Immigrants Sue Kentucky Over Block To Open Home Health Care For Refugees Thursday, Dec 5 2019 

When two Nepalese immigrants wanted to open a home health agency for a growing community of refugees in Louisville, state regulators blocked them and a large Louisville hospital argued the business wasn’t needed. So now, the businessmen are suing Kentucky, challenging a law that some say allows monopolies to form.

Dipendra Tiwari and Kishor Sapkota, represented by the libertarian-leaning Institute of Justice, are suing the Cabinet for Health and Family Services on the premise that Kentucky’s “certificate of need” law — which was used to block their business from opening — is unconstitutional. 

Tiwari and Sapkota’s business, Grace Home Care, would offer “home health care,” which can help older adults avoid a nursing home and live at home. Services can include therapy to help restore people’s ability to do daily tasks, physical therapy, tube feeding, wound dressing and other nursing services.

Institute for Justice

Dipendra Tiwari’s application for a home health agency was turned down in Kentucky.

The business partners mainly want to offer care to Bhutanese refugees that were resettled in Louisville. These refugees — of which there are around 90,000 in the United States — were forced out of Bhutan in the 1990s and moved to camps in Nepal. Between 2014 and 2018 alone, the U.S. took in and resettled almost 1,000 Bhutanese refugees in Louisville. And there’s a small percentage that are over the age of 65 and do not speak English, resulting in barriers to aging care. Tiwari said he wants to change that. 

“The translation issue gets in the way of health care,” Tiwari said. 

There are six home health agencies already in Jefferson County. While several have expanded in the past few years, no new companies have been able to enter the market since 2013. One of the six companies, Baptist Home Health Care Louisville, formally opposed Grace Home Care’s application with the state. Its parent company, Baptist Health Care System, also owns numerous hospitals and home health agencies throughout the state.  

“It felt like the big business, it had some way to influence the state and of obstructing small business[s] not to come and not compete with them,” Tiwari said. “Why is the government obstructing people to set up a business based on their law?”

The law Tiwari is talking about is known as a certificate of need law, which restricts the number of home health agencies in a given county. Agencies must be able to prove at least 250 patients need their service before they’re allowed to operate. The state, in its final decision, said Grace Home Care didn’t do that. 

Kentucky Cabinet for Health and Family Services spokeswoman Christina Dettman declined further comment, citing the pending litigation.

The lawsuit, filed on behalf of Tiwari and Sapkota in the Western District of Kentucky, says that the certificate of need law violates the Constitution. Around 18 states currently have home health certificate of need (CON) laws.

These laws were passed in the 1970s and 1980s, and were intended to reduce health care costs by not allowing companies to open and offer services that communities didn’t really need.  

Research on whether CON laws hold down costs is mixed. A 2015 study showed states that did have the laws on the books had slower health care cost increases compared to states that didn’t have the laws. But there’s also reduced competition in states that do have them, which amounts to the creation of monopolies, according to Momotazur Rahman, an associate professor and researcher at Brown University.

“I think this is an example perhaps of why we cannot improve the quality of home health care much,” Rahman said. “We have a specific group of patients who’d be probably better off by having a home health agency that can serve their needs in a better way. But we cannot open this home health agency because of CON laws, and that is just a reduction in quality of care.”

Which is part of Tiwari’s argument. He immigrated from Nepal to the U.S. for school, and later worked as an accountant at a home health agency in Virginia, where he gained experience in how these agencies operate. Now, he owns an accounting firm in Louisville and finds a lot of his older Bhutanese clients talk about issues with health care access. 

“And the translators that are available in the hospitals often speak a different version of Nepali that these refugees don’t know,” Tiwari said.

The language and cultural barriers can have big implications for immigrants and refugees. For instance, one study found that almost a quarter of Bhutan women refugees over age 65 were anemic after resettling. Research has shown having a health provider who knows the health and cultural issues of a specific population can improve the quality of care and improve health outcomes. 

In addition, if there are language barriers a patient might not be able to communicate that they’re having a specific condition or symptom, which can result in misdiagnosis, longer hospital stays and medical errors. 

