Soul Full of Coal Dust

A Fight for Breath and Justice in Appalachia


By Chris Hamby

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In a devastating and urgent work of investigative journalism, Pulitzer Prize winner Chris Hamby uncovers the tragic resurgence of black lung disease in Appalachia, its Big Coal cover-up, and the resilient mining communities who refuse to back down.
Decades ago, a grassroots uprising forced Congress to enact long-overdue legislation designed to virtually eradicate black lung disease and provide fair compensation to coal miners stricken with the illness. Today, however, both promises remain unfulfilled. Levels of disease have surged, the old scourge has taken an aggressive new form, and ailing miners and widows have been left behind by a dizzying legal system, denied even modest payments and medical care.

In this urgent work of investigative journalism, Pulitzer Prize winner Chris Hamby traces the unforgettable story of how these trends converge in the lives of two men: Gary Fox, a black lung-stricken West Virginia coal miner determined to raise his family from poverty, and John Cline, an idealistic carpenter and rural medical clinic worker who becomes a lawyer in his fifties.  Opposing them are the lawyers at the coal industry’s go-to law firm; well-credentialed doctors who often weigh in for the defense, including an elite unit Johns Hopkins; and Gary’s former employer, Massey Energy, a regional powerhouse run by a cantankerous CEO often portrayed in the media as a dark lord of the coalfields. On the line in Gary and John’s longshot legal battle are fundamental principles of fairness and justice, with consequences for miners and their loved ones throughout the nation.

Taking readers inside courtrooms, hospitals, homes tucked in Appalachian hollows, and dusty mine tunnels, Hamby exposes how coal companies have not only continually flouted a law meant to protect miners from deadly amounts of dust but also enlisted well-credentialed doctors and lawyers to help systematically deny much-needed benefits to miners. The result is a legal and medical thriller that brilliantly illuminates how a band of laborers — aided by a small group of lawyers, doctors and lay advocates, often working out of their homes or in rural clinics and tiny offices – challenged one of the world's most powerful forces, Big Coal, and won.

“Harrowing and cinematic,” (Publishers Weekly, starred review), Soul Full of Coal Dust is a necessary and timely book about injustice and resistance.


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And here's a story you can hardly believe, but it's true, and it's funny and it's beautiful. There was a family of twelve and they were forced off the land. They had no car. They built a trailer out of junk and loaded it with their possessions. They pulled it to the side of 66 and waited. And pretty soon a sedan picked them up. Five of them rode in the sedan and seven on the trailer, and a dog on the trailer. They got to California in two jumps. The man who pulled them fed them. And that's true. But how can such courage be, and such faith in their own species? Very few things would teach such faith.

The people in flight from the terror behind—strange things happen to them, some bitterly cruel and some so beautiful that the faith is refired forever.

—John Steinbeck, The Grapes of Wrath

He's had more hard luck than most men could stand

The mines was his first love but never his friend

He's lived a hard life, and hard he'll die

Black lung's done got him, his time is nigh


Black lung, black lung, you're just biding your time

Soon all of this suffering I'll leave behind

But I can't help but wonder what God had in mind

To send such a devil to claim this soul of mine


He went to the boss man, but he closed the door

Well, it seems you're not wanted when you're sick and you're poor

You're not even covered in their medical plans

And your life depends on the favors of man


Down in the poorhouse on starvation's plan

Where pride is a stranger and doomed is a man

His soul full of coal dust till his body's decayed

And everyone but black lung's done turned him away


Black lung, black lung, oh, your hand's icy cold

As you reach for my life and you torture my soul

Cold as that waterhole down in that dark cave

Where I spent my life's blood diggin' my own grave


Down at the graveyard the boss man came

With his little bunch of flowers, dear God, what a shame

Take back those flowers, don't you sing no sad songs

The die has been cast now, a good man is gone


—Hazel Dickens, "Black Lung" (written for her brother, who died of the disease)

Early twentieth-century claims of the first coal barons to arrive in the area near what is today Beckley, West Virginia, a hub of the state's southern coalfields. (New River Company, 1976)


January 10, 2007

John Cline looked across his kitchen table at a gaunt man with a countenance etched by a life of hard labor. The two had spoken by phone, but now that they were face to face for the first time, the man's rapidly declining health became apparent. Each breath, it seemed, required more effort than the last. John had heard such strained exertions many times before, and he knew the suffering these sounds signified.

