Leobardo Segura Meza is 27 years old. He is a migrant worker who came to the U.S. in 2012, started work as a engineered stone countertop cutter and by 2022 was on the transplant list to replace damaged lungs. He has Silicosis.

Silicosis is a respitory disease caused by silica dust generated by fabricating countertops from engineered stone. The dust builds up and scars the lungs, leaving workers short of breath, weakened and ultimately suffering from lung failure. It is progressive and incurable, but preventable.

With an oxygen tank supporting his damaged lungs, Segura Meza, speaking through an interpreter, appeared before the California OSH Safety Board. "I want to tell you what happened to me," he told the board, "so that you can take emergency measures  to prevent other young people like [me] to get sick."

He was born in Mexico in 1996, and is married with two children. He came to United States in 2012 when he was 16 years old and he used electrical tools to cut and polish the engineered stone to make the countertops.

Before his diagnosis, he had never heard of silicosis before he was diagnosed and now knows that "there's no cure for this illness. The only thing they can do is a lung transplant." He worries that more workers will grow ill and more men may die. Two of his former co-workers, he told the board, had already died waiting for transplants.

At the hearing, medical professionals from the Western Occupational and Environmental Medical Association (WOEMA), the California Department of Public Health, and a university-affiliated medical center—and labor-side representatives said that respirable crystalline silica exposure causes a large number of workers in the engineered stone fabricating industry to suffer from silicosis after inhaling crystalline silica dust during fabrication of the countertops.

According to analysis by Ogletree Deakins, a labor and employment law firm, they spoke in support of a petition to amend the existing regulations via an emergency temporary standard (ETS) that would prohibit fabrication without using water to suppress dust, require airline respirators or power air-purifying respirators for all work involving artificial stone fabrication, increase penalties for silica exposure citations and classify such citations as serious, and mandate that all licensed healthcare professionals report any moderate or severe silicosis diagnoses to Cal/OSHA.

Jane Stiles Fazio with University of California, Los Angeles, a pulmonary and critical care physician, spoke before the health and safety board. "Over the last two years I and my colleagues ... have treated over 40 young men with silicosis. The common denominator is their work in cutting and fabricating engineered stone countertops.

"I have witnessed this disease deteriorate their bodies, turning able bodied, 20 and 30 year old men into skeletons," said Dr. Fazio. "I've witnessed them waste away and die horrible deaths on life support while waiting for lung transplants. I've been to their funerals and I've met their young children who grow up without fathers. This disease is silent at first but can progress rapidly making it hard to diagnose early especially without adequate screening. Over a third of patients that we've diagnosed are the stage of advanced disease. Or an acid and progressive fibrosis at the time that we diagnose them. And the disease will progress regardless of removing their exposure in many cases. I'm honestly shocked and frustrated that in California and in the United States of America, we're allowing the completely preventable deaths of young, honest and unassuming working men and fathers in the name of industry."

Over the past decade, outbreaks of silicosis have been reported in several countries among workers who cut and finish engineered stone slabs for countertops, according to a study in the American Journal of Respiratory and Critical Care Medicine.

The study, Radiographic Screening Reveals High Burden of Silicosis among Workers at an Engineered Stone Countertop Fabrication Facility in California, found that "many affected workers have been young, with rapidly progressive disease. Engineered stone is a composite material made of crushed quartz bound together with polyester resins and pigments, with significantly higher silica content than natural stone materials; engineered stone typically contains >90% silica, compared with <45% in granite and <5% in marble. The disease has been around for centuries, but several recent studies has shown that the disease is growing as the popularity of countertops made from engineered stone grows."

Workers can be exposed to markedly elevated levels of respirable crystalline silica when cutting and finishing engineered stone materials.

Approximately 98,000 people work in the stone fabrication industry in the United States; however, systems for silicosis surveillance and reporting are not well developed, and limited information is available about disease prevalence among industry workers. In early 2019, the California Department of Public Health (CDPH) identified three cases of silicosis, including two fatalities, among former workers at an engineered stone countertop fabrication company (company A). During a 2009 inspection of company A, the California Division of Occupational Safety and Health had measured respirable crystalline silica levels 22 times higher than the permissible exposure limit of 0.1 mg/m3 in effect at that time; in 2019, a repeat California Division of Occupational Safety and Health inspection again identified inadequately controlled silica dust exposures. We sought to determine prevalence of silicosis and related risk factors among current employees of this company. Some of the results of this investigation have been previously reported in the form of an abstract.

At CDPH’s recommendation, company A provided silicosis screening to all current employees working in stone fabrication areas at the company’s two locations. Screening included spirometry and chest radiography, with radiograph classification performed by a National Institute for Occupational Safety and Health–certified B Reader physician according to the International Labor Organization (ILO) system for pneumoconioses. Medical and employment records were reviewed by a CDPH physician, and silicosis was defined as ILO classification of 1/0 or higher. Global Lung Function Initiative reference values were used to calculate lower limit of normal values for FEV1, FVC, and FEV1/FVC ratio.
All 43 currently employed fabrication workers underwent silicosis screening. All were Hispanic men; median age was 37 years. Five employees (12%) had silicosis, and the median age of employees with silicosis was 40 years, and job tasks of these employees included cutting, fabricating, and laminating stone slabs. Duration of employment was available for 36 (84%) employees, including 4 with silicosis. Median duration was 14.9 years among those with silicosis and 6.5 years among those without silicosis. Three employees with silicosis had FEV1 and FVC less than the lower limit of normal with normal FEV1/FVC ratio, a restrictive pattern typical of silicosis; five employees with negative chest radiographs had similar restrictive spirometry patterns.

