions, “the distinction in scale is placing,” stated Almberg.
Mine security advocates are involved that failing to make the strongest case for the proposed rule may embolden opposition from the mining trade and its supporters in Congress. And so they fear that the rule’s enforcement provisions are weak, its attain is simply too expansive and that it may nonetheless finally fail to guard miners from silica’s noxious results.
Concerning the 2023 investigation: Reporters surveyed 25 non-public and federally funded black lung clinics in 13 states and requested knowledge from the Nationwide Institute for Occupational Security and Well being (NIOSH). The NIOSH numbers come from a program that assessments working miners for black lung illness. The clinics reported the outcomes of black lung assessments for principally retired and laid-off miners. Some clinic knowledge was collected and reported by the Black Lung Knowledge and Useful resource Middle on the College of Illinois Chicago. Silica mud knowledge was obtained from the Mine Security and Well being Administration and analyzed by Justin Hicks of Louisville Public Media.
So many miners useless and dying
The mine security company’s predicted variety of circumstances that could possibly be averted with stricter regulation pales compared to what black lung clinics are literally seeing.
Three clinics alone in southwestern Virginia and japanese Kentucky have collectively reported greater than 1,500 circumstances within the final decade. That is six instances the variety of circumstances MSHA says its proposed rule would stop over 60 years.
Dr. Brandon Crum opinions X-rays of coal miners with extreme black lung illness at his clinic in Pikeville, Ky.
Elaine McMillion Sheldon for PBS Frontline
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Elaine McMillion Sheldon for PBS Frontline
Dr. Brandon Crum opinions X-rays of coal miners with extreme black lung illness at his clinic in Pikeville, Ky.
Elaine McMillion Sheldon for PBS Frontline
“As of now, we’re nearly at 700 circumstances of sophisticated black lung,” stated Dr. Brandon Crum, a radiologist specializing in black lung X-ray assessments at United Medical Group in Pikeville, Ky.
“I am shocked that we proceed to see that a lot illness and the severity of the illness,” Crum added. “We’re seeing youthful and youthful miners get it. … Males of their 30s, 40s and 50s frequently.”
Two clinics operated by Stone Mountain Well being Companies in southwestern Virginia report greater than 800 circumstances of sophisticated black lung within the final decade.
That has pulmonologist Drew Harris, Stone Mountain’s medical director, questioning MSHA’s illness predictions. “Not factoring into their danger prediction the quantity of illness that’s at the moment taking place and had been taking place for 10 to fifteen years … will not be acceptable,” Harris stated.
A pair of respiratory remedy clinics in southwest Virginia and japanese Kentucky even have caseloads that defy MSHA’s projections for averted illness and dying.
“We misplaced 11 males within the final seven months … 147 deaths have occurred in my clinics, from black lung, in 10 years. And that’s heartbreaking,” stated Marcy Martinez, a respiratory therapist who operates New Beginnings Pulmonary Rehab, which focuses on remedy for miners with sophisticated black lung.
“I do not suppose they’ve an idea of what the fact is on the market…,” Martinez added.
A wall of pictures of miners with sophisticated black lung who acquired respiratory remedy at New Beginnings Pulmonary Rehab in Norton, Va.
Marcy Martinez, New Beginnings Pulmonary Rehab
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Marcy Martinez, New Beginnings Pulmonary Rehab
The mine security company responds
Almberg, on the College of Illinois Chicago, stated she understands how the company got here up with comparatively small numbers for deaths and circumstances of illness that could possibly be averted with its proposed silica mud rule.
She defined that the company’s predictions had been based mostly on a danger evaluation that is determined by figuring out exactly how a lot silica mud publicity sick miners skilled. That element will not be accessible for the 1000’s of circumstances reported by the clinics and NIOSH.
“They’re probably not in a position to make use of that within the modeling as a result of we’re not in a position to quantify publicity,” Almberg stated.
“I do suppose it’s an underestimate,” Almberg added. The company stated so in its proposal, she famous, although there nonetheless was no point out wherever else of the 1000’s of documented circumstances of illness within the final decade.
