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|760-1400 Cover Letter to Suffolk County Article 14, New York|
01.760 – Suffolk County Proposed Article 14 Opening remarks and cover letter
Updated August 27, 2008
My analysis was to have been presented November 08, 2006 at Suffolk County Department of Health in Yaphank, N.Y. by William Rafti. Unfortunately the public hearing was postponed.
This report was prepared by Westley Wood, President and owner of Unimax
Supply Company of New York City, founded in 1989, also owner of Sacred and
Bowery tattoo shops in Manhattan with the cooperation of and at the bequest of
Suffolk County resident William Rafti, concerned citizen and founder of
Rafti Institute for the advancement of the body arts and safety.
These comments are considered well reasoned, founded on evidence where available and deserving of consideration to make improvements to the Article. They are not presented as a consensus of opinion.
The most important recommendation is to keep the focus on the danger posed by tattoo/piercing: blood borne pathogen exposure. It is commonly understood and explicitly stated by OSHA that tattoo/piercing fall under OSHA Blood Borne Pathogen Standards. These standards are promulgated to protect all occupations exposed to blood and are supported by recognized medical experts in the field. In addition, standards published by the CDC, FDA and EPA protect patients, clients and citizens. Provisions of Article 14 that are contrary to OSHA and CDC standards, or misunderstood, require justification that those deviations are correct and likely to reduce exposure to blood borne pathogens that will result in lower infection rates.
If the Department wants to correct Article 14 it is necessary it should reflect relevant OSHA, CDC, FDA and EPA standards related to the type of situations found in body art shops: blood borne pathogens, not mold, not mildew, not e-coli or food contamination regulations. Efforts to prevent the spread of e-coli in food packaging have no justification within body art codes and are a waste of taxpayer money that will have no effect on exposure incidents. The reduction and minimizing of blood borne pathogen exposure should be the focus of the proposal and the regulations specifically targeted to food preparation should be deleted.
It is reasonable for the body art community to ask the Department to prove that these regulations are likely to reduce infection rates. It is reasonable to ask the department to include a re-evaluation after a period of time to see if the regulations have reduced infection rates or perhaps the regulations can be reduced or eliminated. The CDC cites the US Supreme Court in the landmark "benzene" case that OSHA could not issue a standard without demonstrating a greater-than-expected risk of disease or injury (CDC-NIOSH Risk Assessment Methods). This ruling allowed risk assessment to determine significant risk and set the stage for CQI and evidence-based public health policy-making in other agencies. Since then the biggest champion calling for evidence based public health policy has been the Institute of Health.
The first step in public health policy, the Assessment Step is mandatory to determine if a problem exists at all. This essential assessment step, not carried out by local authorities has allowed agencies to base their body art rulings on feelings, intuition and anecdotal cases without and in some cases in spite of evidence to the contrary. The NYC Acting Commissioner of Health is applauded because he asked the Board to conduct an assessment step. The Board is to be strongly criticized for the disregarded of his advice and fault their decision to substitute an internet search to support their positions instead of examining the health status of body art in the community to see what if any action is required.
Unfortunately people with no background in body art are faced with the task of preparing body art standards. As a result, faulty, unsupportable standards have filled the void copied from one faulty published standard to the next. There is no supporting evidence for any significant risk to the public and no evidence to justify so much of body art regulations, nor to justify the extravagant waste of taxpayer money. One example to save money is the effective and cost-savings of a complaint-driven Department. This works for New York City and can in Suffolk County too.
The people who make body art and work day after day, year after year learn things which no outside observer can know. For example, Article 14 doesn't reflect the decades of safe and effective tattoo establishment layout, but bans open area tattooing requiring the mandatory construction of private rooms for all procedures based on food preparation standards, not tattoo practices. No body art evidence other than the preference of some artists who want separate rooms for their own reasons is presented for this prohibition. This is a matter for individual owners to decide.
