The death of a UC Davis student, who contracted a fatal heart infection after having a swirling tribal tattoo pricked into his forearm this summer, has pointed to a gaping hole in the regulation of tattoo and piercing parlors.

Despite a 1997 law designed to ensure cleanliness and safety, the California Department of Health has never drawn up regulations for oversight, leaving the body art industry less regulated than other cosmetic professions that do non-invasive procedures.

Manicurists and hair stylists, for example, are required to take 1,600 hours of schooling in their craft, including 29 hours of classes in health safety, and pass both written and oral examinations before they can snip hair or paint toenails. Then they are subject to annual state health and cleanliness inspections.

But tattoo artists, piercers and those who apply permanent makeup are not required to take classes, get training in sanitary medical procedure or submit to government health inspections. They don't have to complete the informal short-term apprenticeships that are customary within the body art industry.
The only requirement for most of the estimated 100,000 body artists in California is that they register with their county environmental health department. And even that requirement is not being rigorously enforced, according to the executive director of a council of state environmental health officers.

"All we do when people come to us and say 'I'm going to do tattooing' is register them," said Faith King, a senior environmental health specialist and the keeper of Sacramento County's tattoo and piercing registry, which numbers about 145 artists. "That's the best we can do."

Recognizing the popularity of tattoos and piercing was growing dramatically, Assemblywoman Valerie Brown in 1997 successfully sponsored a bill requiring that artists be registered, adhere to specific sanitary standards and submit to inspections by county officials.

"What I was seeing on college campuses was that tattooing was becoming a way of life, part of a rite of passage," said Brown, who was termed out of the Assembly in 1999 and now is a member of the Sonoma County Board of Supervisors. "I thought if kids were getting tattooed and pierced to the extent that they were, it was incumbent on us to make sure there were regulations in place to protect them."

The bill, which became law on Jan. 1, 1998, required the California Conference of Local Health Officers to establish sterilization, sanitation and safety standards.

Of particular concern is the risk of spreading hepatitis, AIDS and other blood-borne diseases, state officials said.

In June 1998, the group forwarded a 17-page list of standards to the California Department of Health Services, which was supposed to translate it into the state Health and Safety Code.

But that never happened.

"We have limited staff," explained DHS spokeswoman Lea Brooks. "And there are emergencies that pop up."

She said the Berkeley epidemiologist who was given the lead role in writing regulations has been pulled into various other public health crises, such as SARS.

In the interim, environmental health officers in most of California's 58 counties have been waiting -- and watching the number of body artists grow.

"(We) have preferred to use statewide regulations rather than adopt a plethora of local ordinances," said Justin Malan, executive director of the California Conference of Directors of Environmental Health. "But it's been a while."

Although there is plenty of anecdotal evidence to suggest there are more tattoo and piercing artists than ever before, nobody is officially tracking the growth.

The National Tattoo Association does not keep numbers, and California's local health departments this week are gathering statewide data for the first time.

The issue of oversight was raised this month, after 21-year-old Eric Rachesky died of a massive heart infection that his doctor's believe began as an infected tattoo.

While nobody has suggested there was anything unsanitary about the studio that did Eric Rachesky's tattoo, his death has refocused attention on the state's lack of regulation.

Rachesky had finished his junior year at UC Davis on June 25 when he got the design inked into his forearm. It was similar to tattoos he already had on his back and a calf, his father, Ron Rachesky, said.

The other tattoos, done at the same shop, did not get infected. And apparently, it didn't occur to Rachesky that a heart murmur that required him to take an antibiotic before every teeth cleaning might pose a unique infection problem when getting a tattoo.

The tattoo artist did not ask about heart murmurs, his father said.

After Rachesky's death, his father asked tattoo parlors to voluntarily include warnings to clients about the risks of heart murmurs. Many have, but that isn't enough for him.

"It wasn't until my son died that I thought, 'Where do these guys get training?' " he said. "These people are injecting things into people's bodies."

The death has propelled official action, too.

At least a dozen counties now are considering enacting their own standards rather than waiting for the state. Malan's organization is lobbying the state health department to implement temporary enforceable standards now.

Tattooist Bill Liberty recently added a line to his client release form that asks clients if they have a heart murmur.

"We're not doctors," said his wife and office manager, Lori. "But we try to make sure clients are aware of their own health."

Most studios already have procedures that mimic the guidelines under consideration by the state, which include a room solely used for sterilization and one-use needles, according to several body artists and county officials.

Zoe Clapton wore gloves and worked off a stainless steel tray with individually packaged sterile instruments when she dropped a stud through the tongue of one client on Tuesday afternoon at Exotic Body on 30th Street downtown.

She said the industry has undergone a major evolution in the five years she's been piercing.

"The public is getting more informed, so the shops are going to get more informed," said Clapton, who is usually based at Mom's Body Shop on Haight Street in San Francisco but frequently works as a visiting artist at various other shops statewide. Those that aren't using sterile procedures "are very rare," she said.

At Liberty Tattoo on Auburn Boulevard, Liberty showed off his autoclave machine, which sterilizes tools under steam pressure.

Liberty, like most body artists, gives all clients a pamphlet of health care instructions when they leave.

Before customers submit to a tattoo or piercing needle, they need to know the health guidelines and see examples of past work, officials and artists said.

"It's definitely a 'buyer beware' industry," said King, the Sacramento inspector. "People complain that someone did a lousy job, and I think, 'Good grief. You didn't even look to see if this person could spell 'Mom' before you had it put on your arm?' The more you check, the better. ... It's out of my hands."