This story is a co-publication with Public Health Watch, a nonprofit investigative news organization based in Texas. Support for this project comes from the Stabile Center for Investigative Journalism at Columbia University.
TUCSON – The morning of September 13, 2021, began like any other for Chuy Reyes. Even before the scorching Arizona sun had risen, the 50-year old construction worker was standing in the parking lot of a Presbyterian church that is also the home of the Southside Worker Center on Tucson’s Southside. Other day-laborers were already there, waiting for contractors to drive by, offering work. One approached, seeking men for a roofing job. Reyes knew temperatures were supposed to reach triple digits that day, but accepted anyway.
A few hours into his shift, Reyes’ head was pounding and heart was thumping. He had stopped sweating. It was only nine in the morning, the temperature was 90 degrees, and Reyes had been on the rooftop for nearly three hours without a break. He appealed to the contractor, saying he felt ill. He was told to get back to work.
The boss “simply didn’t believe that I wasn’t well,” Reyes said.
Reyes climbed back on the roof. It wasn’t long before he began expelling watery vomit. “It’s like my body was rejecting the water I was drinking,” he said.
Reyes doesn’t remember driving home. Once there, however, he took a shower and waited for the symptoms to subside. A few hours passed, but the dizziness, heart palpitations, and nausea persisted. Around noon, he called his sister-in-law, a nurse. She told him to rush to the emergency room—he was probably experiencing heat stroke.
Reyes is among thousands of outdoor workers who die or suffer from heat-related illness each year in the United States. Environmental heat—according to a 2022 report based on government data by the nonprofit advocacy group Public Citizen—accounts for up to 2,000 worker fatalities and 170,000 work-related injuries each year. Construction workers are among the most vulnerable; they make up more than a third of all occupational heat deaths in the country. According to the report, the odds of dying from heat increase sevenfold for roofers like Reyes.
Although heat is now widely recognized as a hazard, there are no federal regulations for it in the workplace. As temperatures soared this summer, the U.S. Department of Labor’s Occupational Safety and Health Administration issued a hazard alert to remind employers of their obligation to protect workers against heat. The agency is developing a nationwide standard, but that could take on average seven years to complete, according to a report by the U.S. Government Accountability Office.
“Heat illness is one of the most preventable conditions in a workplace environment,” said Peter Dooley, a Tucson-based safety professional for the National Council for Occupational Safety and Health (National COSH). “The solutions are simple: water, rest, shade. But there needs to be a program in place to prevent it.”
In the absence of federal regulation, states like California, Oregon, Washington, Minnesota, and Colorado have enacted laws to protect their workers from heat. Arizona—one of the fastest warming and growing states in the country—has resisted adopting a statewide standard, even as real estate development has boomed, attracting more outdoor workers, many of them immigrants. Arizona is a right-to-work state, so few workers are unionized, hampering their ability to demand safeguards.
In the past two decades, business-friendly state governments in the Sun Belt have provided powerful incentives to companies—low tax rates, tax credits, lax regulations. Property developers have been among the top beneficiaries of these policies and have invested millions in Arizona, attracted by its weak labor protections and pool of cheap and highly-skilled workers.
“I’ve spent 17 years working in this industry and I always used to hear: ‘Safety is fine if there’s time’,” said Luke Kasper, a sheet-metal worker and business representative for the SMART Local Union 359 in Phoenix. “It’s frustrating to see companies not care for workers.”
The Arizona Department of Occupational Safety and Health—ADOSH—has jurisdiction over most of the state’s public and private workplaces, which employ more than 3 million workers. Like about half of the states, Arizona has its own, federally approved occupational health and safety program. The federal government enforces workplace standards in the other half.
As a heat wave blanketed the state in July—with Phoenix recording temperatures of 110º or hotter for 31 days in a row—the agency announced a State Emphasis Program to combat heat illness on the job.
The agency’s 28 inspectors will conduct targeted inspections and outreach to ensure employers offer water, shade and breaks, Trevor Laky, chief of legislative affairs for ADOSH, wrote in an email. Any enforcement actions, however, must come under the general duty clause of the federal Occupational Safety and Health Act, a catchall provision that requires employers to provide a workplace “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” ADOSH stopped short of enacting an enforceable rule specific to heat.
