Like Gonzalez, Reyes was told he had pneumonia before a CT scan and a pulmonary test in Sept. 2021 revealed he had silicosis. He said the doctor told him, “There is no medicine for this disease, and so there is no cure for it.”
Reyes’ weight plunged from 160 lbs. to 115 lbs. He moves today with the sluggishness of an old man. Only a lung transplant will save him.
“I have spoken to God,” Reyes said. “If it is my time to go, I am happy to go with him … If the transplant comes first or it doesn’t come, I have accepted it.”
Most of the silicosis patients at Olive View were uninsured when they were diagnosed, according to Fazio. She said she’s helped those who need a lung transplant obtain benefits under Medi-Cal. But a transplant, which can cost more than $1 million, “is not a perfect solution,” Fazio said. Patients need full-time caregivers and often must relocate to be near a hospital. On average, their lives are extended five to 10 years.
A Scourge Across The Ages
Silicosis is not a new scourge. In fact, it’s considered the oldest known occupational lung disease. The German metallurgist and mineralogist Georgius Agricola described it among miners in the 16th century and the Italian physician Bernardino Ramazzini among stone-cutters in the 17th. Its prevalence among workers in the United States triggered a full-blown public health emergency in the early 20th century.
Dr. Nader Kamangar, left, and Dr. Jane Fazio at Olive View-UCLA Medical Center in Sylmar.Trevor Stamp for LAistThe nadir came in the 1930s, when hundreds of laborers, most of them Black, died after drilling the Hawk's Nest water tunnel through sandstone near Gauley Bridge, West Virginia. The episode triggered congressional hearings and motivated the U.S. Department of Labor to release a public service film, “Stop Silicosis,” in 1938. The film highlighted preventive measures that still apply: ventilation, the suppression of dust with water, and respiratory protection.
Incidence of the disease has ebbed and flowed ever since. Just when it seems it’s been eradicated, it reemerges — among coal miners, construction workers, and now countertop fabricators. The outbreaks have moved from country to country — Israel, Spain, Australia — as the use of artificial stone has spread. Australia considered banning the product because fabrication is inherently dangerous for workers: Synthetic stone contains more than 90% silica, compared with about 30% for granite and about 5% for marble.
Citations And Large Proposed Fines
In early 2019, the California Department of Public Health learned of the 2018 silicosis death of a Bay Area fabrication worker; the man’s brother died of the disease the same year. Both had worked at Stone Etc. in Hayward.
Department officials made a referral to the state’s Division of Occupational Safety and Health, better known as Cal/OSHA. The agency launched a “special emphasis” program for silica and inspected 106 workplaces. It found overexposures at 47 of them and issued 523 citations.
Eighteen citations — three of which alleged willful violations, the most serious category — went to Stone Etc.’s Hayward location; Cal/OSHA proposed a fine of $476,420. The agency issued nine citations, four classified as willful, to the company’s Gardena location and proposed a fine of $417,325. Stone Etc., which did not respond to requests for comment, is contesting the citations.
The COVID-19 pandemic forced Cal/OSHA to suspend the special emphasis program in early 2020. It has resumed, but no inspections had been conducted as of Nov. 18, an agency spokesperson said.
‘Chronic Understaffing’ At Cal/OSHA
Eric Berg, Cal/OSHA’s deputy chief of health, estimated the number of stone-cutting operations in the state to be “in the hundreds. We know of a certain number of cases [of silicosis]. It’s likely there are more cases we’re just not aware of.”
Nor is there reason to believe the problem is limited to California. “We imagine it’s happening all over the United States,” Berg said.
The U.S. Occupational Safety and Health Administration, which polices workplaces in states that don’t have their own federally approved programs, tightened the nation’s silica standard in 2016 and in early 2020 began an initiative to look for cases in which the new limit was exceeded in targeted industries. One of those industries is “cut stone and stone product manufacturing,” which includes countertop fabricators. An OSHA spokesperson said 44 employers with that classification were cited for alleged silica-related violations from Feb. 4, 2020 through Nov. 21, 2022.
Researchers estimated that as of 2018, 96,366 fabrication workers at 8,694 sites in America were at risk of developing silicosis. The numbers are probably higher today. But both federal OSHA and its state counterparts are severely under-resourced. The AFL-CIO reported this year that there were only 755 federal and 964 state workplace inspectors in fiscal year 2021. That translates to one inspector for every 81,427 workers in the U.S.
Many of the fabrication shops employ only a few workers, some of whom are undocumented and unlikely to file complaints with regulators, interviews show. That makes violators harder to find.
Garrett Brown, a retired Cal/OSHA industrial hygienist, said the agency suffers from “chronic understaffing. I’m concerned the division is not going to have the wherewithal to do an effective job of protecting workers in this industry.”
The Cal/OSHA spokesperson said, "We are continuing efforts to hire more industrial hygienists while also providing ongoing training to existing staff on health-related inspection procedures, including those for silica."
Manufacturers ‘Absolutely Know’ About The Dangers
If the government can’t be counted on to extinguish the silicosis crisis among countertop workers, who can?
Raphael Metzger, a lawyer in Long Beach, thinks he has the answer: Sue the manufacturers and suppliers of engineered-stone countertops. He’s filed product liability lawsuits against dozens of them.
