Santa Cruz County Grand Jury • 1997-1998

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Published: October 07, 1997 26 pages
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Findings 100 findings

F1
According to California law, Health and Safety Code 119303 (a), every person engaged in the business of tattooing, body piercing, or permanent cosmetics is required to register with the health department of the county in which they are doing business.
F2
Presently the Santa Cruz County Environmental Health (EH) department requires body art practitioners to register, provide a business address, obtain a copy of the department’s standards (based on the AB 186 “Proposed Model Program”), commit to comply with these standards and pay a one time registration fee of $50 as well as an annual inspection fee of $105. These registration and inspection fees cover the EH department’s administration costs.
F3
According to Environmental Health, health inspections are not performed. Instead, a staff member from EH visits the body art facilities to verify that the individuals registered are still practicing body art. EH said it does not have the standards to go beyond that.
F4
At eight studios visited by the Grand Jury between October 2003 and March 2004, proprietors stated they had never received a visit to check registration nor an inspection from any health agency.
F5
More recently, EH said that its staff is visiting these facilities to check registration and spend time talking with body art facility owners about their concerns regarding their industry and potential public health issues.
F6
Permanent cosmetic practitioners are inspected by a state health agency because they also perform other cosmetic procedures.
F7
One body art practitioner said she had called the county repeatedly to obtain a copy of the standards. Santa Cruz County - 37
F8
As of January 2004, Santa Cruz County Environmental Health (EH) had registered seventeen body art practitioners: ten tattooists; two body piercers and five who apply permanent cosmetics (actually a temporary or semi-permanent tattoo).
F9
Of the eleven studios advertised in a 2003 local phone directory, the proprietors of eight studios cooperated with the Grand Jury by agreeing to an interview and a tour of their facilities.
F10
Health officials said they have received no complaints about any body art facility in recent years.
F11
A few body art practitioners told the Grand Jury that there are a few local shops with inexperienced, even dangerous operators.
F12
In a recent article in the Santa Cruz Sentinel newspaper, one body art practitioner said that some artists put making money before taking safety precautions. Another cited one studio not in compliance with the sanitation, sterilization and safety standards that “cross-contaminated everything and tattooed anyone, at any age, as long as they could pay.”19
F13
A few practitioners said that much of their work was “fix it” jobs, correcting botched tattoos or piercings.
F14
Health officials said they find some body art businesses but not all of them.
F15
Between November 2003 and February 2004, the Grand Jury discovered at least six unregistered individuals advertising their craft: • One unregistered practitioner was distributing business cards on Pacific Avenue offering body piercing, branding and scarification. • Another advertised his craft, tattooing and piercing, on the side of a van seen parked in the Santa Cruz County Jail parking lot. • The third, a piercer, owns a business visited by the Grand Jury and employs an unknown number of other unregistered practitioners. • The fourth and fifth unregistered operators apply permanent cosmetics and were interviewed by the Grand Jury. One unregistered practitioner was not aware of AB 186 regulations, health and safety standards or screening for heart problems. • The sixth unregistered practitioner pierces in a downtown shop. Depending on who answered the phone at this shop, one could schedule an appointment for a piercing or be informed that the establishment sells only tee shirts. Robyn Moormeister, “Body Art: How Risky?”, Santa Cruz Sentinel, 24 August 2003. -38 Santa Cruz County
F16
Currently, health officials cannot say whether unregistered body art practitioners: • Follow any health and safety standards. • Caution their clients about undergoing procedures while intoxicated. • Verify minimum age requirements are met. • Screen their clients to inquire about pre-existing medical conditions.
F17
Local body art professionals say that if requirements were enforced it would drastically reduce the risk of blood-borne disease transmission like hepatitis and HIV.20
F18
During the last ten years tattooing has become one of America’s fastest growing categories of retail business. An estimated 15,000 tattoo studios practice the once- taboo form of body art.21
F19
Health officials said the number of shops has remained stable in Santa Cruz (County) over the last ten years.