“It’s certainly something but it really doesn't do enough,” Dooley said. “They have limited resources in terms of how many workplaces they can visit. It’s a Band Aid to a much bigger problem.”
Arizona lawmakers have failed to act. In February 2023, then-state House Minority Leader Andrés Cano, a Democrat from Tucson, introduced a bill that would have forced ADOSH to establish a statewide standard to protect laborers—farmers, landscapers, construction workers, oil and gas workers and others most susceptible to heat illness. It was the third time Cano had tried. The bill has never made it out of committee.
The gaps in worker safety are most apparent in Arizona’s two largest cities, which are the fastest-warming in the nation. According to a Climate Central report based on government data, average temperatures in Tucson and Phoenix have increased 4.5 and 4.3 degrees, respectively, over the past 20 years—nearly 2 degrees more than the national average. During that period, the cities have experienced phenomenal growth and corresponding expansions of their labor forces.
Since 2001, Arizona’s built landscape has expanded as its population has jumped from 5.2 million to 7.3 million, growing at more than double the national rate. Sprawling suburbs, mega warehouses, commercial complexes, highways and factories have sprung up across the state. Between 2001 and 2019, Arizona added more than 450 square miles of developed land—an area roughly the size of Phoenix itself, according to data from the U.S. Geological Survey. Most of that growth has been concentrated in urban hubs like Phoenix and Tucson.
Working conditions, however, have not kept pace with the growth. According to research by the Labor Center at the University of California, Berkeley, construction workers—the vast majority of whom are immigrants, many undocumented—are paid low wages without benefits, often under the table. Less than 5% are covered by collective bargaining agreements, far below the national rate of more than 13%.
‘Crazy’ growth
As a teenager In the early 2000s, Kasper, the local union leader, threw outdoor parties in the desert near Phoenix. For miles, all he could see were saguaro cacti, some shrubbery, and the feeble twinkle of city lights in the distance. In the years since, the desert has been swallowed up by new subdivisions, a 1.5 million-square-foot Walmart distribution center, an LG battery manufacturing plant and the Taiwan Semiconductor Manufacturing Company.
“I watched as Route 303, now called the Loop, turned from a two-lane regional highway into a six-lane freeway in the last 20 years,” Kasper, a third-generation sheet metal worker, said. “It really shows how crazy the growth has been.”
Today, it’s difficult to see where the city ends as it spreads, amoeba-like, across the Valley of the Sun between the Gila River to the south to the Mazatzal Mountains to the northeast. Downtown Phoenix towers over the landscape. Construction crews can be seen working incessantly across the valley.
A hundred miles southeast of Phoenix, Arizona’s second-largest city, Tucson, lies on the fringe of the Sonoran Desert. It, too, has undergone a development boom in the last two decades, albeit not as dramatic as Phoenix’s. Since 2001, Pima County, which includes Tucson, has added more than 45 square miles of developed land.
The center city has maintained its distinct architectural style—a combination of Mexican Baroque and mid-century modern—since much of the recent development has been concentrated not in the downtown area but in suburbs like Marana, Oro Valley, and Sahuarita.
On the outskirts of the metropolitan area, an industrial hub has arisen, hosting firms involved in transportation logistics, bioscience, aerospace, defense and renewable energy. With residential and commercial construction also on the rise, seasoned workers like Chuy Reyes are in high demand.
‘Everything changed around 2010’
Reyes moved to Tucson in 1990. Originally from Mexico’s Sonora state, he made the treacherous journey to Arizona in search of better work and pay when he was 17.
“I didn’t have to struggle to find work,” he said. “But everything changed around 2010.”
That year, the strictest anti-immigration legislation in the country went into effect. The SB 1070 “show me your papers” law, signed by then-Gov. Jan Brewer, required drivers to present proof of legal immigration status during routine traffic stops. Failure to do so was a misdemeanor. The legislation also strengthened sanctions against employers who hired undocumented workers. The effects on immigrants across the state were profound.