 “They didn’t even necessarily choose to immigrate here, but were relocated here, so that’s another reason that we have this big population that doesn’t have English fluency,” Tiwari said. 

Tiwari said he wants to fill that gap.

The Institute for Justice, which is representing Tiwari, also is suing the state of Iowa for its CON law for eye surgery centers, and in North Carolina over testing service CON laws.

Louisville doctor stresses the importance of HIV screenings Wednesday, Dec 4 2019 

Norton Healthcare is offering HIV screenings at Norton Hospital, and will be rolling them out to all four of its adult emergency departments.

        

Trump Cuts May Hurt Enrollment In Health Insurance Marketplace Tuesday, Dec 3 2019 

It’s open enrollment season for the health insurance marketplace established by the Affordable Care Act. But many people who need to sign up may not know it. The Trump administration has made a number of moves to diminish the law, including cuts to marketing and outreach. That creates obstacles for groups that help people sign up.

It’s a cold fall day at the Jane Pauley Community Health Center on the Eastside of Indianapolis. Rep. Andre Carson is hosting an event to promote Open Enrollment, a time when Hoosiers can sign up for health insurance or make coverage changes through the federal Affordable Care Act.

Carson is a Democrat and supports the federal law.

“As we approach 10 years since the passage of the Affordable Care Act, it’s a great time to reflect on the successes and the millions of Americans who have received health care because of it,” he said.

About 150,000 Hoosiers get insurance through the marketplace, down from a peak of 218,000 in 2015.

After a failed effort to repeal the law, the Trump administration attempted to dismantle it with other moves,  including severe cuts to the advertising budget.

“Well, not not only has the funding for advertising been cut, but also average health care premiums have increased by over $2,300,” Carson said. “And I think that is an unfair burden that is placed on American families, especially Hoosiers.”

Many states have passed measures to strengthen the law. But not Indiana, one of the states that has done the least to preserve it.

Jill Sheridan

Employees from the Jane Pauley Community Health Center.

Darlene Lopez retired this past summer. Too young for Medicare, she wasn’t sure where to turn for health insurance. The unemployment office couldn’t help her, Social Security told her to call 211 where they provided her a list of places that may help, including the Jane Pauley Center.

“Amazingly through God’s grace, I walked through the door and Sherriece was standing there, and she’s helped me so much with the process the whole painful process,” Lopez says. “She took me step by step by step to get me where I’m at today.”

Sherriece Harris is a health navigator. She says a lot of people, like Lopez, don’t know or understand their options.

“People are scared of the marketplace because they’re hearing that the prices are not affordable,” Harris said. “But actually with Miss Lopez it was affordable for her and actually for it, you know, 2020 it even went down even more for her.”

Organizations like community health centers and hospitals have retained and even brought more navigators, despite a more than 80 percent cut in federal funding for the positions since 2016.

Covering Kids and Families of Indiana, a nonprofit that helps people with health coverage, staffs navigators. Policy Director Mark Fairchild says navigators are vital.

“They know the ins and outs, they know the process,” he said. “They’ve seen 100 of these applications, whereas for a consumer, it’s probably their first one and it looks very, very daunting. And they walk you through that process step by step.”

This year Hoosiers can pick from plans provided by at least two companies. But there is a lot of variety in the plan options.

There was a federal push to increase short-term, or so-called “junk,” plans that don’t have to comply with ACA standards such as covering pre-existing conditions.

People can get confused easily, Fairchild said. “As much as I’m in this line of work, I don’t always understand my insurance, right? If we’re being honest, most people really don’t all those ins and outs.

“There’s a lot of jargon a lot of legal terminology. A lot of things you could do wrong to be denied coverage, even if you perfectly well qualify for it.

Fairchild says despite the budget cuts, repeal of the individual mandate and other moves to weaken the federal law, the marketplace has proven resilient. “So a lot of what the Affordable Care Act really sought out to do which was to get people covered and get them used to the benefits of coverage has stuck around.”

That means getting people used to having insurance and the peace of mind that comes with it.