As each man appraised the other, the faint gray light of a frigid day in the southern West Virginia coalfields fell on the smooth maple top, fashioned by John's middle son, that adorned the table John's grandfather had made out of fir. Wind gusted through the patch of land where John and his wife kept a vegetable garden in warmer months. The trees bounding his property to the south had shed their foliage, revealing the precipice preceding the sharp plunge to the Piney Creek Gorge a thousand feet below. In the distance, benches of bare earth lined a stretch of the hillside—the scars of long-finished strip-mining. A railway ran through the gorge, and sometimes when John went for walks in the trails he kept clear behind his house, he still heard the coal trains rumbling through.

This land of scarred beauty had forged both John and the man now seated in his kitchen, a longtime coal miner named Gary Fox. Though they had started life in different worlds, both had come of age amid the political tumult of the late 1960s and the historic coal miners' rebellion that had swept southern West Virginia at the time. Both had made lives for themselves and their families here in the heart of Appalachia. And both had spent decades working, straining against setbacks, building something bigger than themselves.

John was a rarity here in the coalfields: a lawyer who was willing to help coal miners navigate an abstruse legal system in pursuit of modest monthly payments and medical coverage as recompense for the disease that robbed their breath, the old scourge with the disturbingly accurate name "black lung." Most lawyers wouldn't touch these cases. They were complex, time-consuming, and fiercely contested; coal companies and their lawyers made sure of that. Success rates were low, and even after a win, a miner's lawyer had to prevail in yet another round of legal combat against the company to collect fees that barely kept the lights on.

Yet this was the only type of case John took, the only type he'd ever wanted to take. It was why, a few years earlier, he had gone to law school at age fifty-three and emerged with a load of student debt he would still be paying off long after others his age had retired.

Law was his fourth vocation. The first three—community organizer, carpenter, and rural medical-clinic staffer—might suggest the incongruous roving of a restless soul, but John saw each of them, as well as his current one, as variations of the same job, which he described as "trying to be of use."

Here in the house he'd built with his own hands in a small community on the outskirts of Beckley, the nearest thing to a big city southern West Virginia coal country had, he ran a solo practice. He had no assistants, no secretaries, no paralegals; each case was John versus the coal company. His kitchen was the de facto meeting room, and directly overhead on the second floor was his office, a small space covered in manila folders bearing the names of sick miners or their widows, each file stuffed with legal and medical arcana designed to befuddle and discourage those who couldn't find a lawyer like John. Spare shelf space held family photos, and on the wall hung a portrait of Mary Harris "Mother" Jones, the labor activist and "miners' angel" who had adopted West Virginia as her second home. A famous quote of hers was inscribed beside her bespectacled face: Pray for the dead and fight like hell for the living.

John's comportment more closely resembled that of his clients than that of his fellow members of the bar. He favored corduroys or jeans and plaid button-downs. His mop of brown-gray hair and soft voice conveyed a certain boyishness. He had the sturdy frame and callused palms of a laborer.

Gary had found him only through a stroke of luck: a recommendation from a legendary doctor who had been conducting pioneering research into black lung and treating miners for more than forty years at a small clinic in Beckley. John had liked Gary from the first time they spoke on the phone about seven months earlier, but before he agreed to take the case, he needed to gauge whether they would have any shot at winning. Together in John's kitchen, the two men were now trying to figure that out.

This was one of the last stages in a system John had set up; the goal was to take as many cases as he could while making sure his one-man operation didn't get hopelessly overstretched. He typically juggled about fifty cases, their deadlines staggered to avoid everything hitting at once, and each week he fielded about ten more calls from people who hoped he'd represent them.

When a potential client called, the first step was to explain the peculiar legal gauntlet that miners and widows had to traverse. For the few lawyers like John who even considered helping a miner file for benefits, these preliminary conversations could be taxing, as they often engendered frustration for the caller—not at the lawyer but at the demoralizing realization of how the system for awarding claims functioned.