F20
Local body art professionals said they have seen an increase in both studios and practitioners in the same time. • One long time Santa Cruz tattoo practitioner said: “Sixteen years ago, there was one (tattoo) shop and now there’s four or five.” • Another practitioner said that the number of local tattooists and piercers had risen over the last five or six years. He estimated that personally he knew “more than twenty,” admitting that he did not know all of them. • These numbers do not include those who apply semi-permanent tattooing/permanent cosmetics.
F21
To comply with California law regarding tattooing or piercing, practitioners must verify that a client is of the age of majority with either valid photo identification or a parent’s notarized note. • In seven of the nine shops offering piercing and/or tattooing, practitioners follow this law. • In five of these establishments, proprietors photocopy the client’s identification and attach it to a release form signed by the client prior to any procedure.
F22
According to the practitioners, most clients requesting permanent cosmetics are older adults. The high cost of permanent cosmetics deters younger clients. If necessary, practitioners ask for photo identification. Robyn Moormeister, “Body Art: How Risky?”, Santa Cruz Sentinel, 24 August 2003. U.S. News & World Report. Santa Cruz County - 39
F23
For piercing, clients under the age of 18 are required to have notarized, written parental consent if the parent is not present during the procedure. One local piercer requires a notarized parent’s permission note; another requires a parent’s permission note, but does not require it to be notarized.
F24
Neither the American nor the Canadian Red Cross will accept blood donations from anyone who has had a body piercing or tattoo within the previous year because both procedures can transmit dangerous blood-borne diseases.22
F25
The three major viral diseases spread by blood and other body fluids are hepatitis B and C and the Human Immune-deficiency Virus (HIV).23
F26
Health officials estimate as many as 8,000 people in Santa Cruz County are infected with hepatitis C, which often goes undetected in its victims for two decades. Unlike hepatitis B, hepatitis C has no vaccine. Approximately 1,300 county residents know they are infected.24
F27
The California HCV (hepatitis C virus) Task Force recently called for a partnership between all Californians and public health departments, professional medical associations and other health and medical providers to take the required action to responsibly eradicate this disease as a major health epidemic.25
F28
Sanitation measures employed in each of the local facilities visited by the Grand Jury include: • Disinfecting work surfaces between clients. • Frequent hand washing. • The use of disposable surgical gloves.
F29
Sterilization of instruments in an autoclave helps prevent cross-contamination. Used in six of the eight studios visited by the Grand Jury, autoclaves are the only reliable means of sterilization recognized by the Center for Disease Control 26 (The two permanent cosmetic practitioners do not use an autoclave, but do use single-use needles in their work.)
F30
According to the Center for Disease Control, autoclaves must be tested regularly. Use of a properly maintained autoclave is extremely important because if equipment is not properly sterilized between uses, infectious diseases can be spread.27 22 KidsHealth Web site. Center for Disease Control Web site. Shanna McCord, “Board OK’s Free Hepatitis C Tests for Area Patients,” Santa Cruz Sentinel, 28 January 2004. Center for Disease Control Web site. Center for Disease Control Web site. Center for Disease Control Web site. -40 Santa Cruz County
F31
The threat of HIV and HCV transmission is of concern because there is no vaccine for these infectious diseases.28
F32
Four of the body art studios do periodic spore testing as recommended. Other studios either depend on a calibration system to indicate the autoclave’s accuracy or do not test it.
F33
Local health officials said that most body art shops do a very good job of sterilizing needles. However, they do not go into all the shops.
F34
Health officials said there is a potential health hazard of unsterilized needles in tattoo or body piercing establishments.
F35
Student health personnel provide University of California, Santa Cruz (UCSC) students with educational pamphlets to help them make informed, healthy decisions and to reduce the risk of body art-related infection.
F36
At all eight studios visited by the Grand Jury, clients must sign a release form that includes questions about blood-borne diseases.
