BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 1168 AUTHOR: Pan AMENDED: June 10, 2013 HEARING DATE: June 19, 2013 CONSULTANT: Robinson-Taylor SUBJECT : Safe body art. SUMMARY : Makes a number of technical and clarifying changes to existing law governing practitioners engaged in body art in California including the business or performance of tattooing, body piercing, branding and the application of permanent cosmetics. Makes technical changes to the requirements for the performance of ear piercing with a mechanical device. Existing law: 1.Establishes minimum statewide standards for the regulation of body art practitioners engaged in the business of tattooing, branding, body piercing and the application of permanent cosmetics. 2.Requires, effective July 1, 2012, a local enforcement agency (LEAs) to register practitioners and issue permits to body art facilities annually following a site visit and review of specified documentation, such as infection control plans. 3.Establishes a framework under which body art practitioners qualify to provide services, including, among other things, requirements for training, health and safety practices, documentation handling and storage, and inspection compliance. 4.Imposes specified prohibitions on body art practices, including limitations on customers with regard to age and medical condition, and requires informed consent to be given and a signed consent form to be retained prior to the provision of body art services. This bill: General Provisions 1.Includes in the definition of a body art facility a specified building, section of a building, or vehicle in which a Continued--- AB 1168 | Page 2 practitioner demonstrates body art for the purpose of instruction. 2.Deletes definition of "sharps waste" in current law for purposes of the Safe Body Art Act, and instead, defines "sharps waste" to mean any device or instrument having acute rigid corners, edges or protuberances capable of cutting or piercing the skin, that has been used in the performance of body art, and has not been disinfected or sterilized following use, including but not limited to all of the following: a. Tattooing needles and needle bars; b. Disposable piercing needles; and, c. Disposable razors. 3.Defines "sharps waste container" to mean a rigid, puncture resistant, commercial container that, when sealed, is leak resistant and cannot be reopened without great difficulty. Requires such containers to be designed and constructed specifically for the proper containment of sharps waste. 4.Defines "warm water" to mean water that is supplied through a mixing valve or combination faucet at a temperature of at least 100 degrees Fahrenheit. Privacy 5.Requires personal medical information gathered from a customer, prior to the performance of body art, to comply with existing federal privacy law established under the Health Insurance Portability and Accountability Act of 1996. 6.Deletes the requirement that body art facilities shred any confidential medical information after two years from performing the body art procedure on the client. Practitioner Requirements 7.Prohibits a body art practitioner from performing body art at any location other than a permanent or temporary body art facility that has been approved and inspected by the LEA. 8.Deletes the requirement for practitioners who are initially registering with the LEA to provide evidence of at least six months of related experience. 9.Requires a practitioner, at the completion of performing a body art procedure to use a sterile dressing when covering a procedure site. AB 1168| Page 3 10.Adds a single-use marking pen to the items permitted to be used when marking the body piercing site. Permanent Body Art Facilities 11.Prohibits a body art facility from allowing a practitioner, who does not possess a valid practitioner registration, from performing body art procedures at the facility. Authorizes an LEA to suspend or revoke the permit of a body art facility, if the facility allows an unregistered practitioner who does not possess a valid practitioner registration to perform body art. 12.Requires an owner of a body art facility to notify the LEA in writing within 30 days of registration, termination, or new hire of a body art practitioner at the body art facility. 13.Clarifies floor, wall, ceiling, counter and sink surface requirements for permanent body art facilities and requires these facilities to have adequate restroom facilities. 14.Authorizes the LEA to determine the amount of separation between the procedures area of a permanent body art facility and the areas of the facility not related to body art. 15.Requires each procedure area to have a sharps waste container that meets specified requirements. 16.Requires the removal and disposal of all sharps waste to be done by a licensed waste hauler and disposed of at a licensed treatment facility or removed and transported through a mail-back system authorized by DPH. 17.Requires documentation of proper disposal of sharps waste to be maintained for three years and to be available for inspection upon request of the enforcement officer. 18.Specifies that only service animals, as defined by the federal Americans for Disabilities Act, are allowed in certain areas of a body art facility. 19.Requires the results of the biological indicator monitoring test used during the sterilization process to be recorded in a log that is kept on site for three years after the date of the results. Requires a written log of each sterilization cycle to be maintained for three years and made available for AB 1168 | Page 4 inspection upon request of the enforcement officer. 20.Requires a body art facility that does not have access to a decontamination and sterilization area, as specified, or sterilization equipment to maintain written proof on company or laboratory letterhead showing that the pre-sterilized instruments have undergone a sterilization process. Requires the written proof to clearly identify the lot or batch number of the sterilizer run. Mobile Body Art Facilities 21.Deletes existing permit requirements for a practitioner that performs body art in a vehicle and, instead, establishes new requirements governing all aspects of a mobile body art facility including vehicle specifications and requirements regarding counters, sinks, service trays, soap and paper towel dispensers, potable water and waste water. 22.Requires, in mobile body art facilities, that all body art procedures be completed inside with doors and windows closed during the procedure unless the doors and windows are covered by a 16 mesh per square inch screen or better. 