HD48 - The Need to Regulate Tattooists and Tattoo Parlors in the Commonwealth of Virginia
Executive Summary: As requested by the 1993 Session of the Virginia General Assembly, the Board of Health Professions has studied the need to regulate tattooists and tattoo parlors in the Commonwealth. The scope of the study included "traditional" tattoo parlors, salons in which tattooing is used to imprint permanent "make-up," and the practice of body piercing by tattooists. Study methods included the conduct of a public hearing and solicitation of public comment, a review of the regulation of these activities in other jurisdictions and within the Commonwealth, a review of the literature, site visits and interviews, consultation with other State agencies and private organizations, and the application of seven criteria used by the Board to determine if the public health, safety and welfare require that an health occupation or profession be regulated. The criteria are similar to those used by the Board of Professional and Occupational Regulation within the Department of Professional and Occupational Regulation to determine if non-health occupations or professions require regulation in the public interest. An example of a related non-health occupation regulated by that agency is the licensure of cosmetologists by the Board of Cosmetology. Tattooists are not health care practitioners, and their activities are not considered to constitute the practice of cosmetology by the Board of Cosmetology. Application of the seven criteria for evaluating proposals for occupational regulatory programs nonetheless provides a useful perspective. The criteria help determine: (1) if there is a risk for harm from unregulated practices, and how this risk arises; (2) whether specialized skills and training are required; (3) whether members of the occupational group practice autonomously; (4) how the scope of practice differs from other occupations and professions; (5) whether the economic costs of regulation are warranted; (6) whether there are alternatives to occupational regulation that could protect the public; and (7) what mechanism is the least restrictive for providing the desired level of public protection. This Executive Summary presents the conclusions of the Board's review. The conclusions were drawn from application of the Board's criteria to the evidence presented and discovered in the research conducted as part of this review. The findings and recommendations which follow were endorsed unanimously by members of the Board of Health Professions at its meeting on October 19, 1993. Findings 1. There is a risk for harm to the public from the practice of tattooing -- including the application of permanent make-up by tattooing -- and from body piercing. The risk arises from characteristics of these practices, characteristics of clients served, and characteristics of the workplace environment and supervisory practices. Tattooing and body piercing are invasive procedures in which the skin is penetrated by a foreign object. If proper sterilization and antiseptic procedures are not followed by tattooists and body piercers, there is a risk of transmission of blood-borne or other infections. Tattooing and body piercing may cause allergic reactions in persons sensitive to dyes or metals used in ornamentation. The procedures involve discomfort for which effective anesthesia is not legally available from unlicensed providers. 2. The public can be protected from this risk by requiring the use of universal precautions related to the transmission of blood-borne infections, by disclosure requirements to facilitate informed choice, and by strengthening the regulation of tattoo facilities by local jurisdictions. Tattoo facilities should be defined to include permanent make-up salons. Informed personal decisions to obtain tattoos, permanent make-up and body piercing should be based on an understanding of risk. Minors may not be able to fully comprehend the implications of these risks, even when full disclosure occurs. Recommendations The Board of Health Professions endorses the following recommendations to the Governor and the General Assembly. 1. State licensure or certification of tattooists, permanent make-up artists, and body piercers is not warranted by evidence of risk for harm to the public. Disclosure requirements, the strengthening of regulation by local jurisdictions, and a requirement to use universal standards for the prevention of disease transmission are less restrictive means for protecting the public. 2. The General Assembly should consider legislation to add disclosure requirements related to tattooing to the Virginia Consumer Protection Act. Among the matters that should require disclosure are the following: a. permanent make-up involves the use of tattooing, often through multiple applications. b. tattooing and body piercing are invasive procedures in which the skin is penetrated by a foreign object. c. if proper sterilization and antiseptic procedures are not followed, there may be risk for the transmission of blood-borne or other infections. d. tattoos are permanent in nature and difficult to remove. e. tattooing and body piercing involve discomfort for which appropriate anesthesia may not be legally available from tattooists or body piercers. f. tattooing and body piercing may cause allergic reactions in persons sensitive to tattoo dyes and metals used in body ornamentation. 3. The General Assembly should consider revisions to the criminal code to require the use of Center for Disease Control (U.S. Public Health Service) universal disease prevention precautions by all tattooists and body piercers. Failure to observe these precautions should be punishable by law. 4. The General Assembly should consider strengthening the regulation of tattoo parlors, permanent make-up salons, and body piercing by local jurisdictions. Replacement of discretionary authority by a mandate for local regulation should be considered. Cost and Implementation of Recommendations The request for this review included the proviso that the Board of Health Professions "recommend to the Governor and the General Assembly the impact of such regulation [as may be recommended] and any legislative action which it deems appropriate." Because the Board of Health Professions' statutory authority is confined to matters related to the regulation of health occupations and professions, it is unable to provide firm estimates of cost or expert advice on legislative actions to amend the Virginia Consumer Protection Act and the criminal code. It is clear, however, that the limited number of members of this occupational class cannot support the operation of an occupational regulatory board. The Department of Professional and Occupational Regulation -- the agency most likely to house a board for the regulation of a non-health occupation estimates that at least one-hundred practitioners are required to support the direct costs of operating a regulatory board. There are estimated to be fewer than fifty tattooists and body piercers practicing in the Commonwealth. In addition to direct costs, regulation of occupations increases costs to consumers by restricting the number of practitioners who may provide a service. Other states that have studied the regulation of tattooists have concluded that the costs of such regulation would result in driving the industry further underground, to the detriment of the intended objective of protecting the public. The Board of Health Professions has concluded that the direct, indirect, and unintended costs of regulating tattooists as an occupational class far exceeds the costs of the recommended actions to strengthen regulation by localities, require disclosure of relevant risks, and mandate precautions against disease transmission. The Board of Health Professions appreciates this opportunity to be of service to the Governor and the General Assembly of the Commonwealth of Virginia. The report which follows provides the full rationale for the findings, recommendations, and observations presented in this Executive Summary. |
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