Ublester Rodriguez could not have anticipated that his life would be profoundly changed by kitchen and bathroom countertops.

He says that he grew up poor, in a small Mexican town, and came to the United States when he was 14. He spoke no English, but he immediately got a job.

"In the beginning I was working in a Chinese restaurant, from 10 a.m. to 10 p.m. It was all day, so I never had time to go to school," he recalls. "I was a dishwasher."

He labored in restaurant kitchens for about eight years. But he wanted Sundays off to go to church and play soccer. So when his brother-in-law offered to help him get a new job, he jumped at the chance.

That's how he ended up in a workshop that cuts and polishes slabs of an artificial stone to make kitchen and bathroom countertops.

"It was something totally different for me," says Rodriguez.

Back then, in 2000, the material he was cutting was also something totally different for the American countertop industry. The stuff looked a lot like natural granite. In reality, it was made in a factory, from bits of quartz bound together by a resin.

This kind of engineered stone, often marketed as simply "quartz," is now one of the most popular options for kitchen and bathrooms.

Health concerns emerge

The trouble is, workers have gotten sick, and even died, after cutting this engineered stone and breathing in its dangerous dust, public health officials say.

Overseas, some are even calling for a ban on selling engineered quartz for countertops.

Rodriguez, 42, is the first person known to have fallen ill in the U.S. His lungs are so damaged that he is on oxygen about six hours a day. Doctors expect that he will need a lung transplant.

And so far, physicians have identified at least 18 more countertop workers with silicosis in this country. They worry that more cases are out there, and more people are at risk, given that the countertop fabrication industry in the U.S. has around 100,000 workers.

"In the beginning I was angry, but I was angry with me," says Rodriguez, who sued his employer for allegedly causing his illness.

"When I moved from the restaurant to this company, I was getting more money. Because of that change, I ruined my life," he says. "Then I just realized that it wasn't just me. It was the whole company — that they don't protect their employees."

The shop where Rodriguez worked is run by Cosentino, a major player in the countertop industry.

"We are extremely committed to safety and continuously strive to improve our operations," a company spokesperson told NPR. "We hope your article raises awareness in the industry to follow a proper safety culture."

Silestone comes to America

Cosentino, headquartered in Spain, started selling engineered quartz in Europe in 1990, under the brand name Silestone. In 1997, the company formed a subsidiary called Cosentino North America, to bring Silestone to a new market.

The same year that Rodriguez started working with Silestone, the material made its debut at a trade show in Chicago, according to a newspaper account that described "flamenco and tap dancers stomping out rhythms on the quartz surface — which was utterly unaffected."

Silestone's durability and resistance to stains thrilled kitchen designers. It was featured in Time and Good Housekeeping.

The business grew rapidly. As Cosentino executive Brandon Calvo explained in a promotional video, "When we were awarded the national account for Home Depot, I don't think we knew what we were in for. I don't think we knew how big it was."

In 2005, Cosentino ran an advertisement during the Super Bowl, featuring basketball star Dennis Rodman soaking in a bubble bath surrounded by bathroom countertops made of Silestone.

Cosentino wasn't the only company offering the new miracle countertop. Competitors were selling similar materials under such brand names as Caesarstone, Zodiaq and Cambria. Over time, more and more companies started producing slabs of engineered quartz.

Thousands of workers such as Rodriguez toiled in countertop fabrication shops across the country, cutting that raw material into just the right size to fit in customers' kitchens.

In addition to importing slabs of Silestone from Spain and selling them to countertop-making shops, Cosentino also operated its own network of shops, which came to be called Stone Systems. With a dozen locations, Stone Systems bills itself as "the largest network of commonly owned stone fabrication shops" in North America.

Rodriguez worked at Stone Systems of Houston, previously known as Silestone of Houston.

"From 2000 to 2004, we were a small, really small company," says Rodriguez, who cut and polished countertops in a room with about a dozen other workers.

