HRSA Federal Office of Rural Health Policy Black Lung Clinics Program

Right now, my breathing is not too good. I’ve been getting my black lung now, probably
going on two years now. I’m 57 years old. I didn’t expect this, and it changed my
life completely. The Health Resources and Services Administration’s
Black Lung Clinics Program awards grants to health centers, hospitals, and other facilities
that provide medical, outreach, educational, and benefits counseling services to coal miners
across the country, regardless of a miner’s ability to pay. The Centers for Disease Control and Prevention’s
National Institute for Occupational Safety and Health—or NIOSH–has been conducting
regular health surveillance of working coal miners since 1970. In about the last two decades, there has been
an uptick in the prevalence and severity of black lung disease. So the disease is complex and has a broad
spectrum. And one of the things that is actually quite
troubling and concerning is the recent increase in the prevalence of the disease, that is,
the numbers of cases and also the severity of the disease. We’re seeing many more severe cases. I mean it’s worse actually, it’s worse
than it’s ever been. And it’s just not small dots on the X-rays,
it’s huge spots on the X-rays. It’s miners in their thirties, some of them. Well, it’s not an easy journey once you
get the black lung, complicated part. Once it gets complicated, it’s a lot different,
you require a lot more medical help and assistance. There’s very few places that you can find
that help, and through the clinics, that’s one place that you can find it. Many HRSA-funded black lung clinics are located
in areas with large active and retired coal mining communities. Clinic staff have personal ties to these communities
which enables them to build trust with the miners they serve and address these growing
challenges. Just the simple fact that when one of them
comes in and introduces themselves and talks to me about where he’s from, and I ask him,
simply, “What mine did you work in?”, and he worked with my grandfather in one of
the mines and a big smile crosses their face and you can almost see a total relaxation
that they’ve realized that somebody’s actually there that’s going to listen to
them and has a little idea of what they go through. That means a lot to somebody that’s sick. Just treat them like a person and don’t
matter what their age. Treat them like they’re your family. And I feel that that’s the way I’ve been
treated here. Knowledge of the local setting has also enabled
clinics to adapt their services and care delivery models to meet the needs of their communities. Miners’ Colfax Medical Center, located in
Raton, New Mexico, reaches miners through a mobile screening unit that travels throughout
the state. This means miners living in rural areas don’t
have to travel long distances to access specialty care. So, instead of asking people to travel 8 hours
to come see us, we go travel to their communities. The advantage of doing that is not only it’s
convenient to patients, and so we have more people participating, but it also helps us
understand the environment in which they live. We also do telemedicine. That means we allow patients to use telemedicine
via satellite to actually have access to preventive medicine, internal medicine, pulmonary medicine
specialists. And that really cuts down months of wait time. Other clinics collaborate with local black
lung association chapters, participate in health fairs, and hold Miners’ Appreciation
Days to spread the word about their services. When a miner visits a HRSA-funded black lung
clinic, he or she is entitled to a range of services, including lung function testing,
as well as information about the risks associated with coal mine dust exposure. Miners can also receive case management for
conditions such as hearing loss, depression, and cardiovascular disease. As part of the primary care clinics that are
funded by HRSA, we’ve been able to treat patients that otherwise would not have had
treatments for things like hypertension, obesity, asthma, COPD, pulmonary diseases that include
asthma and COPD. We’ve been able to bridge the gap between
specialty care and also primary care. Without HRSA funds, we would not be able to
do the primary care medical services that we’ve been able to do thus far. The HRSA grant for us at Bluestone in our
community has been a God-send. It enables us to be able to help the coal
miners in our community that are not insured or just doesn’t have the money to do the
things that they need to do. Even though we’re a Black Lung program,
we still take care of the whole miner and his whole family if there’s any way possible. Well, it’s helped me considerably lot cause
I lost my insurance after 2014. And when I’d come down, and started talking
with Debbie, and she helped me out cause probably I wouldn’t even have been alive today if
it hadn’t been for the clinic down here. HRSA-funded black lung clinics also provide
assistance to coal miners who file claims for federal black lung benefits. The Black Lung Benefits Act authorizes compensation
to coal miners who are totally disabled by pneumoconiosis resulting from their coal mine
employment and to survivors of coal miners whose deaths are attributable to the disease. If a miner’s claim is successful, the Act
provides him or her with medical coverage for the treatment of lung diseases related
to pneumoconiosis. The Department of Labor’s Division of Coal
Mine Workers Compensation Programs administers claims filed under the Act. Every HRSA-funded black lung clinic has a
benefits counselor on staff who assists miners with the federal black lung benefits claims
process. I feel that one of the most important things
I do is help those miners apply for their federal black lung benefits, and at the same
time, I’m explaining how it works. I’m kind of helping them learn the system… The HRSA grant, it helps us to achieve our
goals because the services that we provide are not reimbursable. We provide benefits counseling services that
we are not able to get reimbursement from insurances for. There are all free services that we provide
to our miners. They go the extra mile to try to help miners
and that’s not everywhere you look. And they advise miners, they counsel them
on benefits and everything, and help the miners and give the miners confidence that they’ve
got somebody helping them. Miners applying for benefits under the Black
Lung Benefits Act are entitled to a free pulmonary evaluation by an approved Department of Labor
provider and must submit an evaluation as part of the claims process. Many HRSA-funded black lung clinics have the
ability to provide these evaluations onsite by Department of Labor-approved providers. We are authorized to examine miners for the
presence of black lung disease, we also examine them to see how severe the disease is, how
much damage there’s been to the lungs from that disease. And then we have to try to make a judgment
as to whether or not the miner is disabled from that disease. And another extremely important advantage
of being a DOL examiner is that you get to be part of a community of physicians, and
attorneys, and benefits counselors who really care deeply about miners’ health. From medical care, to education, to outreach,
to benefits counseling, HRSA’s Black Lung Clinics Program provides vital services to
thousands of coal miners and their families every year. Well, I don’t know what we’d do if we
didn’t have a clinic like this, in the mountains, you know. Some people would be trying to drive miles
and miles, you know, to get help if we didn’t have this here. I’ll have a place in my heart for these
folks for the rest of my life.

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