F37
Physicians and dentists advise all patients at risk for heart valve infection to use preventive antibiotics prior to any invasive medical or dental procedure. About half of the local practitioners screen for pre-existing medical conditions and recommend their clients use preventive antibiotics even though this is not covered in the standards.
F38
Santa Cruz County health officials agree on the issue of pre-notification. They stated that even if the regulations had been in place, it would not have saved the life of a University of California, Davis student who died in August 2003 of a fatal infection, reportedly because he did not take his prescribed antibiotics before the procedure. The regulations specify notification after the procedure but requiring pre-notification is not in the regulations.
F39
The Center for Disease Control (CDC) recommends that personal service workers who tattoo (including semi-permanent tattooing as in permanent cosmetics) and those who pierce be vaccinated against hepatitis B.29 As of January 2004, only two local studios require their practitioners to be vaccinated. Many practitioners and owners of body art establishments were unaware of the need for hepatitis B vaccination.
F40
Any employee with the potential for exposure to blood or other potentially infectious material is required to take Universal Precautions training annually.30 28 Center for Disease Control Web site. Center for Disease Control Web site. Occupational Safety and Health Agency Web site. Santa Cruz County - 41 This training provides information about infection control procedures involving the use of protective barriers. These barriers include gloves, gowns, aprons, masks and protective eyewear, which can reduce the risk of exposure. These measures also include personal hygiene practices like hand washing and the disposal of contaminated materials.31 In accordance with OSHA standards (Universal Precautions) and an Exposure Control Plan, the same health standards employed by physicians and dentists, safety precautions in all eight studios visited by the Grand Jury include: • Discarding all single-use materials, including gloves, sharps and razors. Sharps are deposited in a biohazard container, which is periodically emptied at nearby medical or hazardous waste facilities. • In studios offering tattooing or permanent cosmetics practitioners use individual disposable containers to hold ink, thus avoiding cross- contamination.
F41
No piercing guns are used by any of the seventeen registered body art practitioners. • Local health officials and professional piercers said this method is unsafe, primarily because the guns cannot be properly sterilized. • Blood can aerosolize and contaminate the piercing gun.32 • Piercing guns can shatter tissue and cartilage.33 • Professional body artists said the guns are misused by untrained individuals, such as clerks in clothing or department stores and should be outlawed.34
F42
Piercing guns are exempt from the regulations.
F43
Professional body art practitioners know the health risks increase exponentially when amateurs or untrained individuals perform tattooing or piercing. People who tattoo or pierce themselves or their friends more frequently ignore sterility procedures.35
F44
Important nerve tissue, muscle tissue and organs can suffer permanent injury in an improperly performed piercing.36
F45
A recent review of available body piercing literature focusing on medical complications by the University of Wisconsin Department of Medicine concluded that body piercing carries substantial risk of morbidity. It also found most body piercing in the U.S. is performed by unlicensed, unregistered individuals.37 31 Occupational Safety and Health Agency Web site. Association of Professional Piercers Web site. Association of Professional Piercers Web site. Association of Professional Piercers Web site.. Kathlyn Gay and Christine Whittington, Body Marks. Laura Reybold, The Dangers of Tattooing and Body Piercing. S.S. Tweeten and L.S. Rickman, “Infectious Complications of Body Piercing.” -42 Santa Cruz County
F46
Piercing the upper ear sometimes results in difficult-to-treat infections leading to permanent disfigurement, according to a study of an Oregon outbreak. Seven young people developed infections after upper ear piercings and were left with surgical deformities. (Doctors documented 18 other suspected cases linked to the same facility.) The infection, caused by a pseudomonas organism contaminating the disinfectant solution, moved the state to ban the type of piercing gun used on those infected. Oregon now requires ear-piercers to have basic first-aid training.38
F47
Although a consistent correlation is not known between piercing and endocarditis (most commonly seen as a bacterial infection of one or more of the heart valves), the number of case reports is increasing, and a correlation may well exist.39