Lopez says lots of people need help signing up. “I’m not alone in this, you know other people retire, people lose their jobs.”

Open enrollment for the marketplace ends Dec 15.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Copyright 2019 Side Effects Public Media. To see more, visit Side Effects Public Media.

With Bevin Leaving Office, What’s Next For Passport? Tuesday, Dec 3 2019 

Passport Health Plan will appeal the decision from Gov. Matt Bevin’s administration to drop the company as a state Medicaid provider, just days before incoming Gov. Andy Beshear takes office.

Last week, the Kentucky Cabinet for Health and Family Services announced several new contracts for insurance companies to run Kentucky’s Medicaid benefits. The contract for Passport Health, which is based in Louisville, was not renewed. Neither was Anthem Kentucky’s contract; that company said it will also appeal, but unlike Passport, Anthem operates in several other states, including Indiana, Ohio and California.

Passport’s main business is with Medicaid in Kentucky, so the loss of the state’s contract raises questions about the financial future of the company.

The majority — 91 percent — of Medicaid enrollees get their benefits through one of these Managed Care Organizations, or MCOs. They’re paid by the state and federal governments to run these benefits on a monthly basis per member. The idea is that these companies will better keep down health care costs because they’re only paid a pre-arranged amount, so they might drive people to be healthier or cut out unnecessary spending. This system has been in place since 2013.

Bevin’s administration announced the new Medicaid contracts about two weeks before Bevin’s last day in office: on Dec. 10, which is also Beshear’s inauguration day. And there are several unknowns as to how the changing administration will affect Passport’s chances going forward.

Appeals, Lawsuits Or New Proposals

The Beshear administration could grant an appeal to either Passport or Anthem, but then the number of Medicaid administrators in the state would rise to six, an increase from the current five. This might not sit well with lawmakers who have previously said Kentucky needs to narrow down the field to reduce administrative costs.

Or, Beshear could completely re-issue a request for proposals that would nullify the previous contracts and give Anthem and Passport a new change to apply, according to health care consultant Jeff Myers. He said this has happened in other states. This scenario may be even more likely if Beshear follows through on a promise to immediately revoke Bevin’s controversial changes to Medicaid.

The new Medicaid contracts set out how the state’s chosen insurers will meet those upcoming requirements laid out in Bevin’s proposal. Those changes, including work requirements, have been tied up in court. Myers said he suspects the Beshear administration will issue new RFPs and rescind the current contracts as to not include Bevin’s signature policies in the contracts.

If either Anthem or Passport loses their appeals, Myers said it’s likely they will sue the state; he said such lawsuits are common by insurers that are turned down for new contracts. Because of the way Medicaid proposals are scored, insurers have a lot of leeway to argue their case in court. This, too, could result in the new Beshear administration issuing a new request for proposals for the Medicaid contracts, much as other states like Pennsylvania did in 2018 when faced with lawsuits by losing insurers that didn’t get contracts, according to Myers.

“Pennsylvania, put out a procurement and then abruptly yanked the procurement and then put out another one, because they got sued and they felt they were going to lose,” Myers said, the founder of health care consulting firm OpDis.

It’s also notable that ex-Passport CEO Mark Carter is on Beshear’s transition team for the state’s Cabinet of Health and Family Services. He’ll be part of a small group helping to pick a new secretary and other political appointees that will be influential in the process of either deciding appeals or issuing new RFPs.

But Beshear spokeswoman Crystal Staley downplayed Carter’s involvement in the future of Passport Health.

“Mr. Carter is serving as a volunteer member of the transition team; he is no longer employed or affiliated with Passport and has no role in reviewing any of the contracts,” Staley said.

What’s Next For Passport’s West Louisville Headquarters?

Another potential casualty if Passport is unable to renew its contract with the state could be the $130 million corporate headquarters already underway in Louisville’s California neighborhood. Stalled since February, the building was once expected to be one of the major investments to take place in west Louisville during a current and unprecedented wave of development.

