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:)

CHRONOLOGICAL, LISTING OF PHS ACCOMPLISHMENTS UNDER PUBLIC LAW 91-173

[From the Federal Register, Vol. 35, No. 161, Aug. 19, 1970]

RULES AND REGULATIONS

Title 42-PUBLIC HEALTH

Chapter I-Public Health Service, Department of Health, Education, and

Welfare

SUBCHAPTER C-MEDICAL CARE AND EXAMINATIONS

PART 37-SPECIFICATIONS FOR MEDICAL EXAMINATIONS OF UNDERGROUND COAL

MINERS

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 received 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 § 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.

Sec.

37.1 Scope. 37.2

SUBPART-CHEST ROENTGENOGRAPHIC EXAMINATIONS

Definitions.

37.3 Chest roentgenograms required for miners and new miners. 37.4 Plans for initial chest roentgenographic examinations.

37.5

37.6

Approval of plans.

Roentgenographic examinations conducted by the Secretary. 37.7 Transfer of affected miner to less dusty area.

SPECIFICATIONS FOR GIVING CHEST ROENTGENOGRAMS

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 37.33

Proficiency in the use of the ILO or UICC/Cincinnati Classifications.
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 photographic 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.

47-135 - 71 - 50

(h) "New miner" meeans any individual who began working in or at an underground coal mine for the first time subsequent to 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.

(i) "Operator" means any owner, lessee, or other person who operates, controls, or supervises an underground coal mine.

(j) "ILO Classification" means the extended form of the 1968 revision of the International Labour Office's scheme for classifying the pneumoconioses.

(k) “UICC/Cincinnati Classification" means the classification of the pneumoconioses devised in 1968 by a Working Committee of the International Union Against Cancer.

$37.3 Chest roentgenograms required for miners and new miners.

(a) Every operator shall provide to each miner presently working in or at any of its underground coal mines an opportunity for:

(1) An initial chest roentgenogram by June 30, 1971, provided that this requirement will be considered as having been fulfilled with respect to any miner for whom is submitted a chest roentgenogram which meets the requirements of § 37.20 (d) and which was taken on or after June 30, 1969: (2) A second chest roentgengram by June 30, 1974; and

(3) Such subsequent chest roentgenograms as the Secretary prescribes in this subsection. (b) Every operator shall provide to each new miner presently working or subsequently employed in or at any of its underground coal mines:

(1) An initial chest roentgenogram as soon as possible but in no event later than 6 months after commencement of his employment;

(2) A second chest roentgenogram 3 years following the initial roentgenogram if the miner is still engaged in underground-coal mining; and

(3) A third chest roentgenogram 2 years following the second chest roentgenogram if the miner is still engaged in underground-coal mining and if the second chest roentgenogram shows any evidence of dust retention;

(4) Such subsequent chest roentgenograms as the Secretary prescribes in this subsection.

(c) The operator shall provide the chest roentgenograms in accordance with a plan which meets the specifications of this subpart and which is approved by the Secretary pursuant to § 37.5.

$37.1 Plans for initial chest roentgenographic examinations.

(a) Every plan for initial chest roentgenographic examination of underground coal miners and new miners shall be submitted in writing on such forms as prescribed by the Secretary to the Bureau by September 19, 1970, and shall include:

(1) The name(s) and address(es) of the operator or group of operators participating in the plan;

(2) A time schedule for the required roentgenograms which include the number of miners to be given or offered roentgenograms under the plan; (3) The location (s) at and time (s) during which roentgenograms will be given, in sufficient detail to enable a determination of compilance with § 37.20 (a) to be made:

(4) The names and qualifications, including specialty training and experience, of the individual(s) who will give, read and classify the chest roentgenograms, the office address(es). State license number(s) and date of last State, county, or city radiation protection inspection of the roentgenographic equipment to be used; a listing of any deficiencies that were noted during the course of such inspection and what action was taken to correct the deficiencies.

(5) A description of the technical factors to be employed in accordance with the specifications in § 37.20(d) (1), (2), and (3) and § 37.20(e) (2) and (3).

(6) A statement of the steps that have been taken to assure confidentiality of medical records and roentgenographic findings.

(b) The operator shall advise the Bureau of any change in its plan.

§37.5 Approval of plans.

(a) If, after review of any plan submitted pursuant to this subpart, the Secretary determines that the action to be taken by the operator or group of operators meets the specifications of this subpart and will effectively achieve its pur

pose, the Secretary will forward written notice of his approval of such plan to the operator(s) submitting the plan. Such approval may be conditioned upon such terms as the Secretary deems necessary to carry out the purpose of section 203 of the Act.

(b) Where the Secretary has reason to believe that he will deny approval of a plan he will, prior to the denial, give reasonable notice in writing to the operator(s) and opportunity to amend the plan. The notice shall specify the ground upon which approval is proposed to be denied.

(c) If a plan is denied approval, the Secretary shall advise the operator (s) in writing of the reasons therefor.

§ 37.6 Roentgenographic examinations conducted by the Secretary.

(a) The Secretary will give chest roentgenograms or make arrangements with an appropriate person, agency or institution to give the chest roentgenograms or supplemental examinations required under this subpart in the locality where the miner resides, at the mine, or at a medical facility in a town easily accessible to a mining community or mining communities, under the following circumstances:

(1) Where, in the judgment of the Secretary, due to the lack of adequate medical or other necessary facilities or personnel at the mine or in the locality where the miner resides, the required roentgenographic or supplemental examination cannot be given.

(2) Where the operator has not submitted an approvable plan.

(3) Where, after commencement of an operator's program pursuant to an approved plan, the Secretary, after notice to the operator of his failure to follow the approved plan and, after allowing 30 days to bring the program into compliance, the Secretary determines and notifies the operator that the operator's program still fails to comply with the approved plan.

(b) The operator of the mine shall reimburse the Secretary or such other person, agency, institution, as the case may be, for the actual cost of conducting each examination made in accordance with this section.

§ 37.7 Transfer of affected miner to less dusty area.

(a) Any miner who, in the judgment of the Secretary based upon reading of a chest roentgenogram or the result of other medical examinations, shows category 2(2/1) pneumoconiosis or development of category 1(1/0) pneumoconiosis in less than 10 years (ILO or UICC/Cincinnati Classification) shall be afforded the option by the operator of transferring from his position to any position in any area of the mine where the concentration of respirable dust in the mine atmosphere is not more than 2.0 mg/m3 of air.

(b) Effective December 31, 1972, the option of transferring shall be to any area. in the mine where the concentration of respirable dust in the mine atmosphere is not more than 1.0 mg/m3 of air, or, if such level is not attainable in such mine, to a position in the mine where the concentration is the lowest attainable below 2.0 mg/m3 of air.

(c) Any transfer under this section shall be for such period or periods as may be necessary to prevent further development of pneumoconiosis, and during such period or periods, the miner shall receive compensation for his work at not less than the regular rate of pay received by him immediately prior to his transfer.

SPECIFICATIONS FOR GIVING CHEST ROENTGENOGRAMS

§ 37.20 General provisions.

(a) The chest roentgenographic examination shall be given in the locality in which the miner resides or in a location that is equivalent with respect to convenience of time and place. Examinations at the mine during, immediately preceeding, or immediately following work and a “no-appointment" examination at a medical facility in a town easily accessible to a mining community or mining communities shall be considered of equivalent convenience for purposes of this section.

(b) The initial chest roentgenographic examination shall be supplemented by a completed miner's identification document (Form ECA-108) furnished by the U.S. Public Health Service.