Greg Kelly at residence in Delphia, Ky. A former coal miner, Kelly has a sophisticated stage of black lung illness often called difficult black lung or progressive large fibrosis.

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Greg Kelly at residence in Delphia, Ky. A former coal miner, Kelly has a sophisticated stage of black lung illness often called difficult black lung or progressive large fibrosis.

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Greg Kelly’s grandson, Caden, scampers to the tree-shaded creek behind his grandfather’s home to catch crawdads, as Kelly shuffles alongside, making an attempt to maintain up. Kelly’s small day pack holds an oxygen tank with a transparent tube clipped to his nostril. He has chairs spaced out on the quick route so he can cease each couple of minutes, sit down and catch his breath, till he has sufficient wind and energy to start out out once more for the creek.

NPR and Frontline

“I simply pray that the Lord give me as a lot time as I can with him,” Kelly stated, his eyes welling with tears. “He simply lightens my life. I need to be as enjoyable with him as I can. And do as a lot as I can with him.”

Caden is 9 years outdated, and even at his age he is aware of what occurred to his paw-paw on the Harlan County, Ky., coal mines the place Kelly labored as a roof bolter for 31 years.

“That coal mine made your lungs soiled, did not it?'” Kelly recalled Caden asking. “Yeah it did. … And I can not breathe and I’ve to have my backpack to breathe,” Kelly instructed him.

Former coal miner Danny Smith and his household used to journey their ATVs and go tenting on this reclaimed strip mining web site in Pike County, Ky. However Smith is now not capable of do such issues due to his superior black lung illness.

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Former coal miner Danny Smith and his household used to journey their ATVs and go tenting on this reclaimed strip mining web site in Pike County, Ky. However Smith is now not capable of do such issues due to his superior black lung illness.

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It is a acquainted story throughout Appalachia. Two hours north and east, past twisting mountain roads, Danny Smith revved up a garden mower. He wore denims, a T-shirt and a white face masks stretching from eyes to chin, and he pushed solely about 15 ft earlier than he out of the blue shut off the mower, bent to his knees and began hacking uncontrollably.

“Oh God,” he gasped, as he spit up a crusty black substance with grey streaks, after which stared on the useless lung tissue staining the grass. Nonetheless coughing and respiration exhausting, Smith settled right into a chair on his porch and clipped an oxygen tube to his nostril.

Since being recognized with superior black lung, Smith is ready to mow his garden only some minutes at a time earlier than needing to catch his breath.

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Since being recognized with superior black lung, Smith is ready to mow his garden only some minutes at a time earlier than needing to catch his breath.

Howard Berkes/NPR

After spending simply 12 years underground, his lungs are so dangerous he faces what coal miners many years older and with many years extra in mining have endured. His lung tissue is dying so quick, his respiratory therapist says, it simply peels away.

“I am terrified,” Smith stated, as he remembered his father’s struggling when he was battling the identical coal miner’s illness.

“I positive do not need to undergo what he went by means of. I seen a number of guys that died of black lung and so they all suffered like that.”

Kelly says he used to wrestle together with his grandson earlier than he was recognized with black lung illness. Fishing is without doubt one of the few actions he’s nonetheless capable of do.

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Kelly says he used to wrestle together with his grandson earlier than he was recognized with black lung illness. Fishing is without doubt one of the few actions he’s nonetheless capable of do.

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A multiyear investigation by NPR and the PBS program Frontline discovered that Smith and Kelly are a part of a tragic and just lately found outbreak of the superior stage of black lung illness, often called difficult black lung or progressive large fibrosis.

A federal monitoring program reported simply 99 instances of superior black lung illness nationwide from 2011-2016. However NPR recognized greater than 2,000 coal miners affected by the illness in the identical timeframe, and in simply 5 Appalachian states.

And now, an NPR/Frontline evaluation of federal regulatory information — many years of data recorded by dust-collection displays positioned the place coal miners work — has revealed a tragic failure to acknowledge and reply to clear indicators of hazard.