After 2010, Reyes could work only as a day-laborer. The U.S. Supreme Court in 2012 struck down the provision of the Arizona law that made it harder to employ undocumented workers, but contractors remained wary.
“The jobs that no one else wanted to do, they left them to us,” Reyes said. “Nothing was the same after that.”
Around the same time, Reyes noticed that it was getting hotter. The blistering summer season stretched from May into September. It took longer for the heat to dissipate overnight.
Heat had always been a consideration for Reyes. He remembered to drink water, wear breathable clothing and get some rest when he could. But the last five years have become “unbearable,” he said.
It all came to a head that Monday morning in September 2021. After getting off the phone with his sister-in-law, Reyes—dizzy and in pain—got in the car with his wife and drove to the emergency room. On the way, his feet began to throb. His toes turned numb and purple.
In the emergency room, medical staff told him he’d arrived just in time. The arteries below his waist were clogged; there was no circulation in his legs or feet. The doctors warned him that they might have to amputate his left foot. Reyes protested, knowing this would render him unable to work.
“It felt like I was going to die, like someone had beaten me to death,” he said.
After hours of waiting, Reyes was transferred to Banner - University Medical Center around 1 a.m. on September 14. A team of specialists was waiting for him in the operating room. He received five stents that night: one in his left leg, two near his navel and two in his back. The doctors managed to save his foot, but told him it would never be the same. The blood vessels had sustained too much damage.
Reyes needed eight months to fully heal from the surgery. The damage to his blood vessels left him paralyzed, and he had to relearn to walk.
During this time, Reyes and his wife relied mostly on savings, although she picked up a few shifts as a housekeeper. Reyes’ medical bills were covered by the Arizona Health Care Cost Containment System, the state’s Medicaid program, which is mostly funded by the federal government.
Reyes was paid for a full day’s work the day he collapsed, and the contractor came to see him while he was in the hospital. But Reyes said he hasn’t seen or heard from the man – nor does he want to.
Dire need for a heat standard
When exposed to grueling temperatures for too long, the body loses its ability to expel enough heat to cool down. It struggles to sweat, depleting precious fluids needed for proper metabolic function. The effects are vast, ranging from fatigue to a major cardiac event. First signs can include headaches, rashes, nausea and dizziness. Then come more severe symptoms like cramps, seizures, disorientation and loss of consciousness. Ultimately, if all sweating mechanisms fail and the body is still unable to cool down, life-threatening heat stroke can occur.
Ronda McCarthy is an occupational health specialist who directs medical services at Concentra, a healthcare company in Waco, Texas. According to McCarthy, the physical symptoms of heat illness vary and aren’t always discernible.
“I would see patient after patient come in with signs, symptoms of heat illness and maybe not really know what they were experiencing,” she said.
During rapid-onset heat waves, the elderly, pregnant and those with pre-existing health conditions are most at risk of heat stress. Alcohol or drug use and strenuous physical exertion can also contribute. But it’s often adults working outdoors who suffer most. McCarthy said that it can take years for the symptoms of chronic heat stress to materialize. Many times those symptoms don’t appear to be heat-related, are not taken seriously, or cannot be addressed until there’s been significant damage to their heart or kidneys.
Dr. Siyun Song, an assistant professor in the Department of Civil, Construction, and Environmental Engineering at the University of Alabama, said that worker-training programs for heat have value but don’t go far enough.
“We need a real standard when it comes to heat,” she said.
In Arizona, some employers have adopted their own heat-adaptation plans. And labor unions like Ironworkers Local 75 in Phoenix have inserted heat-illness prevention provisions into their contracts.
“If there isn’t any water on site, we’re leaving,” said Jason Sangster, the local’s business manager.
Day-laborers don’t have the protection of a union or—in most cases—a conscientious employer. They’re hired for one day at a time, with no guarantee there will be work tomorrow. Contractors often hire them for smaller-scale construction projects. According to a study co-authored by Song, workers on these jobs, many of them undocumented, are most susceptible to heat-related illness and deaths.