This summer, Passport announced plans to sell most of the company to its business partner Evolent Health — a deal that Evolent and Passport representatives say they still expect to close this month. At the time, the sale was seen by some as an opportunity to resurrect the headquarters project.

Given the recent news about Passport’s uncertain future, the headquarters plan is somewhat unknown. Passport spokesman Ben Adkins said there may still be a way forward for the project.

“Passport believes strongly that the development of the site at 18th and Broadway will have a positive impact on the community, and a search is under way to identify a developer that can bring the vision for the site to fruition,” he said in an emailed statement. “However, our immediate efforts are focused on mounting a successful protest to the state contract awards so that we can continue to serve our members across the Commonwealth.”

In a recent conference call with analysts, Evolent CEO Frank Williams said he believed the decision to not award Passport a contract is not in the best interest of Kentucky residents and Medicaid beneficiaries. He said he supported Passport’s plan for an appeal, but that it was difficult to say whether the new administration would help the situation.

“What we really want is a fair hearing in the appeal process,” Williams said. “We believe this is a high performance plan. We believe they provide incredible service to members, incredible clinical care for an integrated model.”

He indicated that Passport would file an appeal soon after Beshear takes office. He said appeals take time because the company has to get information on scoring and other details from the state; he pointed to similar situations in Louisiana and Florida. The process could take weeks or months, Williams said.

In the cases of some other successful appeals, Williams said, “there were certain things in the decision process which really didn’t make sense.”

He also said there are some aspects of the scoring process in Kentucky that are “highly subjective.”

When he made the comments, Williams said he did not know the details of Passport’s scoring, but that the companies planned to examine them carefully once received.

‘You can’t put a price on this’: The cost of childhood cancer Thursday, Nov 28 2019 

Close to 15,000 kids will be diagnosed with cancer this year. Still, only about 7% of federal funding goes to pediatric cancer.

        

Study Shows Ohio Valley’s Premature Deaths Driving Down National Longevity Rates Wednesday, Nov 27 2019 

A new medical study shows that after decades of increasing life expectancy across the country, people are living shorter lives. And that trend is in part driven by premature deaths among people in the Ohio Valley due to the opioid epidemic, suicide and alcohol abuse.

The article published Tuesday in the Journal of the American Medical Association focuses specifically on people 25 to 64-years-old whose premature deaths impact what is called the midlife mortality rate.

Among that group, the report calculates about 33,000 excess deaths between 2010 and 2017. A third of those deaths occurred in West Virginia, Ohio, Kentucky and Indiana. The New England region has the second-highest rates of midlife mortality and includes New Hampshire, Maine and Vermont.

Life expectancy in the United States has increased for most of the past 60 years, but the rate began to slow across the country after 2014. Life expectancy across the country peaked in 2016 at roughly 79 years.

The report’s authors say that in spite of spending significantly more on health care than other high-income countries, the United States fares poorly in rates of chronic conditions such as diabetes and high blood pressure.

Understanding the underlying conditions contributing to the decline is key to reversing the trend, according to the report.

Kentucky To Drop Passport And Anthem As Medicaid Providers Wednesday, Nov 27 2019 

Passport Health Plan and Anthem Kentucky will no longer offer Medicaid coverage to Kentuckians starting next summer. State officials announced Wednesday that it did not award those providers contracts following the expiration of their current contracts at the end of June 2020.

This year, there are five Medicaid providers who cover 1.3 million enrollees in Kentucky. The state will renew contracts with Aetna, Humana and WellCare. The latter of which — in a change — will be dedicated to children in the foster care system and those in the juvenile justice system.

Molina and UnitedHealthcare will receive fresh contracts for next year.

Compared to other Medicaid managed care organizations in Kentucky, Passport has struggled financially following a change to reimbursement rates by the state. Passport is the only nonprofit Medicaid provider in the state. Earlier this year, it brought in a new CEO and sold a majority stake to its business partner Evolent.

“We are deeply disappointed in this decision, having been a committed partner to the state and an organization that has been dedicated to improving Kentuckians’ health and wellbeing for more than 20 years, with demonstrable results,” said Passport Chief Executive Officer Scott Bowers in a press release. “We intend to protest the state’s decision with the goal of continuing to provide Medicaid benefits and improve the health and quality of life of our members throughout the Commonwealth.”