The mine security company at first deferred questions on its danger evaluation, and different issues concerning the proposed rule, till after a public remark interval ended Sept. 11.
Just a few weeks later, MSHA responded on to Public Well being Watch, saying it’s contemplating options that it “underestimates the good thing about the proposed [silica dust limit] because the company works towards a remaining rule.”
The assertion additionally famous that Assistant Secretary Williamson attended a latest nationwide convention of black lung clinics and acquired updates from clinic employees, well being consultants, black lung researchers and sick coal miners.
“Williamson is deeply troubled by the quantity of illness — together with probably the most superior kinds — that well being consultants proceed to report in Appalachia,” the company stated.
MSHA has but to announce a timeline for a remaining rule, however given required opinions and approvals from the Labor Division and the Workplace of Administration and Price range, the ultimate language could possibly be months away.
Lungs riddled with fibrotic tissue from sophisticated black lung illness are displayed within the workplace of radiologist Brandon Crum in Pikeville, Ky.
Elaine McMillion Sheldon for PBS Frontline
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Elaine McMillion Sheldon for PBS Frontline
Lungs riddled with fibrotic tissue from sophisticated black lung illness are displayed within the workplace of radiologist Brandon Crum in Pikeville, Ky.
Elaine McMillion Sheldon for PBS Frontline
A historical past of overexposures to poisonous mud
The proposed crackdown on silica follows a fraught historical past of the mine security company’s many years of failure to guard miners from the poisonous mud. The proposal additionally overlooks a historical past of overexposure at coal mines.
Once more, this downplays the necessity and justification for motion.
The rule notes that 93% of silica mud samples have been in compliance with current silica mud limits since 2016. However the remaining 7% of samples quantity to five,300 cases of extreme publicity to the mud based mostly on the newly proposed restrict, in line with MSHA knowledge analyzed by Louisville Public Media and Public Well being Watch.
Within the 30 years main as much as 2016, company knowledge analyzed by NPR and Frontline discovered 21,000 extreme silica mud samples based mostly on the present restrict. Greater than twice that many mud samples — 52,000 — exceeded the newly proposed restrict.
Which means coal miners labored amid harmful ranges of silica mud — which is well inhaled, simply lodges in lungs and might result in extreme illness and dying — tens of 1000’s of instances in 30 years.
Throughout these three many years, the danger of silica mud publicity elevated, as mining consumed the thickest coal seams, leaving thinner seams embedded in rock. Slicing these thinner seams generated extra high quality silica particles.
Additionally, throughout that interval, the company didn’t reply successfully to the risk.
Way back to 1996, inner company memos obtained by NPR acknowledged the issue, together with a cluster of extreme black lung illness linked to silica mud publicity. The company despatched out warnings to mining firms concerning the risk and advised voluntary motion to cut back publicity.
It additionally has since performed coal and silica mud enforcement campaigns, staging particular unannounced inspections at mines persistently exposing miners to extreme mud.
However no motion was taken to particularly regulate silica mud, till now.
The mud satan within the particulars: Are proposed protections robust sufficient?
Mine security advocates credit score the company for proposing two monumental modifications: making the silica mud publicity restrict twice as strict and instantly regulating silica mud for the primary time.
However there is a mud satan within the particulars. Miner advocates complain about components of the proposal that appear to allow self-policing by mining firms and render company oversight and enforcement weak, ineffective or nonexistent. Listed below are their most important issues — and what they suppose could possibly be improved:
Danny Johnson was recognized with progressive huge fibrosis, probably the most extreme stage of black lung illness, at age 57. He had labored for many years in varied mines in southern West Virginia and japanese Kentucky — typically going greater than two weeks in a row with out a time without work.
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Roger Might for Mountain State Highlight
Danny Johnson was recognized with progressive huge fibrosis, probably the most extreme stage of black lung illness, at age 57. He had labored for many years in varied mines in southern West Virginia and japanese Kentucky — typically going greater than two weeks in a row with out a time without work.