For many years, authorities regulators had proof of extreme and poisonous mine mud exposures, the sort that may trigger PMF, as they had been taking place. They knew that miners like Kelly and Smith had been more likely to develop into sick and die. They had been urged to take particular and direct motion to cease it. However they did not.

“We failed,” stated Celeste Monforton, a former mine security regulator within the Clinton administration who reviewed the NPR/Frontline findings.

Kelly and his spouse, Lisa, say grace earlier than Sunday dinner.

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Kelly and his spouse, Lisa, say grace earlier than Sunday dinner.

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“Had we taken motion at the moment, I actually consider that we might not be seeing the illness we’re seeing now,” stated Monforton, now a office security advocate who teaches at George Washington and Texas State universities.

“Having miners die at such younger ages from exposures that occurred 20 years in the past … I imply that is such a gross and frank instance of regulatory failure.”

It is an “epidemic” and “clearly one of many worst industrial medication disasters that is ever been described,” stated Scott Laney, an epidemiologist on the Nationwide Institute for Occupational Security and Well being.

“We’re counting 1000’s of instances,” he stated. “1000’s and 1000’s and 1000’s of black lung instances. 1000’s of instances of essentially the most extreme type of black lung. And we’re not executed counting but.”

“They’re primarily suffocating whereas alive”

This superior stage of black lung leaves lungs crusty and ineffective, says Dr. Robert Cohen, a pulmonologist on the College of Illinois, Chicago who has spent many years learning black lung and PMF illness.

“You will have a a lot more durable time respiration in an effort to’t train,” Cohen famous. “Then you may’t do some easy actions. Then you may barely breathe simply sitting nonetheless. And then you definitely require oxygen. After which even the oxygen is not sufficient. And so … they’re primarily suffocating whereas alive.”

“There’s a number of reminiscences right here, some good, some dangerous,” says Smith, whereas reflecting on his years working on the now defunct Stable Power mine in Pike County.

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“There’s a number of reminiscences right here, some good, some dangerous,” says Smith, whereas reflecting on his years working on the now defunct Stable Power mine in Pike County.

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The poisonous mine mud that causes extreme illness is not coal mud alone. It contains silica, which is generated when miners minimize sandstone as they mine coal. Many coal seams in central Appalachia are embedded in sandstone that incorporates quartz. And when quartz is minimize by mining machines, it creates fantastic and barbed particles of silica mud — fantastic sufficient to be simply inhaled and sharp sufficient to lodge in lungs endlessly.

Previously 30 years, the largest coal seams had been mined out in Appalachia, leaving thinner seams coursing by means of sandstone.

“All the great seams had been gone as a result of there have been hardly no strong seams of coal left,” the 54-year-old Kelly remembered. “And there [was] extra rock within the coal.”

The silica mud that resulted from slicing that rock was way more harmful than coal mud alone.

Silica is “someplace round 20 instances extra poisonous and may trigger illness way more quickly,” stated Laney.

The NPR/Frontline investigation discovered 1000’s of cases through which miners had been uncovered — not simply to coal mud however to harmful ranges of poisonous silica mud. The federal Mine Security and Well being Administration’s personal information chronicle 21,000 cases of extreme publicity to silica since 1986.

On the identical time, NPR recognized black lung diagnoses involving miners of their 30s who additionally skilled fast development to the superior stage of PMF. Smith says he was recognized with PMF at 39. NIOSH has confirmed this development in its research.

“We have got the our bodies to show it”

NPR/Frontline analyzed 30 years of information collected by federal regulators. They measure coal and silica mud the place miners are working, and in 85 % of the samples collected silica was at protected ranges. However for that different 15 % — which quantities to 21,000 mud samples — the information present that miners had been uncovered to extreme silica ranges that violated federal well being requirements.

“That is what causes illness, is the extreme publicity,” stated Jim Weeks, an industrial hygienist and mine mud specialist at MSHA within the Obama administration and on the United Mine Employees union earlier than that.

