External Affairs

Coming Clean: Community Partnerships for Tattoo Removal | to pdf >>
By Cynthia K. Lopez; Nancy Buell, LCSW

It's 7:30 am on a Saturday at the Kaiser Permanente (KP) Medical Center in Hayward, and today a group of physicians and nurses are volunteering their time and expertise to help young people aged 13-25 years remove vestiges of their troubled past. Through an innovative community partnership, these volunteers provide laser treatments to remove tattoos--professionally made and homemade, in all shapes and colors--from the visible areas of the face, neck, arms, and legs of young men and women. As the tattoos fade, so do reminders of gang life or drug problems. In exchange, the young people commit to making positive lifestyle changes. A similar clinic at the KP Medical Center in Fremont serves young people in that area.

	Dr. Dan Tuerk (top) and Dr. Jed Weissberg (left) performing laser treatment (Photos by Nancy Buell)

Partnerships Help Youth and Community
Both the Hayward and Fremont medical centers of KP's Northern California Division have joined with community agencies and local government to advance KP's social mission. They are contributing medical expertise and resources such as space, supplies, medications, and small subsidies to the Hayward New Start Tattoo-Removal Program (launched in 1996) and to Fremont's Project New Start (initiated in April 1997) respectively. Physicians and employees not only volunteer their time at the tattoo-removal clinics but staff participate on associated advisory boards as well.

Hayward New Start's Tattoo-Removal Program is a collaborative effort between KP, the City of Hayward, and Eden Youth Center, which recruits and counsels the young people participating in the program. Hayward's mayor, Roberta Cooper, raises funds for the program with the help of local businesses. These funds support rental of a mobile laser machine at a cost of $550 per half day. KP administers and provides staff for the tattoo-removal clinic.

Project New Start is structured similarly but is part of a countywide effort led by Alameda County Supervisor Gail Steele and encompasses two tattoo-removal projects: one in Fremont (KP participates in this project) and another in Oakland. In Fremont, a community-based youth agency--the Community Counseling and Education Center--recruits, screens, and counsels the youth, and tattoo removal is done at the KP Medical Center there.

Both programs are modeled after San Jose's Project Clean Slate, the San Francisco Bay Area's first tattoo-removal program. Numerous communities in the Bay Area have copied this model to start their own programs, sometimes in direct consultation with KP. Napa County, for example, reviewed KP's protocols, medical consent forms, and other documents to facilitate development of a tattoo-removal program in that county.

Outside Northern California, KP has taken other approaches to support tattoo removal. In December 1997, KP awarded a $25,000 Good Neighbor Grant to help jump-start development of a tattoo-removal program in Kern County, California. In Los Angeles County, dermatologist Nancy Jasso, of KP's Panorama City facility, volunteers her time at a tattoo-removal program jointly sponsored by Holy Cross Hospital and the Los Angeles County Probation Department.

"We know that community health and public health programs have a far greater impact on overall societal well-being and morbidity than the work we do in our individual medical practices," says Dr. Jed Weissberg, former Physician-in-Chief of KP's Fremont Medical Center and now The Permanente Federation's Associate Executive Director for Quality and Performance Improvement. A long-time advocate of tattoo-removal programs, Dr. Weissberg believes that supporting these efforts is simply "the right thing to do" to help address gang violence in the community and to contribute to the overall good of Health Plan members and the general public.

Nancy Buell, LCSW, former KP community health manager and administrative coordinator of both KP tattoo-removal clinics in Northern California agrees. She adds that the clinics address all three KP community health priorities for the East Bay: increasing access to health care, implementing programs for children and youth, and preventing violence. These priorities are determined by a community needs assessment, conducted every three years in collaboration with neighboring hospitals.

Before treatment

After treatment

Exchanging Commitment for a Clean Slate
To be eligible for KP's tattoo-removal programs, participants must be enrolled either in school or in a job training program or must have a stable job; and they must be willing to contribute at least 50 hours of community volunteer work. Moreover, before being eligible for their first tattoo-removal session, these young people must complete certain goals and then stay on track to receive each subsequent treatment. A sponsor at one of the associated youth agencies helps program participants to develop their own goals and supports them throughout the process of reaching them. Indeed, by receiving incremental awards, participants keep moving toward their goals. Advertised primarily by word-of-mouth, the tattoo-removal programs usually have a waiting list of young people hoping to participate. Rocky Villasana is the project coordinator at Eden Youth Center. He serves as coach, mentor, and confidant to the 18 to 20 young people who are scheduled for tattoo removal as well as up to 40 others who are working toward qualification.