“These are extremely dangerous products, and the manufacturers do not provide adequate safe-use instructions” for fabrication workers, Metzger said. He’s suing makers of both synthetic and natural-stone countertops, but the former, he said, are by far the most hazardous.
Manufacturers such as Israel-based Caesarstone, one of the pioneers and dominant players in the artificial stone industry, “absolutely know” about the silicosis problem associated with their products, Metzger said.
A study published a decade ago in the journal Chest, for example, found that 25 silicosis patients referred for evaluation by Israel’s National Lung Transplantation Program from Jan. 1997 through Dec. 2010 all had been “exposed by dry cutting a relatively new, artificial, decorative stone product with high crystalline silica content used primarily for kitchen countertops and bathroom fixtures.” In short, the very product Caesarstone makes. A company spokesperson declined to comment for this article.
Two other manufacturers of engineered stone named in the litigation, Cosentino and Cambria, did not respond to requests for comment.
In 2020, following a Centers for Disease Control and Prevention report of 18 cases of silicosis among stone fabrication workers in four states — including the two fatal ones in the Bay Area — Caesarstone unveiled a training program called Master of Stone.
“While we have long had safety measures in place, this educational initiative was created for our fabricators and industry professionals and addresses all issues of health and safety in the workplace with special emphasis on creating a space free of the potential implications of respirable crystalline silica dust,” the company said in a press release.
Proper Protection Is Expensive
Preventing silicosis is expensive. Manny DeOliveira, president of United Marble and Granite in Santa Clara — one of the largest countertop fabricators in the Bay Area — said he has invested hundreds of thousands of dollars in special machines, training and protective gear.
His workers craft countertops next to enormous waterfall machines fitted with special air filters that suck in the dust and convert it to mud. Cutters wear half-face respirators, goggles and hardhats. During safety trainings, DeOliveira likes to use a little fear, showing workers images of lungs destroyed by silica dust. He hires industrial hygienists to walk the plant and help him comply with Cal/OSHA rules.
DeOliveira said he is committed to protecting his workers, but this makes it harder to compete with fabricators who don’t bother. He thinks that would change if manufacturers and suppliers were held liable for the harm their products cause to workers down the supply chain. “Until that happens, I doubt anything will help,” he said.
Metzger maintains that sophisticated protective measures are financially out of reach for many small operators. He is seeking punitive as well as compensatory damages against Caesarstone and the other countertop manufacturers, he said, because “they consciously disregarded the health and safety of these [fabrication] workers.” His clients are Gonzalez, Reyes and Ana Miriam Gonzalez Moreno, whose husband, Victor, a fabricator, died of silicosis last year at 53.
‘We Cannot Get Over It’
In an interview, Miriam Gonzalez said her husband would come home from work “completely white … all dusty. Even his eyelashes were white, white.” He began coughing and gasping for breath about two years ago, she said, and was diagnosed with silicosis. “Since he kept working, the wounds were scarring over. This was blocking his lungs, closing up his lungs.”
Victor’s weight fell from 230 pounds to 125 pounds, his wife said. When he died, in Sept. 2021, “I withdrew into solitude,” she said. Her grown children — Victor’s stepchildren — were heartbroken, as was her mother.
“My mom still cries all the time, even now,” Miriam, who lives in Burbank, said. “And so do I. It is hard for us. A year has gone by, but I feel like it just happened yesterday. We cannot get over it.”
She and Victor were together for 24 years, but she’d rebuffed his proposals of marriage, fearing it would ruin their relationship. She relented 2½ years ago, as Victor was starting to show symptoms. “I will not get married again,” she said.
Metzger took Victor’s deposition in the summer of 2021. Victor stood during much of his testimony because when he sat, he explained, “I suffocate.”
He had cut granite and marble, as well as Caesarstone and other artificial stone, for 33 years. A short cellphone video he recorded at one of his places of employment shows some of his co-workers toiling in a thick cloud of silica dust with a shrill grinding or sawing noise in the background.
“There were no fans there to let the dust out,” Victor, who was diagnosed with silicosis in Oct. 2019, testified. “I made the video so it could show how other people [working] there could get sick.”
Consumers Have A Choice
Dr. Robert Harrison, an occupational physician on the faculty at UC San Francisco’s Department of Medicine, has been tracking silicosis in the state for almost four years. He knew trouble was coming to the U.S. as he read about the clusters in other countries.
Like Metzger, Harrison believes countertop manufacturers are ultimately responsible for the workers’ illnesses. “They’re making silicosis in a box and shipping it out by the tens of thousands of pounds,” he said. “How could they not know?”
Consumers do have a choice. They can spend more on granite or marble countertops, thereby reducing, though not eliminating, the likelihood that the workers who shape the slabs will get sick. Or, they can avoid stone altogether and turn to countertops made of concrete, wood or porcelain.
Juan Gonzalez Morin was asked if he had a message for would-be buyers of artificial stone products. He did.
Consumers need to know that “behind their kitchens are many people who have been harmed,” he said. “And to value the work of each person. Many of us continue working in this field out of necessity, and many continue because of ignorance, not knowing what causes the damage: the stone.
“Behind the kitchen, basically, there’s sweat and blood and, at the worst, even death.”
Jim Morris is editor-in-chief of Public Health Watch, a nonprofit investigative news organization. Kim Krisberg with Public Health Watch contributed to this story.
