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no explosive mixture at the entrance of the box cut while there was an explosive mixture in the box cut itself.

Mr. MITTELMAX. Just one final comment with reference to what I was raising before as to whether a violation can be cited in these kinds of cases. I am not suggesting anything with reference to this specific case, but I think this is a very important point.

There are criminal and civil penalties in this act for violations of the statute. When accidents of this kind occur, I would assume that the Bureau would be extremely careful in considering whether the invocation of either civil or criminal penalties was warranted in a case of that type.

I am expressing no judgment, of course, with respect to this particular case.

Senator Williams. Mr. Westfield, I certainly appreciate your candid and knowledgeable response to these technical questions that we had.

I want to say to you and Mr. Gershuny, you are the two action men in here, I appreciate your candid replies to our questions.

I will say, Mr. Westfield, I had one devil of a time getting these men into a coal mine here some months ago and I am not too sure that you have made my job any easier to get them back into the mine when we go on our next trip, which will be not too far in the future. Be prepared.

But I do want to say, though, more soberly that the past record of enforcement of the new Coal Mine Health and Safety Act has left much to be desired, but that is history. I am impressed with you gentlemen, your statements of desire and intention. They have impressed me as sound and good.

In our continuing responsibility when we have other hearings on legislative oversight, as we call it. I look forward to conditions that spell enforcement that do mean a greater measure of better health and greater safety for the coal miners. We appreciate very much your statements.

At long last I have Dr. Marcus Key, Director of the Bureau of Occupational Safety and Health of the Environmental Health Service of HEW; and Mr. Bernard Popick, Director of the Bureau of Disability Insurance, Social Security Administration. I know these are long hours, gentlemen, that you have been with us waiting to be heard by the committee. It seems to me that all of these hours have been beneficially educational periods for everybody.



Dr. KEY, Mr. Chairman and members of the subcommittee, I welcome this opportunity to appear before this subcommittee and report on the implementation of the health responsibilities of the Department of Health, Education, and Welfare under the Federal Coal Mine Health and Safety Act. The Department's responsibilities for periodic medical examinations, provisions for autopsies, mandatory health standards, and health research have been delegated to the Public Health Service. The Department's responsibilities for administering Title IV, Black Lung Benefits, have been delegated to the Social Security Administration and will be reported on separately by Mr. Bernard Popick, Director of the Bureau of Disability Insurance, Social Security Administration, who accompanies me.

Speaking for the Public Health Service, I would like to say that our health responsibilities are reasonable and welcomed. The act gives us an opportunity to practice preventive medicine in a large segment of the American work force.

We recognize that the Federal Coal Mine Health and Safety Act is quite explicit and imposes a schedule that is very exacting, but we also recognize that this is just the prescription needed to treat the black lung problem. In some instances where we have fallen behind schedule, we have never been very far behind, and are still optimistic that we can meet the June 30, 1971, deadline for completing the first round of medical examinations of the Nation's 90,000 underground coal miners.

I would like to submit for the record a chronological listing of the Public Health Service's accomplishments under the act. In carrying out these responsibilities, we have been cooperating with the Bureau of Mines, the Bureau of Disability Insurance, the Interim Compliance Panel, and several State health departments. We have sought the advice and assistance of the UMWA, the operators' trade associations, and a number of professional associations such as the American College of Radiology, the American College of Chest Physicians, the Industrial Medical Association, the American Medical Association, and the American Osteopathic Association. For example, the specifications for the content and conduct of the medical examinations were developed during two open meetings attended by representatives of industry, labor, government, and professional groups in Washington on January 23 and February 15, 1970. The proposed medical examination specifications which were published in the Federal Register on June 3, 1970, were further reviewed during the “National Conference on Medicine and the Federal Coal Mine Health and Safety Act of 1969," in Washington, June 15-18, 1970. The Conference was attended by individuals actively engaged in the control and prevention of occupational pulmonary diseases of coal miners and was supported in part by a Public Health Service grant. The final specifications for the medical examinations were approved by the Secretary of Health, Education, and Welfare on August 12 and will be published in the Federal Register on August 19. A copy is submitted for the record.