The dangers of dry cutting

During those early days, according to pretrial depositions from Rodriguez and company executives, cutting was done dry. That means no spray of water on the cutting blades to keep dust from flying into the air.

The company later changed this practice. But for years, Rodriguez did a variety of jobs to process the slabs, surrounded by dust from his own cutting and that of his co-workers.

"We see dust everywhere. Even on the floor, in our hair, in all our bodies, I mean everywhere," recalls Rodriguez.

Dust from cut stone is potentially dangerous if it contains the mineral silica, which can cause a lung disease called silicosis. The lungs become inflamed and develop scars. There's no cure, and the disease is progressive. People with silicosis slowly suffocate.

That's been known for a long time; silicosis is one of the oldest known occupational hazards. In the 1930s, the Department of Labor even made a workplace safety film called Stop Silicosis, which emphasized that silicosis could be prevented by controlling dust with water sprays and vacuum systems.

Rodriguez, who grew up on a farm and worked in restaurant kitchens, didn't know any of that. He also didn't know that because Silestone is made mostly of quartz, it contains a lot of silica. It can be as much as 90% crystalline silica — about twice as much as natural granite.

According to Rodriguez, his bosses didn't explain what he was cutting, or the danger.

"The first time I heard 'silica' was when my doctor told me that I had it," he testified, explaining that safety training available at work had focused on how to avoid injuries like being cut, rather than anything related to lung disease.

"They don't tell us anything about the product," he told NPR. "Nothing."

A lack of testing

What's more, internal company documents produced during the lawsuit show that in 2002, a couple of years after Rodriguez started working there, a safety consultant noted that the facility hadn't been evaluated for employee exposures to silica and recommended doing an assessment. But a firm hired to help the company run a safety program didn't do any testing of the dust in the air, and a document refers to concerns about the cost of lab tests.

"Neither Cosentino nor Stone Systems can make a public statement regarding any legal proceeding or the documents associated therein. So far, any document that has been part of a legal proceeding has been effectively addressed and resolved in that proceeding," a company spokesperson told NPR. The lawsuit was settled confidentially in 2016, with no admission of liability.

Rodriguez worked at the Houston shop for years. During that time, he got married and started a family. He stopped playing soccer, though, because he found it too exhausting.

"I was just thinking, 'Oh, maybe I'm getting older, that's why I'm getting tired so easily,' " he says.

Then he developed a persistent cough. In 2010, his wife insisted that he go to the doctor, who took X-rays.

"And he said, 'Look, uh, your lungs are looking really, really bad. My report came back that you have silicosis,' " remembers Rodriguez. "I had never heard that word before. Never."

Rodriguez had always been healthy — he wasn't a smoker and had been athletic. And now, at just 33 years old, he learned that the silicosis would get worse, and could kill him.

"I remember that I went to the church. And I told God, 'Look, I don't know if I can handle it myself.' I started crying," says Rodriguez. "For me, it was something devastating."

He told his bosses about his diagnosis. They transferred him to another position, an office job, since he had to be away from the silica.

Warning signs

Around that time, managers put up a sign in the Houston fabrication shop that warned workers of the danger of silica, according to testimony in the lawsuit brought by Rodriguez, who was represented by Dallas-based attorney Chris Panatier.

Yet in 2009, a year earlier, the company had tested the workplace air for the first time, according to a document produced by the company during the lawsuit. Those tests revealed silica exposure levels above the legal limit in three of seven workers who wore monitoring devices to assess the air quality around them.

In addition, "results exceeded the 50% advisory action level for three additional measured employees," according to the document, which noted that results at or above this level "indicate the statistical potential for overexposure on other days, and the need for corrective action."

In 2011, another round of air tests found basically the same result: three of seven monitored workers above the permissible exposure limit, according to information revealed in the depositions.

This was so even though all of the processes, the cutting and grinding, were using water to keep down the dust.

NPR requested an interview with Roberto Contreras, the first CEO of Cosentino North America, to ask about the early days of the engineered stone industry in the U.S., the Rodriguez silicosis case, and how the industry's view of silica changed over time.