The process wasn't like going to civil court and presenting a case to a jury, and it wasn't like filing for workers' compensation. It was somewhere in between, a byzantine administrative system that combined the contentiousness of a multimillion-dollar lawsuit with the lesser payouts of a disability-insurance claim—in other words, the worst of both systems, from a miner's perspective. The fact that a miner was struggling to breathe because of black lung caused by years of inhaling coal dust didn't necessarily translate into a win; he had to clear the high bar of proving "total disability." There were no settlements or partial awards; each case was an all-or-nothing fight to the end.

After explaining these daunting realities to the caller, John would pull out a piece of paper, run through a list of basic questions, and jot down the answers, with key dates and facts underlined: age, years of mining experience, specific job duties, smoking history, past medical diagnoses or legal claims. Sometimes it was clear from the start that the caller had no case, and John would explain why. But, he'd tell the miner, the disease might worsen, even without any more dust invading the lungs, so keep monitoring it with periodic X-rays and lung-function tests. Don't hesitate to call back.

If the basic information pointed to a potentially viable claim, John explained what would happen next. The miner had to fill out forms and submit them to the U.S. Department of Labor, which processed these claims. That would unleash a flood of paper from bureaucrats, companies, insurers, and lawyers, and the miner would have to undergo two different medical exams—one by a doctor chosen by the miner from a government-approved list and one by a doctor chosen by the coal company.

If the case cleared the first stage—a determination made by a Labor Department claims examiner, who, at the time, turned down about 85 percent of claims—the coal company's lawyers almost certainly would appeal the decision to an administrative law judge under the Labor Department umbrella. These lawyers would then send copies of the miner's X-rays, CT scans, lung-function tests, and any other medical records to an established network of impeccably credentialed physicians—including some at renowned institutions—who, for a fee, would review them and submit reports that often poked holes in or outright blew up the miner's claim. A miner might be able to afford an additional report or two, but the medicolegal arms race was inevitably one-sided. If a judge nonetheless upheld the award of benefits, the company lawyers could appeal to a higher administrative court, then to a federal appeals court, then possibly to the U.S. Supreme Court.

As the process dragged on, miners sometimes withered and died, leaving their widows to fight on if they could. All of this battling was over monthly payments set by law at just over a third of the salary of an entry-level government employee—in 2007, it was $876.50 for a miner and his wife—plus medical expenses for treatment related to black lung.

Word had spread through the coalfields that companies would rather spend stacks of cash fighting each case to the bitter end than pay the modest benefits to their former employees. No wonder, then, that many miners didn't bother with the system or that most lawyers didn't want to wait for an uncertain payout that might amount to fifteen thousand dollars for five years of work, if they were fortunate.

John had gone through these daunting realities with Gary when he'd first called in June 2006. Gary wasn't discouraged; it was just another trial for a man who'd endured more than his share. He had worked in coal mining for more than thirty years, but his breathing had finally gotten so bad that he thought he had no choice but to retire early and file for benefits, he told John. He'd call back when he did.

John wrote all of this down and stuffed the paper inside a manila folder labeled DOL PHONE CONTACTS. This was where logs of the many calls with potential clients resided until John had enough information to decide whether to take the case. If he eventually did agree to represent the miner, he'd grab a new manila folder, write the client's name on the cover in black Sharpie, put the phone logs inside, and place this fresh case file among the others, which filled shelves lining the office walls, covered the small sofa by his desk, and spilled onto the steps leading up to a small attic where old case files sat packed in boxes and shoved back in a crawl space.

Gary called again in November after he'd filed the forms that set the wheels in motion at the Labor Department's office in the state capital of Charleston, then again in December after he'd been examined by the doctor he'd chosen. Now the paperwork was starting to arrive at the house in Beckley where he and his wife, Mary, lived: a notice that his former employer was contesting his claim, an intimidatingly worded list of twenty-seven questions seeking personal information and medical records dating back decades.

John took it all down; the phone log grew longer. Gary's case was not an obvious loser, he thought. It was time they met.

Now, on this chilly day in January, the two men whose lives and legacies would become intertwined sat together at John's home in the small community of Piney View, about twenty-five minutes from Gary's house. They went over the stack of files Gary had brought. These papers supported John's impression of Gary: He was an extremely sick man. The results of his breathing tests were dismal, and doctors were treating him for what they believed was advanced black lung. Gary's physique, always lanky, was now all sharp angles. Protuberant tendons accentuated his long neck. A dimple on his left cheek popped below his soft green eyes. He'd shed more than thirty pounds over the past couple of years, despite his efforts to keep the weight on.