Roger Might for Mountain State Highlight
1) Sampling is within the palms of the mining firms — extra oversight is required
The proposed rule requires mining firms to pattern coal mines for silica mud when and the place miners are working. The samples will then be despatched to unbiased labs for evaluation.
If the samples present extreme silica, mining firms might be required to cut back the publicity, utilizing what are known as engineering controls: rising air flow to comb away mud; ensuring water sprays are working correctly and tamping down mud; slowing down mining machines to decrease mud; and/0r deciding to not lower thinner coal seams embedded within the rock that produces mud.
These corrective actions and the silica mud sampling are left fully to mining firms. They’re required to maintain data of the samples and their responses, however they don’t seem to be required to ship these data to MSHA.
Federal legislation is “very clear that the last word duty for miners’ security and well being lies with the mine operator,” stated Williamson, the mine security chief.
“Operators have authorized obligations and also you begin out from the premise that individuals are going to adjust to the legislation. … After which if they do not, there are penalties for that.”
In actual fact, there is a historical past of mud sampling fraud, with a Kentucky firm fined and an worker sentenced to jail this yr, and convictions in one other case final yr.
The proposed rule additionally fails to explain MSHA’s oversight and enforcement of mining firm sampling, and responses to harmful ranges of mud.
The company responded by saying it should proceed its current oversight and enforcement routine: quarterly inspections required by federal legislation, which embrace MSHA’s personal silica mud sampling and evaluation. Company inspectors can ask to see mining firm data of mud sampling and corrective actions.
However inspectors are in coal mines solely a fraction of the time. They will not witness a lot of the sampling performed by mine operators and a lot of the modifications firms make to manage extreme mud.
“With out enforcement of the rule … it is primarily ineffective,” stated Drew Harris of the Stone Mountain clinics. “If individuals do not comply with the rule or there is no incentive to comply with the rule, it is not going to have impact. And I am not satisfied that as it’s written there’s sufficient incentive to do the suitable factor.”
West Virginia coal miner Cecil Matney Jr. is extra direct, based mostly on his 25 years of mining expertise.
“In case you’re not holding the corporate chargeable for one thing, they’re gonna break that rule,” he stated.
A makeshift billboard depicting a miner working in a “low coal” mine shaft greets drivers leaving Fleming-Neon, Ky.
Justin Hicks/Louisville Public Media
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Justin Hicks/Louisville Public Media
A makeshift billboard depicting a miner working in a “low coal” mine shaft greets drivers leaving Fleming-Neon, Ky.
Justin Hicks/Louisville Public Media
MSHA added in its latest assertion to Public Well being Watch and its reporting companions that it’s contemplating extra direct oversight and enforcement, no less than in the case of extreme mud detected in mining firm samples.
“MSHA is contemplating requiring that when an operator’s pattern is above the [silica dust limit] that operator studies that overexposure to the MSHA district supervisor,” the company wrote.
“This is able to enable MSHA to take applicable enforcement motion and supply any essential compliance help to operators.”
2) It takes too lengthy to investigate mud samples — faster know-how is on the market
It now takes every week or extra for silica mud samples to achieve labs and bear evaluation, and for mines to get again outcomes. Meaning extreme exposures may proceed, shift after shift, whereas mines await outcomes.
A new sampling course of will get outcomes a lot faster — proper on the finish of each sampled shift. That makes doable a right away response to extreme mud.
Some mining firms are utilizing the brand new sampling course of voluntarily, however MSHA would not require its use as a result of it isn’t thought of dependable sufficient for compliance and enforcement.
NIOSH developed the brand new course of, and in an emailed assertion the federal analysis company stated, “the accuracy of the method, in its present state, may be affected by the presence of different parts within the mud.”
Nonetheless, some mine security advocates think about it “one of the best accessible know-how,” a phrase from federal legislation that they argue permits required use of the machine, even when it is not totally refined.
The machine “would facilitate extra frequent sampling and much more fast correction of hazardous circumstances,” wrote Richard Miller in his feedback on the silica mud proposal. Miller is a retired labor coverage director for the Home Committee on Training and Labor.