It was a surprise to discover that most of Article 14 was actually food processing standards copied from Article 13 and re-labeled as body art standards. What is necessary to protect the food supply is not what is needed for human blood borne pathogen exposure from a tattoo/piercing procedures. Under the mistaken assumption that what was good for food protection also applied to body art, nothing could be farther from the truth. This discovery highlights a significant inappropriateness to the Article.
A provision copied from Article 13 prohibits having anything in a shop that is not directly related to the operation of the shop. That would be appropriate if we were packaging food but not for a body art shop. If applied logically and consistently it would have unintended consequences. One can imagine it would prevent bringing in a newspaper to be read with morning coffee, or a portable computer, or having a desk in the corner of an office, or even making non-business phone calls. These are reasonable prohibitions while cooking food, but ridiculous applied to body art establishments.
Another item. Contrary to body art wisdom and experience, Article 14 prohibits eating or drinking anything in the procedure room. Outsiders and others who have no background or understanding of body arts may not know, but we have learned that snacks and fluids are a necessary and effective tool to maintain the energy and safety of the client and the artist - which by the way is practiced in medical settings (intravenously) and sports events and tattoo/piercing the world over. Every body-artist and many clients know how important this practice is. The board did not know even after 15 years of observation. A client died this year in a shop in Brooklyn because he got up from the chair to get some food, fainted, his head crashing into a glass showcase and died right there. Rules are being written without an intimate knowledge of the subject. When this was mentioned to an inspector while waiting for the non-existant Yapank meeting, (a champion of the safety of Suffolk Body Art), he said if it were true he would have been told about it.
This brings up a good point. Years of practice do not translate into automatic expert opinion. Expert opinion for body art must include a conformance to known and demonstrable expert health opinion. Being a body artist for 10, 15 or 25 years does not make a person an expert. For example, the inspector declared that Suffolk rules and inspections are the reason there are no health problems. The lack of epidemiological evidence to support this cause-and-effect claim actually supports the opposite. Dr. Benjamin Mojica, acting NYC Commissioner during legalization hearings in NYC said 40 years of tattooing did not produced any health problems. We know that health problems are rare in tattoo/piercing with or without regulations. You would think that illegal tattooing in NYC would be a hotbed of infection, but is not the case. By the very nature of tattooing, it is hard enough just to get the ink in, much less spread disease. To transmit disease you really have to work at it. Practicing Universal Precautions, using new gloves and new needles is sufficient. The rest is fluff.
A recent investigation by the CDC of several clusters of hepatitis C outbreaks implicated tattooers not using gloves in public parks, using guitar strings and printer toner for ink as the cause of those outbreaks. Lesions were reported on one tattooist's hands.
Body Artists should be licensed and tested on how to protect themselves and their clients from blood borne pathogen exposure. To create an entire governmental apparatus at vpublic expense with micro-management of the industry based on not knowing cause and effect is not reasonable.
Another ridiculous example: contrary to tried and true practices the Article prohibits anyone: friends, relatives or loved ones being in the room during the procedure. This is so unnecessary and cruel we hope our participation at this time will bring body art experience and knowledge back into consideration.
Body Arts are not medical procedures. No one is demanding that only licensed health care providers practice tattoo/piercing. So a tension develops for Tattoo/Piercing when regulations are crafted treating body arts as if on the one hand it's a food preparation facility and on the other hand it's open infection-prone surgery. Tattoo/Piercing needs to be considered in their own right. We make tattoos; we do piercing, not surgery and we don't package spinach.
Trying to understand how these regulations got it so wrong, we realized it was partly the hierarchical approach, writing regulations as a series of specific steps to cover as much ground as possible, to stipulate everything in as much detail as possible. To illustrate this, consider something as simple as record keeping. The Article requires records be kept in written form in a book solely for that purpose. OSHA and the CDC advise using a “performance approach” which accomplishes the same purpose, which is: records are to be kept, but leaves it up to the establishment to determine in what form they need to be kept. For example, they could be kept on a computer, as long as the records can be made available for inspection if needed. The old maxim about the forest for the trees applies.
