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 --