“It’s properly inside MSHA’s authority, based mostly on the legislative historical past of the Mine Act, to problem a technology-forcing normal that requires operators to make use of greatest accessible know-how — together with know-how that’s off-the-shelf or on-the-horizon,” Miller wrote.
MSHA has not responded to Miller’s declare.
3) Persevering with to work is required even when harmful mud is detected. Miners ought to be avoided soiled air
The proposed rule permits work in harmful ranges of mud “briefly” whereas mine operators take corrective motion to get mud right down to the authorized restrict. In these circumstances, miners can be required to put on protecting mud masks or respirators.
The mining trade has argued for many years that miners may work safely in extreme ranges of mud so long as they put on protecting gear.
The Nationwide Mining Affiliation stated in its feedback on the proposal “that supplemental controls [masks and respirators] are essential to guard well being” and that relying solely on engineering controls, like strong air flow or slowing down mining machines, hasn’t prevented illness and dying.
Danny Johnson, a retired coal miner with sophisticated black lung, holds a protecting masks that was white, however turned black and crusted with mud throughout one working shift in a mine.
Roger Might for Mountain State Highlight
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Roger Might for Mountain State Highlight
However many miners complain that the mud masks and respirators they have been given are sometimes ineffective and even counterproductive.
“You place them over your face … and also you’re gasping for air on a regular basis,” stated Danny Johnson, a 69-year-old retired coal miner with 37 years in coal mines and a case of sophisticated black lung now.
The masks additionally get scorching, he added. “You dissipate. I imply, you dissipate continually.”
Miners have filed a whole bunch of lawsuits over the ineffectiveness of mud masks. Some have resulted in multimillion-dollar verdicts and settlements.
Extra-modern respirators are thought of efficient in conserving out mud. However some miners complain they’ll partially block imaginative and prescient and/or impair listening to, that are important whereas doing laborious and threatening work that requires clear sightlines and communication.
“How lengthy are you going to inform a miner to depend on the respirator to proceed working in a poisonous surroundings recognizing that it is not completely possible for miners to depend on respirators repeatedly underground?” requested Harris of the Stone Mountain clinics.
Harris and others need additional work prohibited till the mine environment is cleared of harmful ranges of mud. This method is a basic precept of office security, known as the hierarchy of controls, which places elimination of hazards as the primary “most popular” motion, and use of private protecting protecting gear, like mud masks and respirators, because the final.
The mine security company responds to this concern and others by saying they are going to be thought of whereas growing a remaining rule.
Debbie Johnson is a black lung nurse who’s used to seeing sick coal miners like her husband, Danny. “He is acquired black lung. An entire lot of them have black lung. … It is the silica mud that is killing them.”
Roger Might for Mountain State Highlight
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Roger Might for Mountain State Highlight
Debbie Johnson is a black lung nurse who’s used to seeing sick coal miners like her husband, Danny. “He is acquired black lung. An entire lot of them have black lung. … It is the silica mud that is killing them.”
Roger Might for Mountain State Highlight
4) Safety is expanded to all mines, not simply coal — a frightening regulatory job
The proposed rule would not simply apply to the nation’s 930 coal mines. It additionally applies to 11,000 different mines, collectively often known as steel/nonmetal mines, which make use of 144,000 extra miners than coal mines. They, for the primary time, might be required to pattern for silica mud, and to offer miners with medical screening for illness.
This can be a huge new regulatory requirement for the mines and the company that regulates them. It requires an intensive mud sampling and medical surveillance infrastructure that doesn’t at the moment exist.
“An similar method is not going to work for coal and [metal/nonmetal] in all circumstances,” stated the Nationwide Mining Affiliation in its response to the proposal. “An try and create a uniform method will complicate sampling efforts and frustrate [the agency’s] desired objective of a clean and fast adoption of this significant initiative.”
Some security advocates fear that together with steel/nonmetal mines within the proposal will make it harder for MSHA to completely defend coal miners, who’re already struggling by the 1000’s.
“Protections for coal staff … are simply at a disaster stage and must be prioritized,” stated Harris of the Stone Mountain clinics, although he acknowledges the significance of defending steel/nonmetal staff as properly.
