After Decades of Quiet Rumbling, an Epidemic Is Erupting Among California Stoneworkers

Eight hours in, he estimated he had walked no more than half a mile.

If he had moved any faster, he would have suffocated.

Hernandez had to check the oximeter clamped to his right pointer finger the way most people check their phones. If his heart rate passed 135 beats per minute, or his oxygen level sank below 80%, he was in trouble.

A few months earlier, his life had looked very different. 

Hernandez — whose real name we are withholding for his protection, given his immigration status — had gone two decades without going to the doctor. He played one or two games of soccer every weekend. He was, in his words, ​“perfectly healthy.” That changed in December 2023, when Hernandez was diagnosed with a condition called silicosis. He had worked for more than a decade with engineered stone, a novel material made primarily of crushed quartz that is commonly used to make countertops. His doctor warned that, if Hernandez ignored the condition, he could be dead within a couple of years.

Silicosis is an irreversible lung disease that can turn fatal. The only way to get it is by inhaling large amounts of silica dust, small particles of a mineral found in stone, sand, gravel and cement — the kind of materials Hernandez handled every day as a stoneworker.

The disease has affected humans for millennia. In roughly 400 B.C., the Greek physician and philosopher Hippocrates described a lung disease that caused difficulty breathing in miners. In 1705, an Italian physician documented the disease in stonecutters. But starting in 2019, California has seen a surge in silicosis diagnoses among people working with engineered stone in particular.

The California Department of Public Health has described it as an epidemic, one primarily plaguing young Latino immigrants like Hernandez who work in shops that fabricate engineered stone.

Engineered stone was invented in the 1960s and began being imported into the United States from Israel and Spain around the 1990s. Often advertised as a cheaper alternative to marble or granite, it’s made by pulverizing stone like quartz into a fine powder, then mixing in polymer resin (to bind the crushed-up pieces) and pigments (to make it pretty). Various manufacturers ship their slabs to stone fabrication shops all over the world to be cut, polished and sold, usually in the form of countertops, tables, desks or showers, made available at retailers like Costco and Home Depot.

At Hernandez’s fabrication shop in Los Angeles County, he operated the water saw, a rotating blade flanked by spray hoses that slices through stone under a continuous stream of water. With each cut, silica dust particles would fly into the air. Once a slab was in the proper shape, Hernandez would pass it on to his coworkers, who used their own power tools to polish it, releasing more clouds of dust.

If you live in the United States, there’s a good chance you have engineered stone in your home or have come across it in someone else’s. Today, engineered stone is among the most popular countertop materials in the country, thanks to its durability, heat resistance and price. This demand has made the global engineered stone industry worth more than $29 billion, but it has led to devastating health consequences for stoneworkers.

Engineered stone contains more than 90% silica content — double that of granite and more than 18 times that of marble. That means, with the transition from natural to engineered stone, workers like Hernandez are inhaling unprecedented amounts of silica dust. When he and his coworkers transform slabs of engineered stone into the puzzle pieces of counters and shower walls, countless nanosized silica particles are released — so small they can penetrate respirators and pass directly into the lungs.

In 2012, the first outbreak of silicosis linked to engineered stone was reported in Israel. In 2014, the first U.S. case came to light in Texas. But in Hernandez’s 15 years in the stonecutting industry, he had never heard of the risk.

“There was no information saying that what I was doing was bad,” he says.

Hernandez and his coworkers believed they were taking full precautions — masking up, wearing safety glasses and blasting streams of water when cutting stone to suppress dust. None of these workers had any idea those measures were powerless against silica.

Neither did the shop owners — themselves also often immigrants who started out as stoneworkers — because the manufacturers didn’t properly warn them, according to allegations in a lawsuit Hernandez filed against dozens of engineered stone companies in 2024. For years, the lawsuit charges, manufacturers neglected to provide stoneworkers with adequate safety instructions or warning labels, which are legally required.

Though other states have cases too, California has emerged as an epicenter. According to Raphael Metzger, an attorney representing engineered stoneworkers with silicosis, that’s partly because California has a robust surveillance program that most states lack.

One 2023 study identified 52 stoneworkers in California who were diagnosed with silicosis. Their median age was 45. Of these, 10 had died and 20 had reached the disease’s most advanced stage. That means nearly 60% of the identified workers were killed or made severely ill by silica dust.