23.Requires a mobile art facility to use only purchased disposable, single-use, pre-sterilized instruments. Requires a mobile art facility to be operated within 200 feet of an accessible restroom. Requires a mobile art facility to be used exclusively for performing body art and prohibits a mobile art facility from being used as a living space or residence. Temporary Body Art Facilities 24.Adds, for temporary body art facilities, requirements regarding floor space, hand washing, trash pick-up, waste water removal, potable water storage capacity, and adequate back-up supplies. Prohibits food, drink or tobacco products in temporary body art facilities 25.Requires the sponsor of a temporary body art event to obtain all necessary permits to conduct business in the jurisdiction where the event will be held. Requires the sponsor to submit a complete temporary facility permit application to the LEA a minimum of 30 days prior to the date of the scheduled event. AB 1168| Page 5 26.Prohibits the sponsor of a temporary body art event from allowing a body art practitioner to perform body art procedures at the event unless the person has a valid California Body Art Practitioner Registration. 27.Deletes the requirement for temporary body art facilities to have eye wash stations. Mechanical Stud and Clasp Ear Piercing 28.Specifies that the piercing of the ear with a mechanical stud and clasp device does not constitute body art or body piercing. Clarifies that ear piercing equipment with a disposable, single-use, pre-sterilized stud and clasp, made with specified materials, may be used only for piercing the ear pursuant to existing law. Enforcement 29.Permits an enforcement officer to impound instruments that are found during an inspection that have been used in an unapproved manner, or used in an unapproved location. 30.Makes other technical and clarifying changes. FISCAL EFFECT : This bill has been deemed non-fiscal. PRIOR VOTES : Assembly Health: 16- 0 Assembly Floor: 74- 0 COMMENTS : 1.Author's statement. Since implementation of AB 300 (Ma), Chapter 638, Statutes of 2011, which created the Safe Body Art Act, both the industry and regulators have identified a number of small but important adjustments that need to be made to the law to ensure effective and efficient implementation. AB 1168 represents consensus language drafted by a stakeholder group assembled by the California Conference of Directors of Environmental Health (CCDEH) which includes environmental health regulators, tattooists, body piercers, permanent cosmetic practitioners, the mechanical ear piercing industry and other health trainers and safe body art advocates. 2.Background. According to the Centers for Disease Control and AB 1168 | Page 6 Prevention, body art is becoming increasingly common, with 21 percent of adults in the United States reporting having at least one tattoo. Unsafe tattooing and piercing practices can lead to serious health impacts such as hepatitis or HIV infection, as well a range of other bloodborne infections. Complications are fairly uncommon, given how common tattoos and piercings are, but because body art breaches the skin, infections are a risk, nevertheless. Tattoo inks are classified as cosmetics and, with limited exceptions, are not regulated by the federal Food and Drug Administration (FDA). Long-term effects of these inks are unknown. Specific risks of tattoos include bloodborne diseases, skin disorders, skin infections, allergic reactions, and complications during diagnostic imaging such as Magnetic Resonance Imaging. Piercing also carries risks, including infection, allergies, nerve damage, and excessive bleeding. 3.Prior legislation. a. AB 300 (Ma), Chapter 638, Statutes of 2011 regulates the performance of body art in California. b. AB 223 (Ma) of 2010, and AB 517 (Ma) of 2009, both of which were substantively identical to AB 300, were vetoed by Governor Schwarzenegger who stated in his veto messages that he did not see a compelling need for additional legislation, given that local jurisdictions have the option to establish these requirements in their own county and many have chosen to do so. 4.Support. The sponsor of this legislation, the California Association of Environmental Health Administrators (CAEHA), which represents all 62 local environmental health departments and the body art safety inspectors in the state, writes in support that this bill is essentially a "clean-up" of the Safe Body Art Act which was signed into law in 2011. Studex Corporation, a California manufacturer of ear piercing instruments, writes in support that this bill appropriately reinforces and leaves unchanged one of the basic premises of the Safe Body Art Act which is that modern retail ear piercing. While widespread and popular, Studex maintains ear piercing is a very different business than the more involved and riskier business of tattooing and manual body piercing. Studex asserts that this bill retains consistent and appropriate standards for modern ear piercing which is AB 1168| Page 7 important for protecting consumers throughout the state and provides uniformity of regulatory oversight of the ear piercing industry. 5.Policy Concern. The FDA has not approved any tattoo pigments for injection into the skin, including those used for ultraviolet and glow-in-the dark tattoos. According to the FDA, many pigments used in tattoo inks are industrial-grade colors suitable for printers' ink or automobile paint. The FDA has received reports of bad reactions to tattoo inks right after tattooing or even years later. Some people report itchy or inflamed skin around their tattoo, skin infections, or reactions to sun exposure which has prompted the FDA to study tattoo ink safety. The FDA is currently researching the following: the chemical composition of the inks and how they break down (metabolize) in the body; the short-term and long-term safety of pigments used in tattoo inks; and, how the body responds to the interaction of light with the inks. Absent FDA findings and national standards regarding tattoo inks, the author may wish to include a provision that requires the public to be informed, as a part of their informed consent, that no tattoo inks, dyes or pigments have been approved by the FDA and that the health consequences of using these products are unknown. SUPPORT AND OPPOSITION : Support: California Association of Environmental Health Administrators (sponsor) Studex Corporation Oppose: None on file. -- END --