“If you don’t give the boss the performance he wants, if you demand things from them, they’ll just fire you,” Reyes said.
‘Disposable’ workers
I met Chuy Reyes and some of his coworkers at the Southside Worker Center, a community collective of construction workers, earlier this year. The center is a spacious room situated in a progressive church on Tucson’s Southside – a mostly Latino, low-income part of the city – that functions as an office, a kitchen and a lounge. A large, light-blue sign on the wall read: “Dignity. Responsibility. Integrity.”
Martin Quintero wore a bright yellow shirt that bore the same slogan on the back. He’s younger than Reyes but also has felt the terrifying effects of heat stress. He described working on a roof on a sweltering day when his muscles started spasming. He grew nauseous, dizzy and dehydrated. He had to take the rest of the day off.
Four other workers sat around the table, listening and nodding along to his story. Employers would rather dismiss them rather than give them a break, one said in Spanish.
Josefina Ahumada, the 74-year-old founder of the center and a longtime social worker and teacher, said it’s rare for employers to prioritize their workers’ well-being over profits.
“Some of them act almost as if the workers are disposable,” she said.
In Arizona, the governor has powerful influence over workplace safety standards, tasked with appointing the head and appoint five members to the Industrial Commission of Arizona, the state body that oversees ADOSH. The commissioners appoint the ADOSH director, who oversees the agency’s inspectors.
The Industrial Commission reviews ADOSH investigations into workplace fatalities or injuries and decides whether employers violated safety laws. If it finds a violation, it can issue a citation and financial penalty. The average fine in Arizona is $8,000.
When Doug Ducey became Arizona’s governor in 2014, his pro-industry policies attracted big and small employers alike. Under his leadership, the state added a half-million private sector jobs. In 2022, its GDP reached $341.8 billion, up from $282.6 billion at the start of Ducey’s first term.
The economic boom brought more clout for business—and less for workers.
ADOSH’s budget fell from $26 million in 2017 to $18.7 million in 2021, crippling operations. Agency data shows that the total fines issued to companies that violated workplace safety standards dropped by half during the same period, from $1.1 million in 2017 to just over $500,000 in 2021. The number of inspectors plummeted from 25 to 14 at one point, according to an investigation by The Arizona Republic. In 2022, federal OSHA threatened to revoke Arizona’s state plan and assume federal control over occupational safety and health issues for what it called a “lengthy series of shortcomings'' that showed “fundamental deficiencies.”
At the time, the commission was composed of three Republicans and one independent, all of whom shared a business background.
“The business community has had a lot of power and clout here in Arizona, specifically with and around health and safety,” said Dooley, with National COSH. “They compromised ADOSH’s ability to even meet the minimum requirements.”
Arizona was allowed to keep its worker safety and health plan after ADOSH adopted federal directives and enacted regulations to bring employer penalties in line with those levied by OSHA.
Katie Hobbs, Arizona’s Democratic governor, has tried to reform the Industrial Commission. Since assuming the governorship at the beginning of the year, she has made worker safety and health one of her priorities. In April, she appointed Dennis Kavanaugh and Cecilia Valdez to the board of the commission. Kavanaugh was counsel for the commission and an attorney for the Arizona Legislative Council; Valdez is a longtime activist and serves as the vice chair of the Pima Area Labor Federation.
Ahumada, of the Southside Worker Center, said she is heartened by the recent changes at the commission but “the effects haven’t filtered down to us.”
This July, almost two years after his heat stroke, Chuy Reyes was back in the emergency room. He was on a landscaping job in Tucson when nausea overcame him. He almost lost consciousness. The temperature reached 115º that day.
“My body feels broken,” he said. “I'm working, but it doesn't feel the same anymore. It feels very forced.”
On the advice of his doctor, Reyes won’t work more than eight hours a day. He makes less money but is at peace with his decision.
“No job is worth your health,” Reyes said. “No matter what.”
Jana Cholakovska is an international investigative reporter covering the environment, public health, labor rights, and politics. She wrote this article for Public Health Watch, a nonprofit investigative news organization based in Texas.