The following year, Australia, seeking to address its own silicosis epidemic, banned engineered stone after determining the fabrication process was too dangerous. But the United States hasn’t instituted a similar ban — and it probably won’t.

Even when a product is found to endanger workers and prompts a government review, agencies like the Occupational Safety and Health Administration (OSHA) often fail to pass effective regulations or even enforce existing ones.

“In the United States, we don’t ban products,” Metzger says. After all, the Environmental Protection Agency only finalized its ban on asbestos in 2024, after a decades-long fight by health and safety advocates and an annual death toll of nearly 40,000.

Now, as a new occupational epidemic is spreading, Hernandez is just one victim among hundreds — and, likely, many more soon.

Outside of California, silicosis is still considered rare. ​“It’s something that we learn about for one minute in medical school and we expect we won’t really ever see it again,” says Dr. Jane Fazio, a pulmonologist at UCLA. Between 1968 and 2004, the disease’s U.S. death toll decreased from 1,065 to 165 per year, as the mining industry declined and national safety standards were established for silica dust exposure.

So Fazio was puzzled when she encountered her first silicosis patient in 2021.

The patient was a Latino man in his 50s, who had flown from Washington to Los Angeles in hopes of landing a spot on California’s waitlist for a lung transplant. Instead, all he had landed was a hospital bed at the Olive View-UCLA Medical Center.

At first glance, the patient was ​“a little bit too thin,” Fazio recalls. In medicine, they would call his condition ​“cachectic.” In English, we might say he was wasting away — losing body mass fast. His temples had sunken in, and he relied on a nasal cannula for oxygen. Any movement could overwhelm him. If this was how he looked on the outside, Fazio could only imagine the state of his lungs.

Pulmonologists use a variety of tests to diagnose people with breathing problems, including CT imaging. On a CT scan, healthy lungs look like black, oval-shaped masses.

Silicosis muddies that image. Imagine dipping a brush in white paint and flicking it over a black canvas. That’s sort of how inhaled silica looks, like small white dots speckling the lungs. Over time, those dots expand until they appear, as Fazio describes them, ​“like blocks of concrete.” When the illness reaches an advanced stage, those solid white areas engulf the lungs.

On this patient’s CT scans, Fazio remembers, the black canvas of his lungs was completely covered in white, meaning the silicosis had advanced to the condition’s last stage, called severe progressive massive fibrosis, in which lung tissue has grown inflamed and scarred over. When lungs are scarred, they can’t fully expand. People with severe silicosis can get winded simply from standing up. They might find themselves out of breath sitting on the sofa.

“People basically die from chronic suffocation,” Fazio says.

The only treatment available for advanced silicosis is a lung transplant. To get one, you have to be sick enough to need it but healthy enough to survive. You also need health insurance — without it, a lung transplant costs more than $1.2 million.

Because Fazio’s patient could barely walk, he was deemed too sick to qualify for a transplant. Over subsequent checkups, Fazio saw him deteriorate until he was admitted to a nursing facility, where he presumably passed away.

Haunted by the case, Fazio decided to investigate, hunting through her hospital’s records for other silicosis diagnoses. She stumbled upon the beginning of California’s silicosis epidemic.

Just up the coast, another physician, Dr. Sheiphali Gandhi of the University of California, San Francisco, was on the cusp of the same discovery. In 2019, her hospital saw its first case of silicosis in a young person working with engineered stone. An epidemiologist then scraped hospital data for cases of silicosis in people younger than 50. By May 2022, Gandhi had identified 18 cases of silicosis associated with engineered stone, which she presented at that year’s American Thoracic Society Conference in San Francisco. Fazio was in the audience.

After the presentation, Fazio approached Gandhi, telling her, ​“I have 18 cases of my own.”

That was the start of their collaboration. Fazio has since seen more than 100 cases of silicosis associated with engineered stone in her clinic — ​“an extraordinary amount” for a U.S. pulmonologist, she notes. She and Gandhi suspect their case count will rise as more workers get tested and diagnosed, and as medical awareness grows. A 2023 study they coauthored found that more than half of identified silicosis patients had been misdiagnosed at first, usually with tuberculosis or pneumonia.

By 2023, Fazio and her colleagues began visiting stone fabrication shops and advertising their free silicosis screening program.