F48
The U. S. Center for Disease Control (CDC) plays the leading role in investigating and documenting the patterns and causes of AIDS and hepatitis throughout the United States. Regarding endocarditis in a piercing-related case it said, “Until prospective randomized studies shed light on the relationship between piercing and endocarditis, prophylactic measures are indicated and should be formulated, particularly for persons at high risk, e.g., those with structural heart diseases.”40
F49
In a 1999 study, the Mayo Clinic found that, in people with a body piercing, nearly one out of four patients with congenital heart disease suffered from infection as a result of the piercing. Only six percent of these patients took antibiotics preventively to fend off an infection.41
F50
Recently the hand-held micro pigmentation machines used for semi-permanent cosmetics underwent a yearlong investigation by the British periodical Health and Safety Executive (HSE). This investigation showed that these machines, like piercing guns, could provide a serious health risk. This system’s inability to be adequately cleaned between clients was brought to the attention of a United Kingdom Environmental Health Service agent by a concerned registered tattooist. Health officials then visited all known users to ensure these machines were taken out of use.42
F51
Currently practitioners in the body art industry are not required to complete any health and safety training. Health risks and safety measures depend on the environment in which a practitioner learns the craft and any personal desire to self- educate.
F52
In addition, the Center for Disease Control (CDC), the nation’s foremost authority on communicable diseases, said that personal service workers who do tattooing or 38 Journal of American Medical Association, February 2004, and CNN Web site: “Oregon Outbreak.” 39 Laura Reybold, The Dangers of Tattooing and Body Piercing. Center for Disease Control Web site. Kathlyn Gay and Christine Whittington, Body Marks. Health and Safety Executive Web site. Santa Cruz County - 43 body piercing should be educated about how HIV is transmitted and take precautions to prevent transmission of HIV and other blood-borne infections in their settings.43
F53
A county health official said that education is the most important public health tool.
F54
The American Red Cross offers Universal Precautions courses designed to be relevant to body artists for about $20.44
F55
In the body art industry, it is customary to follow guidelines recommended by professional organizations such as the Alliance of Professional Tattooists (APT) or the Association of Professional Piercers (APP). The primary purpose of professional body art organizations is to promote education, health and safety as it concerns this industry. These organizations offer workshops that provide up-to-date information on sterilization procedures and complete infection-control guidelines.45
F56
Members of APT must take a nine-hour safety seminar in microbiology and disease transmission within two years of joining and must have practiced the art for a minimum of three years in an established location. APT tries “to educate lawmakers, dispel myths and counter misinformation with researched fact.”46 As of January 2004, six of the ten registered tattooists belong to APT.
F57
Part of APP’s philosophy is that “piercers must act ethically, responsibly and be accountable for quality service.” The APP certifies piercers who agree to follow strict health and safety guidelines.47 As of January 2004, one registered piercer said he was joining APP.
F58
Posted rules in some local body art shops forbid clients to be intoxicated. However, some patients said they were intoxicated while undergoing body art procedures.
F59
In one local body art studio, most of the staff is trained in Cardio-Pulmonary Resuscitation (CPR) and one practitioner is an Emergency Medical Technician (EMT).
F60
In local tattoo and/or body piercing studios, practitioners learn their art through an apprenticeship or on-the-job training. Their experience ranges from four to 20 years.
F61
Permanent cosmetics practitioners interviewed by the Grand Jury had experience ranging from two to 12 years. Both had completed training programs in applying permanent cosmetics. One completed coursework in a single weekend and the other 43 Center for Disease Control Web site. American Red Cross Web site. Association of Professional Piercers and Alliance of Professional Tattooists Web sites. Alliance of Professional Tattooists Web site. Association of Professional Piercers Web site. -44 Santa Cruz County attended a more comprehensive program that entailed 40-50 hours of coursework. Both practitioners said that the portion of their training dedicated to health and safety was minimal.