But John also felt a growing sense that something more was going on. It turned out that this was not the first black lung–benefits claim Gary had filed. He had tried in 1999. After a months-long, ultimately fruitless search for a lawyer, he had gone it alone against the company and lost. Poring over the reports from that initial claim, John saw that many of the same facts that underpinned Gary's current claim had been documented in his previous one. Even then, eight years earlier, doctors had seen evidence of the advanced stage of black lung that, under the rules of the federal program, was supposed to result in an award of benefits. The purpose of these rules was to ensure that miners with this advanced stage got out of the dust immediately, giving them at least a chance to avoid the worst ravages of the disease. In Gary's case, however, that hadn't happened.

Something in Gary's 1999 claim must have gone very wrong. As John read through the files, he got an idea of what that might be.

For about fifteen years, John had been trying to unravel what he believed was a systematic scheme to defraud sick miners orchestrated by the law firm of choice for many titans of the coal industry. Sure enough, this was the firm that had found a way to tank Gary's earlier claim and was now fighting his current one. The case file was filled with reports from the prominent doctors at major national institutions whom the firm frequently enlisted as experts. And all of it was on behalf of one of Appalachia's biggest and most notorious coal companies, run by a baron often portrayed in critical press accounts as a sort of dark lord of the coalfields.

John scribbled a note to himself and, when the two-hour meeting was over, tucked it inside a new manila folder with GARY FOX written in black Sharpie on the front. In time, this small slip of paper would spawn multiple motions and reply briefs, decisions and appeals, documents that filled one folder, then another, then another. It would lead to fraught decisions and sleepless nights, elation and disappointment. And all of this would have great implications not just for Gary and his family but also for countless other miners and their families.

Gary's fight would be, in many respects, the culmination of a battle that had started forty years earlier, when a historic grassroots uprising had extracted long-overdue promises from the government to virtually eradicate black lung and provide compensation to those already afflicted with it. Despite the significant strides advocates had made over the years, these dual pledges had become a mirage for far too many miners and their widows.

This had not happened by chance. The coal industry and the elite professionals it enlisted in its cause had systematically undermined the law in courtrooms, legislative chambers, and dusty mine tunnels. Companies had found ways to dodge the rules intended to prevent the disease, and they had persuaded sympathetic lawmakers to gut some of the law's existing protections and stall or kill proposed improvements. Nationally prominent doctors had found a lucrative market in supplying the reports and testimony that helped doom miners' claims. And top-notch lawyers had become maestros of the benefits system, adept at orchestrating a cacophonous symphony that left many miners disoriented and that denied them what they were due.

At the same time, a small but scrappy coalition of advocates from various walks of life—clinic workers, lay representatives, lawyers, doctors, miners—had been fighting back, pushing reforms in the hopes of making the promises of prevention and compensation realities. John had long been a crucial animating force at the heart of this coalition. With his temperament and experience, he found equal comfort and satisfaction in drafting proposed legislative changes, organizing potluck fund-raisers, sparring with coal companies' lawyers, and traveling to DC with miners to lobby Congress.

The coalition had achieved some reforms, but the coal industry, with its allies in political office and in the medical and legal communities, had beaten back the most sweeping changes that the miners' advocates sought.

Now, Gary seemed to be the embodiment of all the ways that the pledges of disease eradication and fair compensation remained unfulfilled. But John saw something else in Gary. He suspected there was something appalling somewhere in the records of Gary's case and in his lungs, something that might reverberate well beyond Gary's individual claim.

About a week after meeting with Gary, John notified the Labor Department that he was taking the case. Years later, he mused, "I had no idea what I was getting into."

Part One

The breath of a coal miner stricken with advanced black lung disease often has a distinct and haunting timbre. It is a hoarse gasp, a desperate attempt to draw in the oxygen that the body needs to sustain itself, an audible representation of the losing battle being waged every minute of every day inside scarred and shriveled lungs.