This investigation provides the first estimate of silicosis prevalence among a cohort of countertop fabrication workers in the United States. The only prior estimate in this industry came from Queensland, Australia, where the government began offering free silicosis screening to current and former industry workers in 2018. As of May 2020, among 1,047 workers screened, 204 (19.5%) had been diagnosed with silicosis, including 31 (2.9%) diagnosed with progressive massive fibrosis.

This investigation was subject to several limitations. First, chest radiographs may not have been sufficiently sensitive to identify all silicosis cases. Results from a series of 78 countertop fabrication workers with silicosis demonstrated that 43% had normal chest radiographs and were diagnosed instead by chest computed tomographic (CT) imaging, which has been found to have higher sensitivity for pneumoconioses. Second, although the index cases at company A were identified among former employees, only current employees underwent screening; additional silicosis cases might have occurred among former workers, particularly given the lag time between exposure and disease onset. Information about prior employment was also unavailable for screened workers. The screening program in Queensland, which identified a higher prevalence of disease, assessed both current and former industry workers; some workers underwent chest CT imaging in addition to a chest radiograph. Finally, these results are limited to a single employer and may not be generalizable to other workers in this industry.
 

Trade association's general statement

In March 2023, the Engineered Stone Manufacturers Association (ASTA world-wide) released the following general statement:

AStA – the Agglomerated Stone Manufacturers Association – was formed in 2010 to promote Environmental Health and Safety standards with all stakeholders in the agglomerated stone industry, including manufacturers, fabricators and their employees.

Our products are sold and distributed around the world in slab form, which before reaching our end consumers need further processing by stonemasons (also known as fabricators). More specifically, our businesses focus on the kitchen and bath countertop market.

Although our products themselves do not pose any risks to end consumers once installed, it is during their manufacturing and fabrication that the tradesmen performing these tasks are at risk of being exposed to high levels of RCS1 containing dust. Uncontrolled exposure to RCS dust, brought about by improper fabrication, may lead to Silicosis and other occupational respiratory dust related diseases. It is important that all companies and workers who perform these tasks fully understand the risks of such exposure and follow best practices that ensure their tasks are completely safe to perform.

Unfortunately, some employees and employers do not appreciate the gravity of the danger, aided by the fact that some of the diseases take many years to unfold. These factors, accompanied by the slow development of governmental occupational guidelines and  enforcement have negatively impacted the  compliance in the fabrication industry.

While we agree it is incumbent on all employers to ensure that their workers have the necessary means of protection and implement them properly, and while we as product manufacturers, have always communicated the most updated information about our products (such information has been shared via proper labeling warnings, safety data sheets, good practices guides, instructional videos and conventions) it seems further action to education might be required.

And so, as our members have consistently informed fabricators and tradesmen about risks associated with RCS, and have delivered information on the procedures and practices that must be complied with to protect their employees, in some cases, poor adherence seems evident. This fact is tragic, cosidering is well established that Silicosis, and other dust occupational diseases, are 100% preventable.  Engineered stone surfaces can be fabricated and installed with no safety issues or health hazards if it is performed according to the best practices.

Recent developments have demonstrated that unsafe practices are still a reality for some tradesmen. AStA World Wide expresses its deepest sympathy for anyone who has contracted silicosis by simply doing their job, and are fully committed to the eradication of any occupational disease in our industry. However, The engineered stone industry is only one of many industries where workers are exposed to silica dust. As way of example, the official data of Spain´s National Institute of Silicosis for the period 2008-2021 reflects that less than 9% of the silicosis cases diagnosed are related to stone fabricators. Other sectors as mining or slate are over 30%. Likewise, in Australia, almost half of cases of silicosis reported for the period 2000-2019 are from industries outside of engineered stone and it is estimated that up to 600,000 Australian workers are potentially being exposed to silica dust each year across a wide range of industries including quarrying, construction, tunnelling, mining and many manufacturing processes2.

It seems that the target of guaranteeing the safety of tradesmen involved in our value chain – as well as in all relevant industries – cannot be achieved without adequate governmental involvement. We ask health and safety regulators and stakeholders to:

Update existing standards and rules; and most importantly –
Enforce said standards in the fabrication industry.
As a source of inspiration, we believe governments and regulators can look at the state of Victoria’s licensing scheme, which within a relatively short period of less than 3 years managed to dramatically improve the working conditions by requiring fabricators to become licensed and allowing sale of products only to licensed fabricators.

We stive for all of our customers to be completely committed to operating with our products in a fully safe manner and with that commitment, and we continue to actively promote full safety practices at the workplace and collaborate with all industry members and public authorities to continue increasing awareness in our value chain worldwide.