Experts tell Los Angeles health commission engineered‑stone silicosis is rising; motion to study city ban fails

Dr. Fazio, a pulmonologist, told the Los Angeles City Health Commission that Los Angeles and Los Angeles County are seeing an emerging epidemic of silicosis tied to fabricated engineered‑stone countertops, and warned that workers are becoming ill after only five to 10 years of exposure.

The case counts and regulatory responses make the issue immediately relevant to city policy and worker safety: Dr. Fazio described a rapid rise in identified cases, Cal/OSHA officials outlined a new permanent silica standard and enforcement steps, and commissioners debated whether to study banning fabrication of engineered stone within city limits. A motion to study such a ban failed on a 3–3 vote.

Dr. Fazio said engineered stone — sometimes sold as quartz, quartzite or artificial stone — contains markedly higher crystalline silica (commonly reported in the presentation as above 90–96% by weight) than traditional countertop materials (marble <5%, granite roughly 30–45%). He said the material’s popularity over the past decade has been followed by an uptick in occupational disease because cutting and polishing engineered stone produce very high concentrations of respirable silica dust.

“Engineered stone silicosis is an epidemic in Los Angeles,” Dr. Fazio said during the presentation, describing cases he and colleagues have tracked and published. He told the commission the team initially published 52 cases (71% in Los Angeles County) and said statewide case counts later rose to figures he cited as about 294 cases, with 15 deaths and roughly 30 lung transplantations to date. He emphasized that silicosis has no cure and that lung transplantation is not a perfect remedy.

Dr. Fazio described clinical and public‑health patterns drawn from local screening and hospital data: many affected workers are men in their 20s–40s, predominantly Latino immigrants, often underinsured or uninsured, and presenting late in the disease course. He said a California screening project had enrolled roughly 62 workers (66 approached), with about 50 completers and a preliminary 40% rate of silicosis among those screened.

The presentation gave several quantitative details cited to Dr. Fazio: an estimated 800 fabrication shops in California, roughly 4,000 workers in those shops, and a conservative projection of about 1,200 potential cases (which he described as a likely underestimate because informal shops and unregistered operations are common). He also cited hospitalization cost data from a small sample (37 unique individuals, 85 hospitalizations) showing an average hospitalization cost of about $27,000 per patient, with about 65% of those costs paid by public insurance and only about 5% covered by workers’ compensation in the dataset discussed.

Cal/OSHA representatives described how the agency altered its regulatory approach after inspection data showed widespread overexposures and compliance gaps in fabrication shops. Kevin Graulic, principal safety engineer (research and standards) for Cal/OSHA, and Hassan Adam, a regional manager with Cal/OSHA, said the federal 2016 OSHA silica standard had been performance‑based and often required employers to monitor and then prove an overexposure before stronger controls kicked in. Cal/OSHA adopted an emergency temporary standard after industry petitions and later finalized a permanent state standard that went into effect in February of this year, the speakers said.

Cal/OSHA officials described several changes in the state standard that specifically address engineered stone and high‑exposure fabrication tasks: a defined category of “high exposure trigger tasks” that requires engineering controls (wet methods, local exhaust) and elevated respiratory protection regardless of a single monitoring result; elimination of a feasibility exception that previously let some employers avoid controls; stricter housekeeping rules (no dry sweeping or compressed‑air dust cleaning); an expanded medical surveillance program requiring low‑dose CT instead of chest X‑ray in many cases; a medical‑removal program (employer pay protection described as six months of earnings maintenance when removal is recommended by a licensed health care provider); and a reporting requirement for silicosis to both Cal/OSHA and the California Department of Public Health.

Cal/OSHA officials also discussed enforcement and outreach. Hassan Adam said the agency has increased targeted inspections, consultations and community outreach with local organizations and county public‑health staff; he reported that investigators had conducted roughly 92 inspections since the intensified effort began and that Cal/OSHA had issued orders to prohibit use or shut down operations in locations where inspectors observed imminent hazards. “We’ve… shut down probably about 21 or 22 locations,” he said, while noting many shops subsequently worked with Cal/OSHA to abate hazards and reopen in compliance.

On respirators and personal protective equipment, Cal/OSHA staff said the new standard requires powered air‑purifying respirators (PAPR) or respirators giving an assigned protection factor equivalent to 1,000 in workplaces performing high‑exposure tasks, with high‑efficiency (P100/N100/R100 or HEPA) filtration. Officials and Dr. Fazio both emphasized that respirators are the last line of defense and that engineering controls such as wet cutting and local exhaust are more effective at preventing exposure.

Commission discussion focused on the human and economic tradeoffs: commissioners and public questioners raised the losses of life and productive years, the difficulty of reaching informal or small “mom‑and‑pop” fabrication shops, and the potential economic impact of stricter limits or a ban on local fabrication. Commissioner Ho moved that the commission study and evaluate the impact of banning fabrication of engineered stone within the city of Los Angeles; Commissioner Villa seconded the motion. During debate members asked that any study examine job and economic consequences and possible mitigation (retraining, transition assistance) as well as health outcomes.

When called to a voice vote the motion received three ayes and three nays and therefore failed. The chair recorded the result as a tie and said the motion did not pass. Commissioners and staff also noted that, separate from a commission motion, individual commissioners may direct research associates to gather information and that the commission can request follow‑up briefings and data from city departments and the county health department.

Members of the public and the commission pressed for additional next steps: more outreach to workers and consumers, expanded worker screening and surveillance, clearer links between exposure monitoring and case reporting, coordination with state efforts (including the California artificial stone and silicosis project described by Dr. Fazio), and additional city‑level resources for prevention, screening and care navigation. Dr. Fazio and Cal/OSHA representatives both urged multidisciplinary responses combining workplace engineering controls, enforcement, medical surveillance and public education.

What the commission did not decide at the meeting was a formal referral or ordinance. The motion to study a fabrication ban failed on a 3–3 tie; commissioners were told they can still commission research and ask research staff and city departments for additional information before returning to the question.

Votes at a glance

- Motion: “Study and evaluate the impact of the fabrication (ban) of engineered stone within the city of Los Angeles.” Mover: Commissioner Ho. Second: Commissioner Villa. Voice vote: 3 ayes, 3 nays; outcome: failed (motion did not pass).