That’s how Luis Hernandez first heard of the disease.

In November 2023, Hernandez came down with what seemed like the flu: a high fever, sweats, a cough and frequent breathlessness. But it didn’t go away, and Hernandez ​“started feeling really, really, really, really bad.” It was just coincidence that representatives from Fazio’s clinic had visited his shop a couple of months earlier, offering free screenings.

“They were telling us, even if you’re healthy, you have to go and get checkups,” Hernandez recalls.

By the time he saw Fazio in mid-December 2023, Hernandez had dropped from 164 pounds to 127.

On a monitor, Fazio pulled up a scan of Hernandez’s lungs, and told him, ​“Your lungs could collapse.” She could not say how long he had to live, Hernandez recalls, but if he kept deteriorating at his current rate, he could have anywhere from a month to two years. Hernandez left the room and went down to the lobby to break the news to his family, fighting the urge to cry.

Hernandez’s complaint, filed in California in January 2024, contains 371 pages of evidence arguing that dozens of engineered stone manufacturers knew their products were hazardous but did not properly warn workers or shop owners. The complaint alleges that manufacturers failed to update their material safety data sheets — in which they’re legally required to outline the hazards of their products — with adequate safety information or warning labels.

What Metzger and Nevin hope to show in court is not only that engineered stone is deadly but that, for years, manufacturers of engineered stone knew their products were hazardous and failed to give workers any warning.

In 2023, representatives from one engineered stone company, Caesarstone, claimed to Australian regulators that they had only become aware that workers at fabrication shops were contracting silicosis in 2010.

That’s decades after the company started making the product, in 1987, and two years after a lawsuit was filed in Israel alleging that Caesarstone’s products caused a worker’s silicosis. (In its opening statement to Australian regulators in 2023, the company argued ​“a single action filed in 2008 does not give rise to a more serious issue in the industry.”)

By 2012, Israeli researchers published a report in the medical journal Chest detailing 25 workers with silicosis who were exposed to Caesarstone’s products, the first of whom was diagnosed in 1997.

Caesarstone added warning labels in 2010, but they were placed on the backs of the slabs and typically covered ​“less than a half of one percent” of the surface area, the complaint alleges. Other manufacturers likewise made their warning labels so small as to be easily missed, according to Metzger. Caesarstone also allegedly failed to put on its labels any hazard warning symbols — standardized pictures or symbols required by OSHA’s Hazard Communication Standard — until 2018.

Hernandez’s complaint referenced a Caesarstone safety data sheet from March 2012, in which the manufacturer stated that general room ventilation and respiratory equipment approved by the National Institute for Occupational Safety and Health and Mine Safety and Health Administration, like N95 masks, would be adequate protection against vapors and dusts created from working with its products. A January 2020 data sheet included in the complaint also suggested N95 masks would offer sufficient protection against silica particles associated with its product.

These are claims that, Hernandez contends, Caesarstone knew were false.

A spokesperson for Caesarstone declined to respond to specific questions because ​“these are matters of pending litigation.”

In December 2023, Cal/​OSHA, California’s occupational safety and health agency, adopted an emergency temporary standard for work with engineered stone, essentially allowing Cal/​OSHA to close a fabrication shop if they see anyone working without required safety measures. But Metzger questions how the agency — which has seen its budget slashed and personnel reduced — will enforce its emergency standard throughout California, where there are about 920 stone fabrication shops.

To date, there also isn’t an organized labor movement to help protect workers in fabrication shops, as there is in other trades. Almost no fabrication shopworkers belong to a union, Nevin says, and the trade associations that do exist in the industry are dominated by the manufacturers.

One reason for this is that the shops tend to be small, informal work settings that are often family-owned, explains Kevin Riley, director of UCLA’s Labor Occupational Safety and Health program. It’s difficult to organize such a fragmented workforce, where someone’s boss could be their uncle.

Immigrant workers may also feel less comfortable speaking out, especially with ongoing immigration raids, and may prioritize putting food on the table over worrying about organizing, he adds.

Either way, Riley doesn’t ​“think unionization is going to fix the problem” of silicosis. ​“We’re dealing with a product that’s very, very dangerous,” he says.