An NPR evaluate of mine mud laws additionally discovered that federal enforcement doesn’t straight handle silica mud. If regulators measure an excessive amount of silica in mine air, they place coal mines on a lot more durable limits for coal mud. That is presupposed to decrease the silica publicity as a result of coal and silica mud are sometimes blended.

However our investigation discovered that this oblique method to controlling silica mud did not all the time work. MSHA’s 30 years’ mud sampling information present harmful ranges of silica or quartz the place miners had been working near 9,000 instances, even after coal mines had been required to satisfy decreased limits for coal mine mud.

“They did not pay ample consideration,” Weeks concludes. “And …we have got the our bodies to show it. I imply these guys would not be dying if folks had been being attentive to quartz. It is that easy.”

A coal processing plant sits deserted close to Smith’s residence in Pike County.

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A coal processing plant sits deserted close to Smith’s residence in Pike County.

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We discovered one other instance of overexposure in MSHA’s information. Every time federal mine inspectors issued citations for an excessive amount of silica, which they did solely a fraction of the time, they included an estimate of what number of miners had been affected. A evaluate of these information exhibits greater than 9,000 employees had been uncovered to silica ranges that the laws thought of harmful.

This extreme publicity to silica virtually definitely occurs extra usually than the information counsel. That is as a result of the information present solely what occurs when regulators are checking. The inspectors do not verify more often than not miners are working. Mud sampling takes place throughout common mine inspections, that are scheduled 4 instances a yr in underground mines and twice a yr at floor operations.

And till just lately, sampling didn’t happen each hour miners labored or whereas mines had been at full manufacturing.

One other discovering of the NPR/Frontline investigation: Throughout among the heaviest durations of publicity to silica, laws permit miners to work with none monitoring for it in any respect.

A white rock mud

Smith drove us previous a pair of adjoining coal mines close to his residence in Canada, Ky., the place he and different miners minimize nothing however rock for months.

He was reluctant to tug over on the Rockhouse Power Mine, despite the fact that it’s closed, as a result of safety guards had been watching from a parking zone. So he slowly handed by, describing work shifts that lasted 16 hours a day, seven days every week, for months, whereas slicing by means of strong rock. They used drills and mining machines to dig from one coal seam to a different underground.

“It wasn’t coal mud that you’d see,” Smith stated. “It was extra of a white rock … mud.”

Smith and his coworkers had been slicing what’s referred to as a slope mine. It is probably not mining as a result of there is no coal concerned. It is all about slicing by means of mountainsides or blocks of rock to achieve coal seams.

And since there is no coal, it’s thought of improvement mining or development. So sampling the air for poisonous mud isn’t required, despite the fact that it’s the most harmful mud. Former MSHA officers instructed us some inspectors did it, however most didn’t.

Smith spent months slicing at the very least two slope mines in his profession and believes that would clarify his extreme illness, despite the fact that he labored underground solely 12 years.

An outdated {photograph} of Kelly taken when he was 19 captures him taking a break after working within the mines.

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An outdated {photograph} of Kelly taken when he was 19 captures him taking a break after working within the mines.

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“Very attainable,” he stated, as we handed the mine’s deserted conveyor belts that stretch over the street. “Most of my mining profession I run a steady miner. I run a roof bolter additionally. And it is very attainable from all of the hours we labored.”

Roof bolters function a machine that pins roof helps into underground mines by drilling into strong rock. The machines have personalized dust-control methods that suck away mud, however miners complain they get bursts of silica mud after they start drilling after which later after they empty bins that gather the mud that was sucked away throughout drilling.

The machine often called a steady miner grinds up rock and coal. Mud is meant to be managed by large air flow followers that pump air by means of the mine, whereas heavy curtains channel that air to comb away mud. Mining machines spray water as they minimize, to tamp down mud.

NPR interviewed 34 coal miners, all recognized with PMF and with 12 to 40 years in mining in Pennsylvania, West Virginia, Virginia and Kentucky. Typically the mud controls labored, most instructed us, and typically they did not.

