The Price We Pay for Vanity

Unsanitary spa practices may have cost Darlene Lopez a finger -- but the state does little to protect consumers like her from infection.

Darlene Lopez, a fifty-year-old Antioch grandmother, has devoted most of her life to raising her three daughters, working as a bartender to supplement her husband’s electrician salary. With children to raise and bills to pay, she rarely had the time or means to pamper herself. And that’s why her daughter Kathy decided to treat Lopez to a decadent manicure and hair styling for Mother’s Day two years ago.

Kathy took her mom to Nails by Lee in downtown Pittsburg, where a nail tech soaked, filed, clipped, and accidentally stabbed the cuticle skin of Lopez’s never-before-manicured nails, according to documents filed later in Contra Costa County Superior Court. After mopping up the blood with a Kleenex, the manicurist continued to paint Lopez’ nails with porcelain cement.

A photo taken after the mother and daughter’s day at the spa shows a beaming Lopez modeling her long acrylic nails and new hairdo. But after a month, when she returned to the salon to have her artificial tips removed, she noticed a disturbing green film under her real nails. The manicurist allegedly assured her there was no reason for concern.

Lopez took his word for it. But the green stains persisted. Six months later her doctor at Kaiser Permanente diagnosed her with an aggressive staphylococcus infection that had spread to the bone, and which eventually would require an amputation of her index finger below the second knuckle. The grandmother says she also now suffers from a recurring nail fungus, which causes her nails to abnormally thicken and fall off after they grow beyond her fingertips. She filed a lawsuit against Nails by Lee last November, demanding $274,000 in damages.

While tragic, experiences like Lopez’ aren’t unheard of. Dozens of Northern California customers have contracted infections linked to their visit to unsanitary nail salons. One of the worst incidents, three years ago, involved 110 patrons of a Watsonville salon’s luxurious footbath — a regal padded throne that slopes toward a basin of bubbling warm water. Many of the customers had already forgotten about their day at the spa when they began developing disfiguring skin abscesses and boils on their newly shaved and polished legs. The unsightly ulcers were caused by a nasty bug, Mycobacterium fortuitum, which a disease detective from the federal Centers for Disease Control and Prevention later tracked back to the dirty, warm reservoirs of the foot spa machine.

While all of the leg boils eventually healed, some of the women were on antibiotics for as long as six months, and others considered plastic surgery to mask the ugly red scars that resulted, according to statements by CDC investigator Kevin Winthrop.

A New England Journal of Medicine article describing the outbreak identified tiny lesions from freshly shaved legs as a likely portal for the bacteria. The authors also took random samples at spas around the state and found that the rapidly growing mycobacteria were “highly prevalent” in whirlpool footbaths. “After notifying local health departments,” they wrote, “we were informed of at least six sporadic cases of mycobacterial furunculosis of the lower extremities in pedicure customers at other salons.” Such infections, they said, were probably under-recognized and increasing in prevalence.

“There’s great potential for this to happen anywhere,” concurs Marci Abrams, a Santa Cruz County epidemiologist who first investigated the Watsonville outbreak. “These places usually see ten to twelve people in a row without cleaning out the debris in the filters between clients.”

Abrams had demographics in her favor. “There are only 25,000 people in Watsonville and one dermatology office,” she says. “In a larger town, it would be very difficult to pinpoint the source.” For this reason, she adds, the true frequency of disease transmission at nail salons is unknown.

The Watsonville case was the largest recorded outbreak linked to a nail salon, but not the most serious. California codes governing salon sanitation offer no specific guidelines for curbing transmission of blood-borne diseases in beauty establishments. Last year in San Mateo County a pedicurist shaved off a client’s calluses with a contaminated razor tool, causing the woman’s toes to bleed and exposing her, county health investigators believe, to hepatitis C — a deadly blood-borne virus that can slowly destroy the liver of those infected. “While it’s very unlikely that HIV could be transferred in that environment, it’s more likely that hepatitis can be transferred, and I don’t think people really understand that yet,” says Rebecca James Gadberry, co-founder of the Barbering and Cosmetology Legislative Alliance, a political action committee representing the beauty industry.

The State Board of Barbering and Cosmetology, which oversees the safety of California’s 37,000 beauty salons and barber shops and the 420,000 professionals who work in them, currently employs only twelve inspectors for the entire state — one for every 35,000 manicurists, hairdressers, cosmetologists, aestheticians, and electrolysis techs. From 1997 to 1999, the state had just seven to nine inspectors, and the Bay Area hasn’t had a designated inspector for the past two years because of a state hiring freeze and the difficulty of recruiting qualified people at the $30,000 to $36,000 salary level the state offers.

Even beauty industry lobbying groups such as Gadberry’s thinks the state needs to step up its inspections. “Our stance is pro-regulation,” she says. “We’re an industry that understands that we deal with health issues and that we need oversight.”