The question has frequently been asked, why are the specifications for the medical exams of underground coal miners limited to X-ray examinations, when the intent of the Federal Coal Mine Health and Safety Act was to provide for other examinations in addition to the X-ray? The first round of medical exams will be limited to X-ray examination of the chest, except for the 10 to 15 percent of the miners which the Public Health Service will examine in its own mobile units. These miners will receive pulmonary function testing. Other examinations may be indicated by the X-ray examination such as supplementary tests to rule out lung cancer, tuberculosis, and histoplasmosis.

The second round of medical examinations, 3 years hence, will include pulmonary function tests. These tests were not included in the first round of medical exams because of the expediency of initiating the examination program as quickly as possible; because pulmonary function tests are difficult to standardize and the results are not comparable when conducted under a variety of field conditions using different instruments and different techniques; and because no generally accepted pulmonary function criteria are available for transfer to less dusty areas.

In addition to the problem of providing X-ray examinations in relatively inaccessible places and at small mines, we knew there would be the additional problem of reading and classifying the X-rays in a uniform manner. An improved system for reading and classifying chest X-rays has recently been developed by the International Union Against Cancer and by the International Labour Organization, but at the time the act was passed not more than a dozen radiologists in the country were familiar with the new system. Now, thanks to the American College of Radiology, and the American College of Chest Physicians, a crash program has been developed to train radiologists and chest physicians in the use of the new system. By early next year, there should be an adequate number of physicians certified in the use of the system in all of the coal mining areas.

Concern was expressed earlier during these hearings for the appointment of a Health Research Advisory Committee. This Committee was established by the Department on August 5, 1970 with representation from clinical and research disciplines necessary to study and evaluate black lung disease and also from engineering disciplines that can make contributions in the health area. The statutory members have been appointed, and letters of invitation have gone out to the nonstatutory members. The first meeting of this very important advisory committee is expected this fall. It should be pointed out that our health research activities under the Federal Coal Mine Health and Safety Act have not been delayed because the Health Research Advisory Committee has not been functioning. During last fiscal year, we funded research contracts in the amount of $500,000 for such projects as an instantaneous mass monitor for mine dust, respiratory protective devices, and medical studies of coal workers' pneumoconiosis. These projects will, of course, be reviewed by the Health Research Advisory Committee at its first meeting.

We will be pleased to answer any questions which the committee may have.

(The information previously referred to follows :)


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1. Appointment of HEW member to the interim com- HEW

pliance panel. 2. Medical examination symposia to develop criteria for HEW

examinations. 3. Regulations for approval of coal mine dust personal HEW and DI

sampler. 4. Recommendations on emergency medical assistance, HEW and DI

potable water, and sanitation. 5. Interim noise standard..

HEW 6. Regulations for dust sampling procedure.

HEW and DI 7. Cooperation with SSA in developing criteria for HEW

black lung benefits. 8. Cooperation with Bureau of Mines in a series of 6 DI

briefing sessions-operators and miners. 9. Coal Mine Health Research Advisory Committee..... HEW 10. Proposed specifications for medical examinations of HEW

underground coal miners. 11. Ist of 6 American College of Radiology courses on HEW

"X-ray Description of Pneumoconiosis.' 12. National Conference on Medicine and the Federal HEW

Coal Mine Health and Safety Act of 1969. 13. Examination of 90,000 underground coal miners..... HEW 14. Contracts for examination of underground coal miners HEW

in 7 States. 15. 9 contracts for health research...

HEW 16. Contract for medical record and retrieval system at HEW

West Virginia University Medical Center. 17. Contract for confirmatory reading of chest X-rays by HEW

consultant panels of radiologists. 18. Autopsy program..

HEW 19. Final specifications for medical examinations of HEW

underground coal miners. 20. Quartz dust standard..

HEW 21. Proposed mandatory noise standard and test pro- HEW

cedure effective Dec. 30, 1970.

Mar. 28, 1970.
Apr. 3, 1970.

Apr. 17, 1970.
Feb. 19-Mar. 8, 1970.
Aug. 5, 1970.
June 3, 1970.
June 13-14, 1970-
June 15-18, 1970.
2,363 by June 30, 19
June 30, 1970.