Federal regulation requires mining firms to supply mud masks or respirators to miners, however their use isn’t required. The regulation considers them a secondary and elective technique of safety. Mines are required to supply air away from harmful mud, before everything.

Many of the sick and dying miners we interviewed who used mud masks stated they usually did not work.

“They’d clog up with mud, sweat and spit,” stated Edward Wayne Brown, who spent 21 years underground in Buchanan County, Va. “After which it looks like someone simply sitting there with their hand over your face.”

In reality, dozens of miners, together with Smith, have filed product legal responsibility lawsuits towards mud masks suppliers. Most instances are nonetheless pending however a couple of have resulted in multimillion-dollar verdicts for the miners.

“That is in all probability the oldest identified occupational hazard,” stated retired industrial hygienist Weeks, who has a group of vintage books to show it — with references to mine mud hazards from Pliny the Elder within the first century and one other courting to the 15th century.

“There’s nothing new about this,” Weeks added. “And also you’d suppose by now we might have found out the way to take care of it.”

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Consciousness of silica mud as a hazard in the USA goes again at the very least 100 years, with a collection of research and experiences starting in 1908. Within the 1930s, a whole bunch of employees had been sickened and killed by publicity to silica mud whereas tunneling by means of a mountain of strong rock in West Virginia.

In 1974, NIOSH first referred to as for silica publicity limits twice as strict as these in place for coal miners and different employees. Nevertheless it wasn’t till the 1990s that MSHA and others started to get critical about silica in coal mines.

NPR and Frontline obtained inner memos from the Clinton administration that confirmed alarm again then about clusters of superior lung illness amongst coal miners as younger as 40. MSHA despatched out alerts to coal mining firms, warning about extreme publicity to silica mud and extreme illness amongst miners. NIOSH once more referred to as for a silica publicity restrict that might be twice as powerful, plus separate regulation of silica, as did a Division of Labor advisory committee.

“We began a nationwide marketing campaign first to lift consciousness,” recalled Davitt McAteer, the assistant secretary of labor for mine security and well being from 1994 to 2000.

“And it was that marketing campaign that started to attempt to go after the silica necessities, elevate the silica commonplace, and begin on a separate path to regulate silica.”

McAteer proposed a main overhaul of the mud sampling system, which included different loopholes that permitted extreme exposures and inaccurate measurement of coal mine mud. However the effort encountered stiff opposition from the Nationwide Mining Affiliation, the business’s largest lobbying group. The group sued over some parts of the plan and received.

“After which we ran out of time,” McAteer says. “And it is one thing that is unlucky and put a number of lives in danger.”

Mine mud loopholes

The regulation of silica mud wasn’t addressed throughout the administration of George W. Bush. Throughout the Obama administration, mine security advocate Joe Essential was answerable for MSHA. Essential was the longtime well being and security director on the mineworkers union and was on that Labor Division advisory committee that sought more durable regulation of silica again in 1996.

“It was very apparent that that complete scheme that had been in place, that has left so many individuals sick, needed to be modified and needed to be mounted,” Essential stated.

He was profitable in closing main mine mud loopholes, and he deployed new expertise — mud sampling gadgets that measured coal mud in actual time and helped make sampling extra instant, trustworthy and correct.

Essential additionally made the publicity restrict for coal mine mud more durable. However not the publicity restrict for silica. He did not embody any particular motion on silica in his plan.

“A excessive tide rises all boats, because the saying goes,” Essential defined. “We had been going to get a profit out of lowering total mud publicity by what we did. [That] wouldn’t solely decrease coal mine mud however all mud that was a part of that, together with silica.”

However because the NPR/Frontline information evaluation exhibits, that formulation failed 1000’s of instances previously. Reducing total mine mud does not essentially scale back silica publicity to protected ranges.

Smith labored largely for Sidney Coal Co. throughout his 12 years as an underground miner. Sidney was owned by Massey Power, a defunct coal large with a number of mine disasters in its historical past and a CEO who went to federal jail for conspiracy to violate mine security legal guidelines.