"I really have no comments on this topic," replied Contreras in a written message. "I can only tell you I am not aware of any early case of Silicosis in a Stone Systems shop. Also, as far as I know, all Stone System shops work with equipment that cuts with water, they do not dry grind or cut anything; totally minimizing Silicosis."

In 2015, Contreras gave a deposition in Rodriguez's lawsuit. He said then, under oath, that he did not recall when he learned that silica can cause lung damage and other health impacts.

"I cannot tell you the exact time, but it was sometime in the mid 2000s," Contreras testified. He noted that he had personally worked in a fabrication shop without getting sick. "Later we went into wet grinding. And so I didn't — I didn't think there was an issue."

Travis Dupre, the current vice president of sales for Stone Systems, testified in a deposition that he learned of the dangers of silica through word of mouth in the industry, around late 2003 or early 2004, when the Houston shop had moved to a new facility and instituted wet processes.

"We felt like we were doing what was reasonable. We had switched everything to wet grinding. We had moved into a facility with better ventilation. We'd enforced no dry cutting. We felt like we were taking the reasonable steps," Dupre testified.

Referring to the sign put up in 2010 with a warning about silica, Dupre testified, "we should have put the sign up earlier."

Relying on respirators

Rodriguez testified that early on, workers had been given simple face masks to ward off dust, but sometimes these weren't available, so workers reused old ones or even would use something like "a piece of towel."

Then they were given respirators. In 2002, a safety consultant started a formal respirator program, and Rodriguez was fit-tested for a respirator with replaceable filters that seals to the face and provides more protection, according to documents and testimony.

But government regulations say that relying on respirators should only be used as a last resort, if silica dust in the environment can't be adequately controlled with other measures such as vacuums or water.

That's because it is hard to properly and reliably wear a respirator day after day for years while doing manual labor. It's much more protective, safety experts say, to remove silica from the surrounding environment.

The Houston shop wasn't the only one in Cosentino's Stone Systems network that had issues with silica. Its countertop-cutting facilities in other states were being cited by the Occupational Safety and Health Administration for exposing workers to this hazard.

In March 2013, for example, OSHA received a complaint about conditions at Stone Systems of New England, in Rhode Island. The inspector's report noted that wet grinding and cutting techniques were used, but "there has been no testing done to validate effectiveness of the wet methods to control the dust."

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OSHA did that testing, which showed that one worker there was exposed to airborne silica levels approximately 4.6 times the permissible limit. Another worker was exposed to 17.5 times the limit. At that higher level of exposure, the respirator being worn wouldn't offer enough protection, according to OSHA documents describing the violation.

What's more, not all workers had been properly fit-tested for respirators, and some wearing respirators had facial hair, which interferes with the seal to the face, according to the citation.

When asked about these OSHA citations in Rhode Island, as well as other OSHA citations from 2011 related to silica exposure in its shops in Minnesota and Colorado, a spokesperson for Cosentino replied that "all OSHA citations mentioned in your questions were minor citations and the penalties were significantly reduced. In addition, all of them were fully abated and resolved."

In 2014, Rodriguez and his illness came to the attention of occupational health specialists who had been on the lookout for cases in this industry.

Overseas cases

They had just written a blog post about engineered quartz workers coming down with silicosis overseas in Israel and Spain, where this material was first made and sold for years before it came to the U.S.

"Healthcare providers who suspect that their patients' health problems may be caused by working with quartz-containing materials are encouraged to report their concern to their state health department," they urged.

Two months later, the Texas Department of State Health Services learned about Rodriguez. Officials contacted the National Institute for Occupational Safety and Health and asked it to evaluate the hazards in the shop where he had worked.

Researchers visited in April 2015, saying that they were doing so because "to our knowledge, this was the first reported case in North America of silicosis from occupational exposure to quartz surfacing materials" and that state officials had "asked us to evaluate employees' exposures to airborne crystalline silica at the facility where the person with silicosis worked," according to their report.