Villasana believes tattoo-removal services are urgently needed. A faded tattoo can help remove the threat of violence, especially for former gang members. And highly visible tattoos (eg, a teardrop near the eye) can be detrimental for individuals seeking jobs that necessitate frequent customer contact."A tattoo can take up to a year to be completely removed," says Rocky, explaining that treatments are given every eight weeks and that at least four to eight sessions are needed to finish the process. Although the procedure hurts a bit, Rocky says that most of the kids are not fearful. For many of them, the program affords the only real opportunity they'll have in the near future to get tattoos removed. On the open market, a single tattoo-removal session costs anywhere from $300 to $500, which amounts to thousands of dollars for a full course of treatment.

Augusta Ortiz, a 23-year-old single parent, is grateful for the help in changing her life. "I used to be a follower and not a leader," she said in explaining why she got tattoos in the first place. "I thought they were cool. My friend had a [tattoo] machine at home, and I was involved in the gangster life in Los Angeles. The tattoos mean nothing to me now."

Ortiz is a recent graduate of a two-year program in computer office administration. She says she used to wear lots of jewelry to cover the dots and initials tattooed on her hands and wrists but that she could never easily conceal the "smile now, cry later" tattoo on her ankle--especially when wearing business attire. Now into her fourth treatment, Augusta sees that the tattoos are fading away. "It's great," she says, because "a lot of people judge you from the outside."

Working Together for a Common Cause
Establishing a tattoo-removal program or any community partnership project requires the commitment of a team as well as a lot of hard work. Nancy Buell recalls the launch of Hayward New Start. "Over a dozen community groups came together to create this program. We borrowed protocols and procedures from other programs and modified them as we went along. The program structure is really quite simple, and it transfers easily to new communities," she said. KP's direct involvement has set an example for other community hospitals, which are now joining these collaborative efforts and expanding program capacity

Before treatment

After treatment

Dr. Lorraine Weinstein, a general surgeon at the Fremont KP Medical Center and a regular volunteer in the tattoo-removal program, attributes its success to excellent organization and a collaborative spirit. Dr. Weinstein says that volunteers find the effort worthwhile, results are visible, and patients are appropriately screened and motivated. "No one feels overly burdened," she says, "and there is a team feeling among us."

Physician training and certification for tattoo removal are relatively simple to obtain and usually involve a seminar in which participants learn how to use the equipment and how to comply with safety procedures. Experienced physicians proctor all new volunteers. At the Hayward and Fremont KP Medical Centers, any and all physicians are encouraged to participate in the project. So far, several general surgeons, including a plastic surgeon, a dermatologist, and a gastroenterologist, have received certification.

Dr. Daniel Tuerk, a former plastic surgeon at the KP Medical Center in Hayward, has volunteered for the Hayward clinic since its inception and was the first KP physician at his site to be certified to perform laser tattoo removal. "I'm not idealistic enough to think that we're changing all of these kids," he says, "but it's gratifying to me to be able to help them undo at least one mistake that used to be irreversible." Dr. Tuerk, now retired, continues to volunteer for Hayward New Start.

With Dr. Vic Narurkar, a dermatologic laser surgeon and researcher from the University of California at Davis, Dr. Tuerk set up the medical aspects of the Hayward tattoo-removal program. Dr. Narurkar has worked with many programs throughout Northern California to develop their own tattoo-removal services.

Through his contacts with laser manufacturers in Silicon Valley, Dr. Narurkar helps programs to gain access to the latest equipment. According to Dr. Narurkar, today's lasers are less expensive to rent or purchase and are less cumbersome to operate than in the past. Using the latest technology, a single portable unit is able to use multiple wavelengths of light to shatter different colors of ink into particles. The body's defense cells (macrophages) then sweep the particles away. Both the Hayward and Fremont programs rent equipment to avoid maintenance costs and the need to transport machines between facilities. In addition, renting allows old technology to be easily exchanged for new, and all rentals come with a certified laser technician. Currently, the programs use a Versapulse/C laser.

"In truth, the technological part is easy," says Narurkar. "The tough part is putting together the community alliance that sets up a framework to reach these kids."

He may be right, but advocates are committed to keeping the programs alive, especially after seeing the positive reaction of participants who complete the treatment and make concrete steps toward achieving their goals. Earlier this year, the Hayward tattoo-removal program held its first
graduation ceremony: graduates received certificates of accomplishment, accolades from their sponsors, and congratulatory hugs from families and friends. They also posed for the cameras and waving tattoo-free hands smiled delightedly without any visible labels of their past.

For more information regarding the tattoo removal program, please contact the KP Public Affairs Department at 510-618-5804.

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