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Smith labored largely for Sidney Coal Co. throughout his 12 years as an underground miner. Sidney was owned by Massey Power, a defunct coal large with a number of mine disasters in its historical past and a CEO who went to federal jail for conspiracy to violate mine security legal guidelines.

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Monforton wonders why MSHA missed or ignored that a part of the mud sampling information.

“The truth that [NPR and Frontline] went again for 30 years and checked out that information, and that information was accessible to the company to evaluate as nicely, why wasn’t that downside acknowledged and rectified?” Monforton requested.

Essential and different former MSHA officers say they thought they had been doing what they wanted to do to regulate silica.

One other company did act on silica throughout the Obama administration. The Occupational Security and Well being Administration concluded a 44-year evaluate of silica publicity by enacting more durable regulation of silica mud.

So now, each business within the nation that cuts rock, each business besides mining, has separate regulation of silica and an publicity restrict twice as powerful — the restrict first advisable by NIOSH in 1974.

Mining firms additionally knew they had been slicing extra quartz, creating extra silica mud, and exposing miners to poisonous mud. They weren’t solely clearly warned by MSHA within the 1990s; they may see what was happening of their mines. Slicing rock slows mining machines and hurts manufacturing. And rock must be faraway from coal earlier than it may be bought.

So NPR and Frontline wished to know why mining firms did not act on their very own to guard their employees.

“Positive they may have executed that,” responded Bruce Watzman, the Nationwide Mining Affiliation’s prime lobbyist for greater than 30 years. “However … I am not going to invest on why they did or did not do what they selected.”

“Our focus right here is ahead wanting,” he stated. “How can we forestall this sooner or later? I can not reply for … what occurred previously.”

Watzman additionally asserted that the business “is doing much better at present than we did previously, much better.”

That evaluation relies on new information from MSHA following the brand new coal mine mud guidelines that started to take impact in 2014. Since then, mining firms have met publicity limits for coal and silica mud 99 % of the time, the information present.

MSHA cited the identical information in a written assertion to NPR and Frontline.

“The mud rule … has enormously decreased miners’ publicity to respirable mud,” wrote MSHA spokeswoman Amy Louviere, who additionally famous a pointy drop previously 10 years within the proportion of mine mud samples with extra silica. Her assertion didn’t handle the NPR/Frontline findings displaying 30 years of extreme publicity to silica.

“MSHA continues to work diligently to guard coal miners’ well being,” Louviere stated.

However NIOSH epidemiologist Laney is not satisfied the issue is solved.

“They’re sampled very occasionally so we do not know what is going on on with these miners after they’re not being sampled,” Laney stated. “Ninety-nine % of the time we do not have info on that.”

That is additionally the conclusion of a current evaluate by the Nationwide Academies of Sciences, Engineering and Drugs. The brand new coal mud guidelines, the evaluate committee stated, “might not assure that exposures will likely be managed adequately or that future illness charges will decline.”

It should additionally take 10 years or extra to know whether or not the brand new mud guidelines lead to fewer instances of illness. It takes that lengthy for illness to develop.

“I stated I think silica. I did not say it was”

MSHA declined a number of requests for interviews with prime company officers, together with David Zatezalo, a former coal firm government and business lobbyist who now heads the company.

So we confirmed up at West Virginia College in September the place Zatezalo was scheduled to make a uncommon public look.

“You hear the phrase in well being circles of progressive large fibrosis, these kinds of issues,” Zatezalo instructed an viewers of mining engineering college students, company staff and business executives and lobbyists.

“To me, I consider these are all clearly silica issues,” Zatezalo continued. “Silica is one thing that must be managed.”

However instantly after his speech, when NPR and Frontline approached him, Zatezalo appeared out of the blue unsure about silica and PMF.

“I do not suppose that the science of the causation is that well-defined,” Zatezalo stated.

Requested concerning the direct hyperlink between silica and illness he described in his speech, Zatezalo turned defensive.