Even if regulators could enforce their rules, experts are wary of trusting them to fully protect workers. Under federal law and precedent set in lower courts, OSHA is only allowed to adopt regulations that are technologically and economically feasible for industry implementation. And according to a 2024 study, the cost of precautions needed to fully protect people working with engineered stone — including ventilation systems, powered air purifying respirators and other equipment — would exceed the total annual revenues of many mom-and-pop fabrication shops. That means OSHA is legally prohibited from creating regulations that would effectively protect workers against silicosis.

To Metzger, no regulation would be enough. ​“It’s an inherently defective product,” he says. ​“It cannot be made safe. There’s a whole slew of other products that can be used and look nice and function well as kitchen and bathroom countertops but [that] don’t kill the workers who make them.”

The furniture retailer IKEA has already removed engineered stone from its U.S. and Australian stores.

In December 2025, the Western Occupational & Environmental Medical Association — a regional nonprofit representing occupational health physicians and experts — filed a petition to the Cal/​OSHA Standards Board to prohibit fabrication of engineered stone with more than 1% crystalline silica. The letter states, in part, the ​“evidence is now clear that engineered stone containing crystalline silica is too toxic to fabricate and install safely, and education and enforcement alone will not be sufficient to curtail the escalating occupational health emergency caused by this product.”

Hearings on the petition are ongoing.

Where regulators and industry fail to protect workers, Metzger says successful litigation may offer hope for change.

The strategy has worked in the past. Up until the late 2000s, an artificial butter flavoring called diacetyl was commonly used in microwave popcorn. Many factory workers exposed to the flavoring developed a lung disease, nicknamed ​“popcorn lung.” In separate lawsuits, workers sued the manufacturers and were awarded verdicts totaling tens of millions of dollars. While the U.S. government never banned diacetyl, the mounting publicity and lawsuits caused enough concern among consumers, and potentially insurance agencies, that manufacturers stopped using the chemical.

Metzger believes that will be the solution to the silicosis epidemic as well.

In August 2024, Metzger and Nevin’s first silicosis case, representing a 34-year-old stoneworker, reached a verdict: The jury awarded their client $52.4 million.

While Nevin says he can’t estimate how long it will take to get verdicts in the hundreds of cases he and Metzger are working on — manufacturers ​“do everything they can to slow the lawsuit down,” he explains — they expect to file more in the coming years. Metzger sees half a dozen new potential clients every week.

Meanwhile, manufacturers have been urging House lawmakers in D.C. to pass a bill that would ban such lawsuits against them.

At a January hearing, Rebecca Shult, the chief legal officer for Minnesota-based manufacturer Cambria, claimed that ​“bad actor” fabrication shops were to blame for workers’ injuries, not the ​“dozens of innocent stone slab manufacturers” being sued.

“Cambria has no control over these third-party businesses and their dangerous conditions,” Shult argued. ​“We don’t own them and we don’t operate them.”

Cambria declined to respond to questions from In These Times.

As Hernandez’s lawsuit awaited consideration in 2024, Hernandez worked hard to follow his doctor’s orders — but the days only got harder.

He could no longer use stairs. Showers suffocated him. Putting on his pants in the morning left him gasping.

By November 2024, doctors told him he wouldn’t make it to Christmas without a lung transplant. He had reached a point where the simple act of eating made him faint, and he relied on a machine for oxygen.

At the same time, he was running out of savings and had to start selling all he had held dear, including his prized collection of Pokemon cards. He told himself that, if he died, those belongings would mean nothing.

“There were no longer emotions,” he says. ​“It was just the motivation to get that transplant.”

In early December 2024, doctors found a match, and Hernandez underwent an 11-hour double-lung transplant.

A year later, in 2025, the first defendants in his case began settling. By this past February, just weeks into the trial, the last of the 24 manufacturers agreed to settle for confidential amounts.

That same week, the annual Pokemon Go event Hernandez had attended two years earlier was happening again. He wanted to join his friends, but he didn’t have the strength to walk around the stadium. He also couldn’t risk being around big crowds, now that he was on lifelong immunosuppressants, related to the transplant.

These days, Hernandez is focused on rebuilding his health and ​“trying to get the word out” on behalf of the hundreds of others affected.

“I’m still struggling,” he says. ​“But it’s the struggle that’s keeping me alive.”

This piece was published in collaboration with the Investigative Reporting Lab at Yale.