F62
More stringent health and safety training is required for non-invasive procedures such as those practiced by manicurists and hair stylists. Requirements for practitioners in hair and nail salons include: • Twenty-nine hours of health and safety training as part of a 1,600-hour program. • Must pass both an oral and a written exam. • The workplace is subject to an annual state health inspection.48
F63
The Hazard Evaluations and Technical Assistance Branch of the National Institute for Occupational Safety and Health (NIOSH) conducts field investigations of possible health hazards in the workplace. Recently NIOSH evaluated potential occupational blood-borne pathogen exposure during body piercing. NIOSH found: • Body piercers are at risk for infection with blood-borne pathogens through needle sticks and contact with contaminated surfaces. • The piercers had completed blood-borne pathogen training. • The wrong type of gloves were worn handling decontaminates. • Studios did not have OSHA exposure control programs in place. • Ventilation systems did not provide adequate filtration and directional airflow. In this evaluation, NIOSH made health and safety suggestions for both studio owners and the body piercers.49
F64
Even when a reputable artist under hygienic conditions performs body art and aftercare directions are followed, infection can occur because of improper hygiene in areas of the body with high bacterial content. Piercing has a greater tendency toward infection because often the piercing goes through all layers of the tissue pierced, not just through superficial skin layers. Because piercing takes weeks or months to heal, the risk of infection is prolonged.50
F65
Center for Disease Control and Prevention (CDC) said, “Healing of piercing generally will take weeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) or inflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abraded tissues come into contact with an infected person’s blood or other infectious body 48 Jean-Chris Miller, The Body Art Book. National Institute for Occupational Safety and Health (NIOSH), Health Hazard Evaluation, Center for Disease Control Web site. Laura Reynold, The Dangers of Tattooing and Body Piercing. Santa Cruz County - 45 fluid. Additionally, HIV could be transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.”51
F66
Reputable practitioners carefully explain aftercare instructions to each client to help prevent infection and promote healing. Following a reputable practitioner’s aftercare advice greatly improves the chances for a healthy, positive outcome.52 In all of the studios visited by the Grand Jury, practitioners explain aftercare to clients in detail. They also distribute written instructions.
F67
UCSC health officials said that most infection from body art is due to the patient ignoring or forgetting the aftercare advice. In addition, there is a greater incidence of infection with piercing than with tattooing.
F68
Some contradictions with body art aftercare instruction exist in local shops: • Aftercare instructions from some body art studios recommend washing with anti-bacterial soap; others insist the only aftercare cleaning should be with a saline solution made with edible sea salt dissolved in water. The saline solution cleaning procedure is also recommended by APT and APP. • Some local practitioners recommend the use of a topical ointment such as Neosporin. Many medical authorities argue against the use of Neosporin because one of the three antibiotics it contains, neomycin, can cause an allergic reaction.
F69
Non-infectious risks in body art include allergic reactions from materials used in tattooing and piercing procedures or to aftercare products to aid in healing.53
F70
The greatest potential for an allergic reaction in tattooing during the procedure comes from the pigments. Tattoo ‘ink’ is a misnomer, because black is the only actual ink used in tattooing. Other colors are made from mixing dry pigments with a suspension fluid. In addition to suspension fluid, metallic salts in certain colors can cause allergic reactions. Premixed colors made from plastic-based pigments are even more likely to cause allergic reactions.54
F71
Fewer than half of the local practitioners offering tattooing or semi-permanent tattooing (permanent cosmetics) offer clients a “patch test” to check for possible allergic reaction to the dye.