“No, I stated I think silica. I did not say it was. … I believe till such time as you determine what it’s you do not actually know,” Zatezalo responded.

To this point, below Zatezalo, MSHA has no plan to deal with a more durable restrict for silica mud or separate regulation of silica in coal mines.

A CT scan exhibits the harm to Smith’s lungs brought on by progressive large fibrosis.

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A CT scan exhibits the harm to Smith’s lungs brought on by progressive large fibrosis.

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Within the meantime, the PMF epidemic continues. The most important cluster of illness ever reported, in keeping with NIOSH, continues to construct on the Stone Mountain Well being Companies black lung clinics in Southwestern Virginia. The clinics proceed to diagnose new instances on the price of a few dozen a month.

“I am not seeing any slowdown by any means,” says Ron Carson, who directed the Stone Mountain clinics for 28 years earlier than retiring earlier this yr.

“I believe that America must know that these miners … have paid a value,” Carson added, his voice breaking. Carson cited the nation’s many years of dependence on coal for energy and metal manufacturing.

“They paid a value in order that we will have luxurious and … so many have died. 1000’s have died.”

“Each one among us is both crippled or useless”

Kelly has a protracted checklist of easy duties he can now not accomplish: strolling up his driveway to the mailbox; climbing the few steps to his barn; using horses; even simply getting as much as head to the lavatory. He has to cease and relaxation on the way in which, he says.

However what hurts essentially the most are the issues he cannot do together with his grandson, Caden, particularly playful wrestling on the ground.

“Now he has to wrestle a pillow whereas I name the match,” Kelly stated, his voice halting and his eyes purple. “It is nonetheless enjoyable, however …” and Kelly paused, his face tight and the tears flowing.

“I need to be that pillow.”

Incomplete initiatives are sprinkled round Kelly’s residence. Kelly has a protracted checklist of easy duties he can now not accomplish; even simply strolling to the mailbox is troublesome.

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Incomplete initiatives are sprinkled round Kelly’s residence. Kelly has a protracted checklist of easy duties he can now not accomplish; even simply strolling to the mailbox is troublesome.

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Smith pulled as much as one other mine, which was additionally closed however had no guards in its weed-choked parking zone. This Stable Power mine, together with the Rockhouse mine he drove by earlier, was operated by Massey Power, now a defunct firm with lethal mine disasters in its historical past and a CEO who went to jail for conspiracy to violate mine security legal guidelines.

Smith obtained out and walked as much as a rusted fence with a padlock. A ball cap shaded his face. Sun shades hid his tears.

“It is [been] consuming at me for the final two years,” he stated, “that I’ll die over this. … Of all of the issues that would’ve killed me whereas I did work there, the rockfalls and all that stuff, I lived by means of all of that. And I discover out years later I’ll die over black lung. And it is heartbreaking.”

Smith then talked about his spouse and two daughters and puzzled what is going to occur to them when he is gone. He puzzled concerning the grandchildren he might by no means see. His voice breaking once more, he talked concerning the pleasure of being a younger miner, concerning the hope and promise of excellent pay and good lives.

“We was all younger and powerful and stout and so they took benefit of us. Each one among us is both crippled or useless. We was all younger males,” he stated, crying softly.

Smith has a plot picked out for himself within the household cemetery on his property, behind the headstone of his dad and mom.

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Smith has a plot picked out for himself within the household cemetery on his property, behind the headstone of his dad and mom.

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Again at his home in a slim valley — a holler — in Canada, Ky., Smith pointed to a household cemetery on a knoll on the fringe of the garden he has a lot problem mowing. It includes a single headstone with vivid flowers and the names of his dad and mom. Behind it, Smith instructed us, within the shade, is the burial plot he has picked out for himself. He is 46 years outdated.

NPR’s Adelina Lancianese, Barbara Van Woerkom, Katie Lawrie and Cat Schuknecht; Elaine McMillion Sheldon of FRONTLINE; Benny Becker and Jeff Younger of Ohio Valley ReSource; and Ellen Smith of Mine Security and Well being Information contributed to this story.