This hierarchical approach has an overall detrimental effect because it keeps body arts subservient, unable to grow, never able to develop concepts that serve to guide body artists into applying principles to daily new situations. The regulations create body artists as employees of the Department the same way having gasoline engines keeps us dependent on oil.
It needs to be noted that the NEHA code written a decade ago, which is being used to support Article 14 is not tattoo/piercing authoritative, does not represent tattoo or piercing expert opinion, but in fact was a document never mentioned in public by the writers who used their opinions as supporting evidence. It's an old trick having each person testify to the others' qualifications or members of the group setting up new organizations to add weight to their testimony. Their effort is viewed by some as an attempted take-over of the credentialing of the entire body art movement with them at the helm. There was a similar attempt to take control of NYC in 1996 but that was exposed and defeated. ThisNEHA publication does not deserve any more weight than any self-testimony presented without evidence. The contributing authors are not authorities in body art, not recognized as authorities and do not have the support of even a substantial number of the body art community. The same errors permeate that rule-book.
A third surprise was that the writers were unfamiliar with OSHA Blood Borne Pathogens Standards, unaware of the FDA position on tattoo and inks, did not know the difference between antiseptics and hard surface disinfectants, requiring, (in three places) in the Article that only EPA hospital disinfectants (e-gads) be used on the skin. And without hesitation, the Article discards known sound, published expert medical wound healing techniques in favor of ritual practices which delay healing, are not Best Practice for Continuous Quality Improvement and actually increase infection exposure. A practice that contradicts expert medical opinion should be investigated, not just accept because it is practiced or espoused by a few artists. Being a tattoo artist does not make anyone an authority, The familiar refrain "Made by Tattoo Artists for Tattoo Artists' is a joke,
A fourth concern centers on openness because supporting documents were not made available but had apparent restricted distribution. One of these documents, the only "study" cited more than once in meetings, that carried all the weight, the Pace Study, is flawed, distorted and transparently false. A summary critique of that is appended at the end of these comments. The only other source used, in defense of trying to prohibit genital piercings, was one out-of-context quote from the World Health Organization (WHO). The accusation was made that Suffolk Piercers were participating in female genital mutilation, which as defined by WHO is the removal of a young girl’s clitoris. This was a low blow. Together with their failure to follow the Commissioner's instructions this should disqualify those Board members from writing regulations. They deserve censure for their silent consent without knowing what it meant.
A final area, the Article prevents the body art communities from developing into a professional society by usurping their basic ability to determine competency in the industry and attending to their own credentialing. Enforcing an apprenticeship program that has never been part of tattoo history or precedent, (Kate Hellenbrand's personal correspondence with WW) directly prevents the rise of a professional community in control of their own destiny. Competency has never been a matter of time, never dependent on apprenticeships but based on individual progress and dedication to the craft. There are no experts acknowledged by all body arts, there are no qualifications that are universally accepted, no organizations recognized or supported by the body art world at this time, only pretenders to those titles because their business cards proclaim it. The Body Art Community has the need and the right to develop and learn to determine levels of competence of skill if they are ever able to say of themselves that they are a profession.
Studying the regulations we came to realize that body arts, especially Tattoo as a historical movement, as a community with traditions and accumulated wisdom, as a living breathing participant – for the most part, everyone stayed home, and except for only one shop owner and William Rafti, no one ever attended any meetings. Regulations were being written in absentia. Partly it can be surmised because the industry is not treated as able to regulate itself, meaning become professional, but kept as siblings under constant watch by their guardians. We hope this presentation and report will correct some of these shortcomings not only in Suffolk County but to counter the silent voice of body art across the country. We should not allow Departments to structure-in a child-parent existence for our industry.
We hope these insights asking for evidence and fair play will wake the community of body artists to realize we must participate and cannot remain silent merely accepting the crumbs that fall from the master's table. We have the most envious record of safety of any activity on the planet and body artists have to tell the story.
Comments, corrections, errors?
Please reply to WWOOD36@GMAIL.COM
These are personal views
and opinions of Wes Wood and do not necessarily represent the views and
opinions of Unimax Supply Co Inc.
Index of Sections
Suffolk County Article 14 760-14