F72
Allergic reactions during piercing come from the type of metal the jewelry is made of or the cleaning solution used. The highest grade of surgical stainless steel, 51 Center for Disease Control Web site. Laura Reynold, The Dangers of Tattooing and Body Piercing. Association of Professional Piercers and Alliance of Professional Tattooists Web sites. Jean-Chris Miller, The Body Art Book. -46 Santa Cruz County niobium, titanium and 14 or 18 karat gold are the preferred metals because they are the least reactive and won’t leach impurities into the body.55
F73
Many body art professionals recommend the use of skin lotion for use on the body art site. Others disagree, saying lotion has been shown to be a vehicle for bacteria, which can cause infections and scabbing.56
F74
Adverse effects such as scarring or allergic reactions have been reported with the use of Q-switch lasers for tattoo removal.57
F75
Medical personnel and laboratories are required by state law to report certain infectious diseases. They do not usually report all bacterial infections related to body art.
F76
Infections are usually listed as reportable communicable diseases so it is difficult to track data.
F77
Out of the state’s standard list of reportable disease, the diseases one might conceivably contract from tattooing or body piercing are HIV or hepatitis B or C. Otherwise, the more common staph or strep bacterial infections would get reported as “occurrence of any unusual disease.”
F78
UCSC Student Health Services are required to report only multi-drug resistant staph infection. They see approximately four or five such cases per year.
F79
Ninety percent of infections relating to body art that the Student Health Services sees respond well to antibiotics.
F80
California hospitals, clinics and physicians are not required to report infections related to body art.
F81
Local disease control said no cases of HIV or hepatitis have been reported. It has no methodology by which reportable cases of these infectious diseases can be investigated for possible relationship to body art.
F82
The county does not do any disease surveillance of the relationship between body art and hepatitis or HIV.
F83
The county health services offers free laboratory testing for hepatitis C.
F84
Local health officials said that it is hard to get the data to show that there are hazards. It is hard to relate the reported infections directly back to tattooing or piercing and hard to link them one way or the other. Jean-Chris Miller, The Body Art Book. Alliance of Professional Tattooists Web site. The Medical Letter, and AAD Web site. Santa Cruz County - 47
F85
Getting statistics is difficult so local health departments rely on certain venues of research and knowledge above and beyond their level of expertise. One of those channels of information is the California Conference of Local Health Officers (CCLHO); others are very specialized units in Sacramento within the Department of Health Services. Local health officials look to these expert entities for guidance.
F86
According to one local health official, the long incubation period is part of the problem of tracking.
F87
The state is developing a form for reporting the hepatitis C virus. Current state regulations require public health to report only acute hepatitis B.
F88
The European Commission of the Institute for Health and Consumer Protection, reviewing the risks and health effects of body art, said that it is very likely that a great number of skin reactions related to body piercing and tattooing go unreported.58
F89
In the 2003 “State of the County’s Health” presentation, the County Health Officer concluded: • Infectious diseases will likely become a greater threat in the years ahead. Among increases in disease, hepatitis A, B, and C were noted. • Population dynamics and life style choices may signal worsening of the county’s health status in the years ahead unless greater efforts are made to prevent disease and improve access to health care. • Health system reform is imperative but not likely without more visible alarms. • Improvement in our local system of health care through greater cooperation and marshalling of existing resources.
F90
The California Conference of Directors of Environmental Health (CCDEH) conducted an e-mail survey asking all Environmental Health agencies in the state to respond to four questions. A. Only 32 counties of 58 California counties complied.59 • California law requires body art practitioners to register and pay a registration fee. • Twenty-four of the responding counties regulate body art practitioners; eight counties do not. • Of the 24 counties regulating body art practitioners and/or facilities: 58 World Health Organization and the University of Regensburg, European Commission: “Review of Risks and Health Effects from Tattoos, Body Piercing, and Related Practices”. May 2003. California Conference of Directors of Environmental Health, Tattoo and Bodypiercing [sic] Survey Results, 10 September 2003. -48 Santa Cruz County a) Thirteen do not inspect these facilities. b) Seven inspect once a year. c) One inspects four times a year. d) Three inspect only upon receiving a complaint. B. The survey also asked if the counties had a local ordinance. • Twenty-four counties (of the 32 respondents) have no local ordinance and are waiting for the state to implement AB 186. • Six jurisdictions have local ordinances: Pasadena and Long Beach (city ordinances); Kings, Orange, Yolo and Siskiyou Counties (tattoo ordinances only). • Four other counties are currently considering proposing a local ordinance.