This story has been updated.

 

 

Jewish Hospital To Pay $10 Million In Federal Settlement Alleging Fraud Tuesday, Nov 26 2019 

Jewish Hospital’s former parent company is paying more than $10 million to settle multiple allegations of fraud at the Louisville facility. The claims initially included in a federal whistleblower lawsuit allege Jewish Hospital illegally profited from prescriptions filled in the hospital’s in-house pharmacy, defrauded Medicare and filled prescriptions for patients without proper documentation of doctors’ orders.

The settlement was finalized on October 30, a few days before the University of Louisville announced it closed on the deal to buy Jewish and other KentuckyOne properties. Catholic Health Initiatives, Jewish Hospital’s previous parent company, confirmed it is paying the settlement money to the federal government, which was a party to the lawsuit.

The settlement stems from a whistleblower lawsuit originally filed in U.S. District Court in 2017 against Jewish Hospital and St. Mary’s Healthcare, KentuckyOne Health and University of Louisville Physicians. In that suit, former Jewish Hospital pharmacist Robert Stone laid out several allegations, including that Jewish used its own in-house pharmacy that filled drugs — and were reimbursed by Medicare for them — that didn’t always have doctor’s signatures. This violates a major federal health care regulation meant to ensure that patients are getting medically necessary drugs.

Jewish Hospital also allegedly filled and was paid by Medicare for prescriptions that the pharmacy didn’t verify were actually needed by patients.

The final settlement agreed to by Jewish Hospital and St. Mary’s Healthcare and the federal government only includes two of the original five allegations made by Stone, plus one additional allegation that wasn’t in the original complaint. In the settlement, Jewish Hospital denies the allegations and does not admit liability.

Michael Romano, spokesman for Jewish’s former parent company CHI said in an emailed statement that the in-house pharmacy, called Pharmacy Plus and Pharmacy Plus Specialty, closed in June.

“The primary allegation in the lawsuit was that Pharmacy Plus delivered needed refill medications by mail to transplant patients without keeping appropriate documentation of proof of delivery, or detailed notes of the patient’s current quantity at hand, both of which are part of the refill documentation requirements of the Medicare program,” Romano said.

Robert Thomas, Jr., an attorney for Stone who worked on the case, said the hospital cut corners in an effort to bring in revenue.

“The pharmacy was doing everything it could to capture the doctor’s prescriptions, rather than having those prescriptions go elsewhere; so if you make sure that everything goes through smoothly, without checking all the things that need to be checked, then you’ve reduced the number of hassles that the patients and the doctor have to encounter in getting the prescriptions filled,” Thomas said. “But if you reduce all those hassles, you’ve also cut corners in ways that mean people who are deceased are getting prescriptions or people who don’t actually need that particular drug or getting a prescription.”

The Lawsuit’s Origins

There are a number of rules that regulate how hospitals and pharmacies get paid by the government insurance program Medicare, which covers people with disabilities and those over age 65. When a health care provider gives financial incentives to doctors to refer patients, or routinely gives patients a copay break to incentivize their business — both claims included in the suit against Jewish Hospital — those acts are illegal and fall under a law called the False Claims Act.

“It’s a very strong law that it punishes companies that try to cheat the federal government or that cheat the federal government,” said Lexington Attorney Brian Vines, who worked on the case.

The story of the lawsuit began in 2014 when Jewish Hospital opened Pharmacy Plus, its own specialty pharmacy that could fill expensive drugs for high-cost patients including those who underwent transplant surgery. The lawsuit alleges that these patients were previously having their prescriptions filled at outside pharmacies, and Jewish saw an opportunity to profit by filling those prescriptions in-house.

But according to the lawsuit, Jewish Hospital doctors, including some from U of L Physicians who had admitting privileges, were reluctant at first to send patients’ prescriptions to the new in-house pharmacy. So, the settlement and lawsuit claim Jewish Hospital incentivized the doctors and patients to use the in-house pharmacy.