The state board has a history of dysfunction. It was eliminated by the legislature in 1997, and its authority was transferred to the Department of Consumer Affairs. “It does not appear that the routine inspections conducted by the board have any demonstrable impact on the misuse of chemicals or toxic compounds by licensees, control of parasites, or in protecting the public from … other communicable disease,” a state review committee concluded in a 1996 report recommending the board’s dissolution.

But the program continued to be understaffed and backlogged with cases under Consumer Affairs; investigation of complaints was taking as long as two years. Former state Senator Richard Polanco responded with a bill to reestablish the nine-member Board of Barbering and Cosmetology. The new law took effect in January, but Governor Davis and the legislature have only appointed one board member to date, thus hamstringing any effort to reform the inspections process. “In order for anything to change, the board has to convene and vote on each item. Until there are people in those positions, there is no board to speak of,” says Phoenix-based industry consultant Nancy King.

One key problem, according to industry experts, is economic: Because manicures are so cheap, discount salons rely on volume to make money, leading many to cut corners on hygiene. They forgo proper cleaning procedures, opting for cheap disinfectants or useless substitutes such as Windex, and reuse manicure tools between clients. “They should really be sterilizing equipment in medium-level EPA-grade disinfectant for four to ten hours,” says Shelley Sekula Rodriguez, a dermatologist at Houston’s Baylor College of Medicine, who is considered an expert on nail salon hygiene.

On the rare occasions that an unlucky salon finds an inspector at its door, the owners have little to fear. Even though 84 percent of the violations in 2000 were for failure to practice proper disinfection and sanitation, the relatively skimpy $25 to $500 fines for violating disease-prevention regulations were only levied on repeat offenders. “Enforcing a program at that level is tantamount to not having a program at all,” says Julianne D’Angelo Fellmeth, administrative director for the Center for Public Interest Law at UC San Diego.

Jim Jacobs, the supervising inspector for the state cosmetology board, says the only way to get nail salons to comply with infection-control regulations is to hit violators with higher fines. After the Watsonville outbreak, the board established new penalties which are now as high as $250 per chair — the typical salon has four to five — for repeat offenders who fail to clean debris out of foot spa filters. “At that point, it doesn’t make business sense not to do it,” he says. A new bill introduced in February by Fremont state Senator Liz Figueroa, now winding its way through the legislature, would raise fine limits from $2,500 to $5,000 per inspection and give the state board more authority to enforce regulations — assuming its empty seats are ever filled.

Paradoxically, some pro-industry critics of the state board have used its ineffectiveness as an argument to abolish regulation; they also cite the low number of complaints about 130 per year that require an investigation.

Yet the volume of complaints the board receives doesn’t necessarily reflect what’s happening in the spas. Customers such as Darlene Lopez, for example, opted for a lawsuit rather than navigating the state bureaucracy. Or consider Nails R Us of El Cerrito, which has never been cited by the cosmetology board, but has been sued twice over health issues.

Richmond resident Alice Robinson contended in a 1995 lawsuit that she contracted a nail fungus at the salon, causing permanent scarring and disfigurement. Janice Russell, another plaintiff, sued Nails R Us the following year for allegedly inflicting a deep puncture wound into the meat of her thumb that became infected and cost her $1,000 in medical treatments and three weeks of disability time off from work. Robinson’s case was dismissed, while Russell settled for $4,000.

The salon, nevertheless, is in visible violation of state health codes. On a June 7 visit to Nails R Us, grime could be seen on the manicure tables, showcases, and walls. State law requires salons to disinfect tools between customers in a bactericidal, fungicidal, and virucidal agent, but at Nails R Us, manicure tools were stored in drinking glasses clouded by an unidentifiable white film, the remnants of previous clients’ skin and nails still visible on their tips. As a reporter looked on, these utensils were reused between patrons without washing or disinfecting, and three customers used the foot spa “throne” without any cleaning or disinfection in between — a practice that was banned by the state after the Watsonville outbreak.

With the California legislature primed to slash the budgets of almost every state department, the cosmetology board will probably face additional cutbacks in the coming months on top of the current hiring freeze. Patrons, King says, will have to take responsibility for protecting themselves from injury or infection at nail salons. “The consumer needs to know what to look for,” she says. “If you walked into a dentist’s office and saw pieces of skin on dental equipment, you wouldn’t let them put it in your mouth.

“If you see contaminated tools in a salon, you should leave,” she continues. “If you don’t, you’re keeping people who are dangerous in business.”

Putting the responsibility on the patron is preposterous, counters one public health official who asked that her name not be used. “I think the way this industry is operating is just abysmal,” she says. “I don’t think the burden of protecting oneself from a blood-borne disease should fall on the consumer.”

Perhaps not, but an expanded inspection and enforcement program would require a directive from the legislature, something board spokesman Rick Lopes says he doesn’t expect anytime soon. Until the system is overhauled, Lopes concedes, consumers will simply have to fend for themselves.

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