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(From the Federal Register, Vol. 35, No. 161, Aug. 19, 1970)


Title 42-PUBLIC HEALTH Chapter 1–Public Health Service, Department of Health, Education, and





Chest Roentgenographic Examinations On June 3, 1970, notice of proposed rule making was published in the FEDERAL REGISTER (35 F.R. 8584) to amend Title 42, Code of Federal Regulations by the addition of a new Part 37. As proposed, the part set forth the specifications for giving, reading, classifying, and submitting the chest roentgenograms required to be given to underground coal miners by section 203 of the Federal Coal Mine Health and Safety Act (Public Law 91–173).

Interested persons were offered the opportunity to participate in the rule making through the submission of comments. A number of comments were re ceived and due consideration has been given to all relevant material presented.

In light of the comments a number of revisions have been made in the rules as proposed, principally with respect to the content of an operator's plan for initial roentgenographic examinations in 37.4 and with respect to specifications for giving chest roentgenograms in § 37.20. The regulations specify a date, 30 days after publication, when operators' initial plans must be submitted and clarify that additional films, or supplemental examination, may be required when the existence of pneumoconiosis cannot be determined from the roentgenogram or roentgenograms submitted. The forms required by the regulations are available from the Bureau of Occupational Safety and Health, 1014 Broadway, Cincinnati, Ohio 45202.

In addition, the organization of Part 37 has been revised so that the specifications for chest roentgenographic examinations appear as a subpart rather than as the entire part.

Because the regulations require the physician who will read and classify the roentgenograms to have demonstrated proficiency in the use of the ILO or UICC/Cincinnati Classifications of the Pneumoconioses, by either submitting sample chest roentgenograms that have been classified properly under $ 37.31 or by successfully completing a course in one of the classification systems, the Bureau of Occupational Safety and Health is supporting a number of classification courses to be held on a regional basis. Details of these courses can be obtained from the American College of Radiology, 6900 Wisconsin Avenue, Bethesda, Md. 20014. Any plans which include the use of physicians who have signified their intent to take an approved course may be approved conditionally as provided in 8 37.5.

In accordance with the notice of proposed rule making, Part 37, as set forth below, is hereby adopted effective on the date of its publication in the FEDERAL REGISTER.

SUBPART-CHEST ROENTGENOGRAPHIC EXAMINATIONS Sec. 37.1 Scope. 37.2 Definitions. 37.3 Chest roentgenograms required for miners and new miners. 37.4 Plans for initial chest roentgenographic examinations. 37.5 Approval of plans. 37.6 Roentgenographic examinations conducted by the Secretary. 37.7 Transfer of affected miner to less dusty area.


37.20 General provisions. 37.21 Ability to take high quality chest roentgenograms. 37.22 Protection against radiation emitted by roentgenographic equipment.

SPECIFICATIONS FOR READING, CLASSIFYING, AND SUBMITTING FILMS 37.30 Reading and classifying chest roentgenograms. 37.31 Proficiency in the use of the ILO or UICC/Cincinnati Classifications. 37.33 Notifications to miners of abnormal findings.

AUTHORITY: The provisions of this Part 37 issued under the authority of sec. 203, 83 Stat. 763; Public Law 91–173. $ 37.1 Scope.

The provisions of this subpart set forth the specifications for giving, readign, classifying, and submitting chest roentgenograms required by section 203 of the Act to be given to underground coal miners and new miners. $ 37.2 Definitions.

As used in this subpart, all terms not defined herein shall have the meaning given them in the Act.

(a) "Act" means the Federal Coal Mine Health and Safety Act of 1969 (Public Law 91–173).

(b) "Secretary" means the Secretary of Health, Education, and Welfare.

(c) "Bureau" means the Bureau of Occupational Safety and Health, Environmental Health Service, 1014 Broadway, Cincinnati, Ohio 45202.

(d) “Panel of Radiologists” means the U.S. Public Health Service Consultant Panel of Radiologists, 1014 Broadway, Cincinnati, Ohio 45202.

(e) “ALFORD” means the Appalachian Laboratory for Occupational Respiratory Diseases, Environmental Health Service, Box 4258, Morgantown, W. Va. 26505.

(f) "Chest roentgenogram" means an X-ray view of the chest recorded on photographie film.

(g) "Miner" means any individual who is working in or at any underground coal mine and who has been employed to work in or at any underground coal mine on or before December 30, 1969, but does not include any surface worker who does not have direct contact with underground coal mining or with coal processing operations.

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