The Allegations

In addition to the incentives allegedly offered to keep prescriptions in-house, in the settlement the federal government alleges Jewish also waived co-pays and deductibles for insulin prescriptions at the Jewish pharmacy. This complaint wasn’t in the original lawsuit, but whistleblower attorney Robert Thomas Jr. said the DOJ likely figured out this was happening during investigations.

“Co-pays are there as kind of a check to make sure that people really do need this medicine, and if [pharmacies] are routinely waiving co-pays across the board, then usually something else is going on,” Thomas said.

The lawsuit also alleged that Jewish’s pharmacy provided specialized “care coordinators” to U of L Physicians who practiced at Jewish to help fill prescriptions. Those actions qualified as “kickbacks,” according to the suit because the coordinators were saving the doctors time in prescription paperwork, and thus fall under the Anti-Kickback Act.

“The resulting referrals have turned Pharmacy Plus and Pharmacy Plus Specialty into a revenue center for defendants, earning millions of dollars annually,” the lawsuit states.

U of L Physicians was a defendant in the whistleblower lawsuit, but was not included in the federal settlement. U of L spokesman John Karman declined to comment on U of L Physicians’ role in the lawsuit.

Thomas said he thinks the Department of Justice chose to hone in on only a few allegations in the settlement because Jewish Hospital was facing financial issues — and a potential sale to U of L.

“I think the economics of the hospital, being a target of an acquisition, meant that there was only so much money that could be captured and only so much time that could be devoted to the case,” Thomas said. “I think they [the Department of Justice] took the issues that were in front of them and easiest to prove, and when they realized that they weren’t going to be able to get too much further, they called it a day.”

Under the terms of the settlement, former Jewish Hospital parent company CHI will pay the U.S. government $10,101,132. The government will pay $1.85 million to Robert Stone, the whistleblower pharmacist who filed the initial lawsuit.

U of L Health expands women’s health services to downtown and South Louisville Tuesday, Nov 26 2019 

By Matthew Keck —

The University of Louisville Health Frazier Rehab Institute is bringing their women’s health services to two more of their locations: the U of L Health – Mary and Elizabeth and downtown campuses.

David McArthur, U of L Health media relations, said this expansion has been planned over the last six months. He said U of L Health wanted to serve the needs of the entire Louisville area, and these two locations allow them to do so.

U of L Health – Medical Center East is where they developed the Women’s Health and Pelvic Floor Therapy program. This program was developed to help women living with urinary problems, pelvic pain and pregnancy pain or weaknesses, to name a few.

According to a study in the Journal of the American Medicine Association, up to one in five women in America are affected by pelvic floor disorders. ” More than 25 million Americans have urinary incontinence, and the experience can leave them feeling ashamed, socially isolated, and depressed,” states the U of L Health Frazier Rehab website. “Recent research has demonstrated the effectiveness of physical therapy in treating the symptoms of urinary incontinence.”

This program treats women through different stages of life with common diagnoses like:

  • Urinary Incontinence or Urinary Urgency.
  • Dyspareunia/Painful intercourse.
  • Interstitial cystitis/bladder pain/painful urination.
  • Pelvic pain.
  • Vaginismus/pelvic muscle tightness.
  • Vulvodynia/vaginal burning.
  • Pelvic floor myalgia (muscle pain)/muscle spasm.
  • Levator ani syndrome.
  • Pregnancy- and post-pregnancy related issues.
  • Post-surgical pelvic pain.

With this program, they provide treatments to address muscle weakness or imbalance which may be causing these issues. According to their website, “Pelvic floor muscle training, in conjunction with bladder retraining, has been shown to reduce or resolve symptoms of urinary incontinence in women.”