The first time I heard this sound was in the spring of 2011. I was a cub reporter at the nonprofit investigative news outlet the Center for Public Integrity, based in Washington, DC. I had the good fortune to be assigned to a team focusing on the environment, labor, and public health led by editor and reporter Jim Morris. With his beard and shaved head, Jim could come off as gruff, an impression he didn't discourage, but he had a contagious compassion for working people. He both guided me and left me largely to my own devices—a reporter's dream.

I began to learn about a part of America I hadn't known. I grew up in Tennessee, but I'd been ensconced in a middle-class suburb. Now, reporting on labor, I found myself drawn to gritty industrial towns and rural communities. I spent hours driving around chemical plants and oil refineries, marveling at the mazes of twisting metal and flashing lights. (More than once, this ended with my getting pulled over and questioned by plant security.) I donned comically large coveralls and toured a sugar refinery. But what I found most compelling were the people—factory workers, men and women who'd lost loved ones in accidents, or survivors whose lives had been forever altered. So many of them shared traits that I'd not seen often when writing about other subjects (especially politics): candor, quiet strength, gratitude that someone cared about their stories.

It was May 2011 when Jim received an embargoed copy of a report on the worst coal-mine disaster in forty years: the 2010 explosion at Massey Energy Company's Upper Big Branch mine in southern West Virginia that killed twenty-nine men. In coal country, Massey was notorious. The company's cantankerous, mustachioed CEO, Don Blankenship, was a throwback to a past era of coal barons. Under his leadership, Massey was fabulously productive, but this economic success was accompanied by a prodigious tally of environmental and safety violations. The Upper Big Branch blast was the worst in a series of accidents at the company's mines.

The report had been commissioned by the West Virginia governor and written by a team of investigators led by former Mine Safety and Health Administration chief Davitt McAteer. Blankenship had claimed that the explosion was an unforeseeable catastrophe that had resulted from a sudden, unexpected release of methane from the coal seam. McAteer's report determined that, to the contrary, the disaster was a result of company management's disregard for basic, time-tested safety practices. The mine wasn't properly ventilated, leading to a dangerous buildup of explosive gases, the report found, and because the company had allowed coal dust to accumulate, the blast spread quickly throughout the mine.

"The story of Upper Big Branch is a cautionary tale of hubris," the report concluded. "A company that was a towering presence in the Appalachian coalfields operated its mines in a profoundly reckless manner, and 29 coal miners paid with their lives for the corporate risk-taking."

Jim and I knew that other news outlets had also received an embargoed copy of the report. We assumed that their stories would focus on the findings related to the explosion's cause, so we discussed whether there was anything noteworthy in the report that other publications might overlook. It turned out that there was: on page 32 out of 120, a seven-paragraph sidebar described a grim discovery that doctors had made when examining the bodies of the miners killed in the blast.

Of the twenty-nine victims, twenty-four had enough lung tissue for pathologists to examine during autopsies. Of those, seventeen had black lung. The victims ranged in age from twenty-five to sixty-one. This astronomical rate of disease accompanied by the relative youth of some of the miners whose lungs bore the hallmarks of it was "an alarming finding," the report said.

Until I read that page, I'd thought, as many Americans probably do, that black lung was a historical relic, the sort of medieval scourge that advances in engineering and medical science surely had eradicated long ago. And in fact, by the twenty-first century, that should have been the case. In 1969, Congress enacted a law imposing tough new limits on the amount of disease-causing coal dust allowed in mine air, a provision that was supposed to have virtually eliminated black lung.

More than forty years later, however, the centuries-old miners' curse remained. The law had led to significant improvements, but since the late 1990s, the once-encouraging trend line had flipped: rates of disease had been rising. Government researchers were tracking the resurgence, trying to understand the cause of the dismaying reversal. Worse, as these scientists were documenting, there was an even larger increase in the prevalence of the most severe stage of black lung, and it seemed to be taking a nasty new form, striking younger miners and progressing more quickly.

This, Jim and I decided, would be the focus of our story. Over a few days, I read up on the disease, the regulatory system, and the recent research. I spoke with doctors who said there was no justification for the continued existence of an entirely preventable ailment, with coal-industry representatives who expressed sympathy for miners but cautioned that enhanced regulation could cripple a vital American industry, and with miners who were the largely unseen victims.