Mine security chief Williamson pushed again, saying the company “has duties to guard all miners’ security and well being.”
Williamson offered a highlighted copy of the company’s fiscal yr 2024 funds request, which seeks a rise of greater than $20 million for expanded enforcement: $7 million is particularly for silica mud enforcement, and greater than $2 million would improve the capability of MSHA’s labs to accommodate an anticipated escalation in mud samples collected by company inspectors.
“We have demonstrated that it is a precedence. And we have requested for extra money to have the ability to do it,” Williamson stated.
The funds request has the assist of the White Home however nonetheless have to be authorised by Congress. The Home Appropriations Committee has already proposed reducing the company’s requested funds by practically $63 million.
The urgency to behave: “Am I going to see my children develop up?”
In Logan County, West Virginia, coal miner Cecil Matney Jr. would not wish to see youthful miners find yourself like him. “Am I going to get to see my children develop up?” he requested. “That is one thing you do not know.”
Matney is simply 50 however already has a prognosis of sophisticated black lung.
“It appears like a ton of bricks laying in your chest while you’re making an attempt to catch your breath,” he stated. “My spouse’s woken me up considering I used to be dying as a result of I wasn’t respiratory.”
Matney nonetheless works beneath a particular federal program that retains him in mining however in jobs away from harmful mud.
Regardless of coal plant and mine shutdowns that price greater than 50,000 different miners their jobs since 2011, some 40,000 coal miners nonetheless work in U.S. mines.
Overseas demand for American coal continues, particularly for high-value metallurgical coal used to make metal. “Met” coal, because it’s known as, is so precious that mining firms will lower thinner and thinner seams, and an increasing number of silica-bearing rock, to retrieve it.
Greater than 12,000 miners labored in metallurgical mines final yr, in line with the Power Info Administration.
1000’s of miners will seemingly proceed to mine coal for years to return and can proceed to face publicity to silica mud.
“We do not have as many miners as we used to, say 20 years in the past,” stated radiologist Crum, “however I feel the proportion of miners which can be going to contract black lung will in all probability be larger, and the proportion of extreme illness might be considerably larger.”
Danny Smith has picked out his gravesite within the high left nook of the household cemetery at his house in Canada, Ky.
Elaine McMillion Sheldon for PBS Frontline
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Elaine McMillion Sheldon for PBS Frontline
Again in japanese Kentucky, Danny Smith typed out extra messages on his cellphone, an oxygen tube clipped to his nostrils. He is on oxygen on a regular basis now, he wrote. He cannot get sufficient air with out it and he is being assessed for a double-lung transplant.
“I completely agree that one thing must be finished,” Smith wrote, comfortable to see that MSHA plans to do extra to guard miners from the silica mud that made his life so troublesome at such a younger age.
He is additionally wistful about what he calls the “billion-dollar coal fields” in his nook of Appalachia and the prosperity mining jobs made doable.
“Coal mining made it what it was at one time,” he stated. “Folks had very comfy lives right here.”
There was a pause in his typing. Then these phrases slowly appeared:
“I’d relatively be poor and [have] no house as to really feel what I have been feeling these days and figuring out it should solely worsen.”
This story comes from Public Well being Watch and was produced in partnership with Louisville Public Media and Mountain State Highlight. An earlier model of this story ran on Aug. 31 on Public Well being Watch and associate websites. This model of the story has been up to date with further reporting.
Public Well being Watch is an unbiased nonprofit investigative newsroom centered on public, environmental and occupational well being.
Howard Berkes is a retired NPR investigations correspondent who collaborated with the PBS collection Frontline on a landmark 2018 investigation exposing an epidemic of sophisticated black lung illness and the failure of federal regulators to forestall it.
Justin Hicks is the information reporter for Louisville Public Media and the Kentucky Middle for Investigative Reporting.
Allen Siegler is the general public well being reporter for Mountain State Highlight, an unbiased investigative reporting information service centered on West Virginia.
Carmel Wroth edited this story for NPR.