The program features multiple treatments and therapies including:

  • Assessment to determine the type of incontinence (stress, urge, or both), the extent of incontinence, and assessment of the strength, motor control and endurance of pelvic floor muscles.
  • Assessment of musculoskeletal issues with particular emphasis on pelvic and back pain.
  • Comprehensive treatment plan in collaboration with the patient’s physician.
  • Therapeutic exercise to enhance pelvic floor and abdominal muscle function, and incorporation of these exercises into daily activities.
  • Surface EMG (electromyography) to measure muscle activity and to provide patients with feedback on the muscle control as it develops.
  • Electrical stimulation to facilitate muscle contraction or to reduce pain.
  • Recommendations on lifestyle changes that will help make the bladder less irritable, including avoiding common bladder irritants, retraining the bladder, keeping a bladder diary and lifting, moving, and exercising correctly.

The goal of this program is to reduce or resolve these issues with muscle treatment or therapy.

The post U of L Health expands women’s health services to downtown and South Louisville appeared first on The Louisville Cardinal.

MSHA Comment Period Shows Divide On Measures To Protect Miners Health Monday, Nov 25 2019 

The comment period has closed for the Mine Safety and Health Administration’s proposed rule on respirable silica, a major contributor to skyrocketing rates of lung disease among coal miners. The 49 relevant comments included a striking testimony from an anonymous coal miner sharing details of the ways in which current mine operators cheat on dust monitoring protocols.

MSHA issued the request for comment following an NPR/PBS Frontline investigation that found the agency had failed to adequately protect miners despite knowing that silica dust was contributing to an epidemic of black lung disease. Silica is a component of coal mine dust, and is released when miners cut into rock layers surrounding seams of coal. Particulates lodge in miners’ lungs for the rest of their lives, hardening lung tissue and preventing them from getting enough oxygen. 

The miner submitted testimony through the Appalachian Citizens Law Center, which withheld the miner’s name out of concern for the safety of his job. The miner said he worked underground for eight years before getting an MSHA dust sampling certification in 2017. 

I only did the dust sampling for a few months because the mine I was working for appeared to be violating the rules so much that I was afraid they would get caught and I would be held responsible,” the miner wrote.

“I learned that the company would hang the CPDMs in the intake air,” the miner continued. 

CPDMs refer to Continuous Personal Dust Monitors, devices designed to be worn by miners and to report real-time dust levels. Hanging the device in the flow of clean air would trigger its motion sensor, tricking the device into recording that a miner was wearing it while working while ensuring it only tracked clean air. 

“This letter reflects what a lot of miners tell me when they come to me for black lung evaluations,” said Dr. Robert Cohen, director of the Mining Education and Research Center at the University of Illinois at Chicago. “They often report that they could get in trouble if they turned in what they called a bad sample, that they were told to or encouraged to make sure their dust samples did not exceed the exposure limits.” 

In its request for comment, MSHA said it would consider stronger environmental controls and a lower exposure limit, but it also suggested it was open to the use of personal protective equipment, or PPE, such as airstream helmets, which miners say are too bulky and uncomfortable for frequent use. 

“A lot of the mines buy what they want and they’re big and uncomfortable,” wrote commenter John Ormsbee, who identified himself as a current miner, speaking of the challenges of using personal protective equipment to meet silica standards. “Most make your glasses fog up and create a bigger hazard.”

Cohen submitted a comment on behalf of the American Thoracic Society, which supports a separately enforceable silica standard. “PPE is an unreliable method of controlling dust exposure,” Cohen said. “It makes no sense that we would allow PPE and therefore have less stringent air control requirements That would be a huge disservice, and it would go against our hierarchy of controls and our understanding of industrial hygiene that’s been in place for generations.”

The National Mining Association did not submit a comment, but has previously supported increased use of PPE. 

The Appalachian Citizens Law Center and the United Mine Workers of America both urged MSHA to adopt an emergency temporary standard to reflect the urgent need to address dust exposure for working miners. 

Industry groups in associated fields, such as the Portland Cement Association and the National Stone, Sand and Gravel Association urged MSHA to regulate coal mining separately from other industries that also expose workers to respirable silica.

Roughly 20 percent of experienced Appalachian coal miners have some form of black lung disease. The National Institute for Occupational Safety and Health says that nation-wide, rates of black lung are higher than they’ve been since record-keeping began in the 1970s.

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