"Although the company used wet methods to control dust, we found overexposures to respirable crystalline silica," the report states. "Exposures were highest for employees using pneumatic wet grinders with diamond cup wheels. We recommended the company use engineering controls to decrease exposures."

In confidential interviews with NIOSH, some employees said they cleaned or swept up dust without using wet methods — a bad idea, as it can send invisible silica swirling up into the air.

Also, some workers "reported not having received training on the hazards of crystalline silica related to their work at the facility," according to the NIOSH report.

Cosentino agreed to let NIOSH researchers run additional tests in the Houston shop and in Stone Systems of Minnesota, to study how silica can be controlled while cutting stone and engineered quartz countertops.

"By doing so, Stone Systems has been leading the trial and implementation of safety measures to benefit all industry participants for the benefit of all employees that work in this business," the company told NPR in a written statement.

Chaolong Qi, a NIOSH researcher, says he has found that cutting or grinding engineered stone made of quartz releases higher amounts of silica than natural stone.

Even though the hand-held grinders used by workers delivered a spray of dust-dampening water, says Qi, "sometimes the water might not be wetting the surface effectively. So they get a little bit of dust coming out, always."

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Those little puffs of dust likely weren't a problem when countertop fabricators were working exclusively with natural stone, he says, "because natural stone has much less silica content. Now, they work more and more with engineered stone, which has much higher silica content, up to like 90% plus. That becomes an issue."

"Traditionally they felt that the wet operation is sufficient, but it looks like it's not," says Qi. He has been evaluating additional engineering controls like having certain processes done in an isolated booth equipped with special air-handling equipment.

"There will be ways to reduce exposure below the OSHA standard," he says. "I can definitely say it's a solvable problem."

Cosentino executives allowed an NPR reporter to tour one of its facilities, Stone Systems of New Jersey.

Next to workers finishing countertops with water-fed, hand-held tools, there were dust removal systems — devices that suck dust toward curtains of flowing water. Dupre said they were installed a couple of years ago.

Reduced silica levels

Posted on the wall of the employee break room were the results of silica testing done last December. Workers' names were listed next to their exposure level. All of the silica levels were low — less than half of what the government allows.

Dupre said results like this are the goal of Stone Systems for every location around the country. And that the company complies with OSHA regulations.

In February 2018, Stone Systems of New England, in Rhode Island, was again visited by an OSHA inspector, who observed several workers wearing respirators incorrectly, with straps in the wrong position or with facial hair. The OSHA inspection report said that airborne silica levels hadn't been tested since OSHA's previous inspection, in 2013.

"Since the employer has not performed sampling since that time, it is reasonable to assume that the overexposure still exists," the report noted, saying the respirator problems could allow "workers to be over-exposed to silica-containing dusts."

When asked about the OSHA inspector's assertion that no air sampling had been done there for five years, the company did not dispute it.

A handwritten portion of documents from the 2018 OSHA inspection noted that the Rhode Island shop was planning to install new dust removal equipment.

"Stone Systems is constantly working to improve the safety at all facilities. Specifically, Stone Systems has invested, and continues to invest, in engineering controls (including general ventilation systems, local extraction systems and filtration systems, among others), that have been further tested by NIOSH," the company told NPR in a statement.

Asked about Rodriguez, his former employer told NPR that owing to issues of privacy, "neither Stone Systems nor Cosentino may discuss the medical condition of any current or past employees, whether or not connected with this subject."

Rodriguez feels fortunate that his lungs haven't declined as rapidly as he first feared.

Even so, "the doctors have been telling me that I have to start looking for a lung transplant," he says. "I know it's going to get worse."

He tries to appreciate each day as it comes. Still, he says, he gets short of breath and tires easily.

And it's hard to be so limited in what he can do at the age of 42, especially because he has young children.

"Sometimes I just want to play with my kids, run with my kids, or even go outside and walk," says Rodriguez.