Although massage use has been documented throughout history in almost every culture, it is today, in America, what is called an "emerging profession". Massage is emerging in the sense of still developing its identity as a profession, growing into a sophisticated umbrella encompassing a multitude of disciplines and purposes.
Massage is being used for managing stress, enhancing self-awareness, maintaining health, increasing athletic performance, rehabilitating from injuries, and as an adjunct to medical treatment for a wide variety of conditions such as stroke, depression, cancer, AIDS and for pre-term babies. Massage in day and resort spas is the fastest growing segment of the industry.
Until the advent of high technology medical modalities during World War II, massage was a major technique used by nurses and physical therapists. Today, it is an almost forgotten part of their training, although it remains in their scope of practice and is used by some, particularly those in private practice. Massage is emerging as distinct from nursing and physical therapy, focusing more on the person as a whole rather than on treating local dysfunction. Massage is finding multiple identities as massage therapists work in hospitals, chiropractors' offices, athletic venues, health clubs, and private clinics. On-site (clothed) chair massage is frequently offered in offices, and at conventions, fairs, airports, and grocery stores.
Massage is also emerging from an association in this country with the sex industry, which used massage, starting in the 1950's, as a cover for prostitution. Today, massage therapists far outnumber those using the term "massage" as a front for illicit activities. Yet in much of California, massage therapists are subject to local ordinances that inappropriately and oppressively regulate them as "adult entertainment". Restrictive zoning, excessive fees, VD tests, required showers and separate restrooms, even for the sole practitioner office, prohibited home visits - all these and more are typical of most local massage regulations. Local officials realize this is unfair and inappropriate for the massage profession, but they have no other cost-effective ways to regulate "massage parlors". Today, most local officials would prefer a state agency to regulate the profession. This would assure the city or county that anyone providing or applying to provide massage has met a uniform standard, and more importantly, that one statewide agency exists to revoke permits of establishments and individuals found to be operating illegitimately. Currently San Joaquin County prosecutors are suing a Lodi "massage parlor", alleging that the business is a front for prostitution - and that gives it an unfair competitive advantage over legitimate massage businesses. Such a lawsuit indicates how far local jurisdictions are willing to go, and as with the more typical red light abatement, it is not cheap. There is no way that local governments can recover these costs via either permit fees or fines. Appropriate state regulation would make this control much easier, with actual costs fully funded by the profession itself. (Addendum B3).
A few cities may regret the loss of revenue from massage permits if the process is shifted to the state. However, in most cities that have had to deal with illicit parlors, the cost to build a case for, and conduct, red light abatement far outweighs revenue to the city and county. In almost all cases, there are endless court challenges and delays, with significant cost and personnel resources. In contrast, if massage therapy was regulated as the legitimate profession it is, rather than as "adult entertainment", many of the legitimate therapists currently working outside of the vice laws (and often with the tacit approval of local officials who recognize them as legitimate and contributing professionals) would come forward and obtain business licenses. Additionally, more massage therapists would add to local tax revenue by choosing self-employment over lower paid work in spas and chiropractic offices if they did not need to contend with the onerous provisions of local parlor laws. The public would have greater access and enjoy lower costs.
There are relatively few documented cases of physical injury caused by massage therapists. (Addendum B1-3). Appropriate state level regulation will allow the state to collect data and remedy the substantial harm caused by the current complex of local ordinances that make access to the benefits of massage therapy more restricted, unreliable, and expensive for the citizens of California (Addendum B4a-f).
Several years ago, occupational therapy, a profession that has clear origins in physical therapy, emerged to the point of convincing the California State Legislature that their Certification Act should be changed to a Licensing Act, with a required state regulatory board. Certainly there has been little physical injury caused by Occupational Therapists, either before or subsequent to state regulation.
Even more than occupational therapists, massage therapists should be regulated by the state, rather than by local sex-industry ordinances. Today, any vice officer will tell you that massage is typically not even available at the illicit parlors - only the title is used to cover the sexual activities.
Massage has grown into the third most requested Complementary and Alternative Practice. (According to a 1993 study by Eisenberg et al. at Harvard Medical School and Beth Israel Hospital, over 34% of Americans use alternative or complementary health care, spending about $10 billion dollars a year out-of-pocket -only $3 billion less than the sum for all hospitalizations in this country. Only chiropractic and relaxation techniques were more popular. A recent update of this study revealed even higher figures. (Addendum A1). In California, 200 schools are approved to offer instruction in massage, with programs ranging from 100 hours to 1,000 hours, and at least two college level Associate degrees. In addition to the large number of proprietary schools approved by the Bureau of Private Post-Secondary and Vocational Education (BPPVE) or nationally accredited, massage as a vocation is now taught in cosmetology schools, trade schools and several state funded community colleges. DeAnza College in Cupertino is an accredited community college in the state college system, and offers both Certificate programs and Associate degrees in massage. (Addendum F and G).
For the consumer, it can be a problem identifying the legitimate massage business. Many clients, not knowing how to distinguish legitimate massage practitioners from "massage parlors", choose instead the high profile spas. This places the small businesses at a disadvantage in trying to establish their credibility. The high fees charged by many cities, and the requirements for showers and other structures, can place the cost of opening a practice out of reach for the independent massage therapist, many of whom work part-time. The result is less access to reasonably priced services, as the average price in a spa is 30-50% higher than in an independent massage office. The perception of massage as vice has resulted in many cities requiring expensive conditional use permits. Restricting massage businesses from opening within 1,000 feet of schools, churches or residences has effectively zoned massage out of many small cities. Although land use will remain a local issue, as city planners become more confident in the legitimacy of massage businesses, the zoning laws have eased in other states.
There is a very high turn-over in the massage profession, estimated by the professional associations as being 25% annually. Some of the reason for this is the low pay of those working for others. However, many therapists leave the profession in part due to the humiliation of being treated like prostitutes by the permit process and being solicited by clients who have been to the adult establishments. There is a real harm and disincentive to the individual who has just completed a state approved professional educational program to find out that they have to apply to the vice department for a permit. The current situation also causes experienced therapists, used to practicing in states that rationally regulate massage professionally, to avoid immigrating into California.
Only in regulated states are we able to know the extent of abuse of clients. Sexual impropriety is perhaps the number one grievance against massage therapists in the regulated states. In states without regulatory boards, local police rarely prosecute criminally. A number of these cases end up in civil court. In California, often nothing prevents the offender from continuing to practice, especially in regions with no massage regulation at all. State-wide regulation would provide for centralized tracking of offenders and their prohibition from practicing anywhere in the state. Predators from one of the 33 licensed states who have lost their licenses would not be eligible for California licensing.
The public deserves to know that when they enter a massage business they will not be solicited for sexual services, that their requests for such services will not be met, and that the massage practitioner will not violate professional boundaries. The public also deserves to have an agency empowered to take action against any practitioners who abuse their professional status.
At the time of preparation of this Sunrise Model, AB 1388 is currently being amended. These decisions are being made in negotiation within the profession, with schools, cities and counties, law enforcement, the spa industry, and related health and non-massage somatic professions. Pre-emption of local regulations of massage as vice is clearly a must to all parties. It is the intent of the preparers of this Sunrise to address the interests of as many stakeholders as possible, while finding a means to solve the significant problems to the public and profession caused by onerous local massage ordinances.
Note: The document above is the cover letter submitted by the AMTA-CA to the legislature with the response to the sunrise questiionnaire. The sunrise questionnaire is a unform means of determining the need for proposed occupational regulation.