Singular mine catastrophes—fires, explosions, cave-ins—garnered media attention and prompted reform proposals by lawmakers, but black lung continued to exact a little noticed but much larger toll. Between 1995 and 2004, more than three hundred coal workers died in accidents; meanwhile, black lung claimed about ten thousand.


  • "In Soul Full of Coal Dust, Hamby employs dogged investigative work and a deep well of empathy for his subjects to painstakingly bring this private pathos to life...With thorough reporting, and boundless concern for his subjects, Hamby has created a powerful document of this drama, one that is unfolding, largely unseen, in the hills and valleys of West Virginia.”
     —Hector Tobar, The New York Times Book Review
  • “Lively and arduously researched. There are many surprising revelations in Hamby’s book. With relentless curiosity and empathy, Hamby has reached deep into Appalachia’s coal hills and discovered the bright places where change occurs. Here he has found dramas of heroism, self-sacrifice and determination. With his latest work, he has performed another public service by portraying the often-forgotten people of coal country as active agents in their own history.”
     —Minneapolis Star Tribune
  • “Hamby has delivered… extending and enriching his reporting on the West Virginia miners with advanced-stage black lung on the brink of poverty who teamed up with his idealistic lawyer to wage battle against the coal industry. Beyond courtrooms and mines, Hamby journeys deep into hollows and homes and powerfully evokes the injustices done to miners who “battled breathlessness to make it from their front porches to their mailboxes and dragged oxygen tanks wherever they went.”
     —The National Book Review
  • "An important story told with care and eloquence, Soul Full of Coal Dust will have you rooting for its underdog heroes and shaking your head -- and maybe even your fist -- at the coal barons and their hired guns who for decades" manipulated a rigged system to deprive injured miners of simple justice."—DanFagin, author of the Pulitzer Prize-winning Toms River
  • "A devastating and essential indictment of corruption in coal country."—Laurence Leamer, author of The Price of Justice
  • "There are two kinds of cruelty. One you see on a face, and in the actions of a particular person. The other you can't see unless, like Pulitzer Prize-winning investigative journalist Chris Hamby, you uncover a hidden system-in this case of corrupt West Virginia mine company officials, paid-off lawyers, and lying doctors who deny ill miners and widows recompense for unnecessary suffering and death from black lung. It's a riveting David and Goliath story, close up and personal, and illuminating the heroic tenacity it took two men to win a hugely important fight."—Arlie RussellHochschild, author of Strangers In Their Own Land: Anger and Mourningon the American Right, a National Book Award finalist
  • Soul Full of Coal Dust is a revelatory David versus Goliath story, this wondrous layering of history with a present-day bare-knuckles fight for justice. Chris Hamby has pulled off an astonishing feat of investigative journalism, one that left me rooting for these hard-bitten coal miners as they take on the unmoored greed of the coal companies and their minions.”
     —Alex Kotlowitz, author of An American Summer, the winner of the J. Anthony Lukas Book Prize
  • “Under the double pressures of the climate crisis and our increasingly polarized political landscape, coal miners are often stereotyped as symbols of all that’s wrong with the nation. Through an intimate journey into the lives of miners suffering the horrific ravages of black lung, Hamby calculates the cost of a pressing scourge, and restores humanity and dignity to a group of American workers who have given their lives for American power.”
     —Eliza Griswold, author of the Pulitzer Prize-winning Amity and Prosperity
  • “A devastating and essential indictment of corruption in coal country.”
     —Laurence Leamer, author of The Price of Justice
  • “Harrowing and cinematic … This eloquent and sobering reminder of the human damage caused by the coal industry deserves to be widely read.”
     —Publishers Weekly starred review
  • “Hamby’s research is extensive, and his investment in revealing the plight of
    the miners and their families in the hope of reform is clear.”

On Sale
Aug 18, 2020
Page Count
448 pages

Chris Hamby

About the Author

Chris Hamby is an investigative reporter at The New York Times. While working at the Center For Public Integrity, Hamby won the 2014 Pulitzer Prize for Investigative Reporting for his series of stories on coal miners and was later awarded the Lukas Prize to develop his reporting into a book. He was also a finalist for the 2017 Pulitzer Prize for International Reporting for his work on multinational corporations and their violations of domestic regulations and environmental law. He lives in Washington, D.C.

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