Need to Know

• Silicosis among engineered stone countertop fabrication workers is drawing renewed national attention because of a major investigative report published by KFF Health News and CBS News.
• H.R. 5437, a bill that would shield stone slab manufacturers from litigation, is coming under fire by medical professionals.
• Government agencies, health organizations, and media outlets are intensifying focus on workplace safety standards, dust control measures, and enforcement.

California has now confirmed 519 cases of engineered stone silicosis and 29 deaths since 2019, according to data from the California Department of Public Health. The median age at diagnosis is 46. The median age at death is 49. The numbers represent a sharp increase from the 432 cases and 25 deaths reported as of November 2025.

The KFF report estimates the global engineered stone market at roughly $30 billion and notes cases are now appearing from California to Texas, Florida and the Northeast. Because silicosis is not a nationally reportable disease and surveillance varies by state, no comprehensive national count exists.

Federal Legislation Draws Fire

Much of the article focuses on H.R. 5437, the Protection of Lawful Commerce in Stone Slab Products Act, introduced by Rep. Tom McClintock, R-Calif., in September 2025. The bill would prohibit civil lawsuits against manufacturers and sellers of stone slab products for harm resulting from the fabrication of those products by third parties. It would also dismiss pending cases.

The House Judiciary Subcommittee held a hearing on the bill on January 14, 2026, titled "Between a Rock and a Hard Place: Protecting the American Stone Slab Industry from Lawfare."

David Michaels, an epidemiologist and former assistant secretary of labor who oversaw the Occupational Safety and Health Administration under President Barack Obama, compared the industry's position to tobacco companies claiming cigarettes are safe, according to the report. More than 370 lawsuits have been filed by workers against engineered stone manufacturers.

Manufacturers maintain the material can be fabricated safely with proper dust controls. Rebecca Shult, chief legal officer for Cambria, the leading domestic manufacturer of engineered quartz slabs, testified at the January hearing that the company runs its own fabrication shops with wet cutting and ventilation controls, saying the company's experience demonstrates quartz can be cut safely. Cambria has reported no cases of silicosis among its own workers.

Fabricator Compliance with Silica Standards Remains Low

The KFF report also cited findings from California's Division of Occupational Safety and Health showing that compliance with existing silica standards remains low among small- and mid-sized fabrication shops. Officials visiting more than 100 shops in recent months reported that no workers were observed wearing appropriate respiratory protection during high-risk cutting and polishing tasks. An estimated 25 percent of shops continue to dry-cut stone, according to the report.

California's SB 20, the Silicosis Training, Outreach and Prevention Act, took effect on January 1, 2026. The law bans dry cutting of stone containing more than 0.1 percent crystalline silica, requires shop certification and classifies silica-related illness as a serious injury under the state's Labor Code. The state also designated silicosis a reportable disease in June 2025.

Separately, the Western Occupational and Environmental Medical Association, representing more than 600 occupational medicine physicians across seven western states, petitioned Cal/OSHA's Standards Board in December of 2025 to ban all fabrication and installation of engineered stone containing more than 1 percent crystalline silica. The board has six months to review and issue a decision.

Massachusetts reported its first confirmed case of silicosis linked to the stone countertop industry in December of 2025, involving a man in his 40s who worked for two fabrication companies over 14 years.

Medical Research on Silicosis Continues

A pictorial review published in the March 2026 issue of the journal Radiographics by researchers from UCLA, UCSF and other institutions found that engineered stone silicosis often presents with atypical imaging features, including accelerated disease progression and extrapulmonary complications. The authors noted these atypical presentations contributed to initial underdiagnosis and misdiagnosis among workers.

The National Institute for Occupational Safety and Health published a blog post in late January of 2026 detailing efforts by its Respiratory Health Division and the California Department of Public Health to build a national list of stone countertop fabrication facilities using business classification codes.

Dr. Sheiphali Gandhi, an occupational and environmental pulmonologist at the University of California, San Francisco, told KFF Health News that the true burden of disease remains uncertain because there is no national surveillance system.