F91
The Grand Jury sent an e-mail questionnaire to the counties and cities that either have a local ordinance or are considering one. It found: • All charge a one-time registration fee (between $25 and $50). • Orange County charges a $220 “health service fee” for tattoo and permanent cosmetics shops. • All counties said they plan to use the CCLHO model program although one county suggested it would tailor it to suit its local needs. Another county will use the proposed model program with the guidance of its county health officer. • “Low priority” and “lack of follow through” are the most common responses to a question regarding the delay in the state health department regulations. • Most county EH departments welcome the input of body art professionals in drafting their ordinance or in augmenting the state regulations. The counties considering local ordinances have met with their local body art practitioners.
F92
It has been five years since the final draft of the Sanitation, Sterilization and Safety Standards were submitted to the California Department of Health Services. Local health officials report: • The status of implementing the standards mandated by AB 186 is not encouraging. It is a very low priority on the state level. • Establishing a set of statewide regulations would probably take another two years at least.
F93
Local health officials disagree on whether Santa Cruz County should follow the lead of the more proactive counties or localities. • Some health officials said that they should take a strong look at the data for any significant documentation that there is a public health threat. If there Santa Cruz County - 49 were not, they would wait for the state and hope practitioners are doing enough to protect themselves and their clients. If something came up, they say that is the time to do something. • Another local health official said some standards should be implemented because it is only a matter of time before a problem occurs.
F94
Santa Cruz health officials agree that a local interest or local advocacy group supporting the need for a local ordinance in the absence of state regulations might motivate the county to consider a local ordinance.
F95
If a local ordinance were drafted, health officials said they would meet with local professional body artists. Health officials said practitioners know more about the body art industry.
F96
According to one local health official, if Santa Cruz County decided to go ahead with a local ordinance, it could happen in two or three months. Local health officials would: • Gather documentation that a significant health risk does exist. • Present the documentation to the Board of Supervisors with a
F97
Cost should not be a factor.60 According to health officials, a reasonable annual inspection fee would cover costs and not be too much of an impact on body art businesses.
F98
Each county evaluates the health and safety risks and their health officer then designates the risks significant enough to move forward and adopt a local ordinance. Some counties, compelled by local advocacy groups, have chosen to draft their own local ordinances. In one case, a board member suggested the county adopt a local ordinance. In other cases, a citizen’s group, or medical community, or even the body art practitioners motivated the county to proceed with a local ordinance.
F99
A nearby county is moving forward with a local ordinance because it has determined that until the state acts, the public should have some assurance that they will have a safe experience in the application of body art. • Currently, this county registers both the proprietors of these studios and the individual body art operators for a fee of $25. California Health and Safety Code 119303 HS 4 (b) allows a county to charge body art facilities an additional amount if necessary to cover the cost of registering and inspecting.” -50 Santa Cruz County • It has registered 40 practitioners. • The inspection fee will cover the cost of regular annual inspections of these facilities and practitioners’ work areas. • This county’s body art ordinance would include requirements for all piercing, body piercing as well as “ear piercing only” facilities.
F100
One San Francisco Bay Area county has a population size similar to Santa Cruz County and a similar number of registered body art practitioners. At present, this county does not have its own regulations but if the state does not come through soon, it said it will consider implementing a local ordinance. • Like Santa Cruz County, it charges a one-time $50 registration fee and does not inspect body art facilities. • It will employ the CCLHO model program. • It plans to confer with body art industry representatives to help draft its ordinance. Conclusions

Recommendations 19