Candace Combs stands in front of InSymmetry Spa in the Mission. Photo by Abraham Rodriguez

Department of Public Health looses barrage of warning letters on massage therapists; city laws aimed at curbing trafficking leave many small businesses in limbo

Kim Pierce, a local massage therapist, was heading into 2019 in a good place: She had affordable rent at ActivSpace, a building on 18th and Treat, and more clients than she could handle. 

That lasted until January, when 52 of her fellow massage therapists received notices from the Department of Public Health warning that they were not legally permitted to work in that building. Although Pierce did not receive a notice — her business was not listed on Yelp — she didn’t want to risk it. 

She ultimately left in April. 

I’m still looking for a space to work,” she said in a recent interview. 

That’s because a 2015 law, authored by then-Supervisor Katy Tang, requires massage therapists to seek conditional use authorization from the city to set up shop anywhere in the city. They must also register with the Health Department — a costly process. What’s more, massage therapists say the law has had a major unintended consequence: It has purportedly encouraged more therapists to not register with the city and, instead, fly by night. 

The situation may not become easier anytime soon for Pierce, or her fellow massage therapists. 

Last week, the Department of Public Health served 206 massage therapists letters warning them to come into compliance with the ordinance in 30 days, or be fined $1,000 a day, DPH spokeswoman Veronica Vien confirmed in an email.

“We received a whistleblower complaint alleging over 200 locations/businesses were operating without a massage establishment permit,” she wrote.

Marianne Smith, who was served with a notice on Friday, says she was told by a Department of Public Health official that upwards of 226 massage therapists were served with notices. 

“It’s horrible,” Smith told Mission Local on Monday. “It’s so frustrating that we — legitimate businesses — are always being lumped in with illegal syndicates.”   

Massage therapists say that the 2015 law, an effort to weed out human trafficking rings associated with massage parlors, has instead subjected San Francisco’s entire massage industry to a bureaucratic full-court press: Initial inspections by three different city departments, licensing fees, and random visits by the Health Department — processes individual massage therapists say they cannot afford. 

Adrienne Lalanne was also served with a notice Friday, as she was not registered with the Health Department. She fears she’ll no longer be able to afford her spot in a chiropractor’s office that she’s worked out of for 13 years, given the costs of registering with the city. 

“I just saw the fees last night,” she said. “That’s astronomically high.” 

Initially setting up a massage establishment costs $6,327, which includes a panoply of registrations and inspection fees. Annually, establishments must pay $2,822. For a sole practitioner, especially, this is a lot. The U.S. Bureau of Labor Statistics estimates massage therapists’ median income is $41,421 a year.

But the real cost burden lies in the conditional use process. Obtaining conditional use can take up to 11 months, according to the March 2019 Budget and Legislative Analyst report. Any business seeking conditional use — including massage therapists — must have a space selected at the very beginning of the process. That means a massage therapist must have months of rent saved up before beginning the process. 

No other alternative health service — such as acupuncture or chiropractic — is subjected to the same rules and costs. 

Here we are in 2019 and we are seeing the effects of the law,” said Candice Combs, president of the San Francisco Massage Council and owner of the InSymmetry Spa in the Mission. “It’s forcing everyone to go underground or leave the city. At some point, we’re not going to have services in San Francisco” 

“You don’t kill an entire industry because some people are doing it wrong,” she added. 

In January, more than 100 massage therapists, acupuncturists, hair stylists and others caught up crackdown at ActivSpace, a sprawling Mission building zoned for “production, distribution, and repair” (PDR) — but housing many businesses that did not fit this description. 

While the Board of Supervisors in July passed legislation that granted amnesty to many of the scores of acupuncturists, tattoo artists, and hairstylists doing business there illegally, many massage therapists had jumped ship before the legislation passed. 

The Office of Small Business, furthermore, reports that only around half a dozen massage therapists have officially sought to stay following the January crackdown. Because of the city’s rules, it’s likely been difficult for them to find another place to set up shop. 

At least legally.

Human Trafficking 

The prevalence of so-called “sex massage” establishments is unclear. 

A Health Department spokesperson said the department “suspects” that, as of 2019, roughly 30 percent of the 188 licensed massage businesses in the city are offering sexual services for money — though that “suspicion” is based only on indicators like using beds instead of massage tables or how the masseurs are dressed. 

A 2019 report by Department of the Status of Women stated that “strong” evidence exists that such an industry thrives in San Francisco. Regardless, the Health Department found only two cases of “illicit massage establishments” in 2017. It found no such cases in 2016. (The report did not provide data for 2018.) 

And yet, Polaris, a Washington, D.C. nonprofit that tracks human trafficking in the United States, argued in a 2018 report that San Francisco is one of three major nexuses of human trafficking, next to New York and Los Angeles — based on an analysis of Mandarin Chinese-language website ads. 

“42 percent of the ads in California [San Francisco and Los Angeles] show one or more flags of trafficking (most commonly promises of more than $4,000 income a month, housing and transportation provided, visas handled, or parameters around an applicant’s appearance or age),” the report says

This situation appeared to amplify in San Francisco with the 2008 passage of California Assembly Bill 731, which made it possible for any massage establishment to bypass municipal control by obtaining a state massage license. 

“Since the passage of AB 731 there have been two essential loopholes that have allowed for the proliferation of illicit operations to exist under the guise of legitimate massage establishments,” wrote Regina Dick-Endrizzi, the director of the Office of Small Business, in a 2015 letter supporting Tang’s law. 

This is where you go for all your neon-sign massage and family dental care needs. Photo by Mateo Hoke

Dick-Endrizzi explained that the law did not establish an agency that regulated recipients of the permits, and that it only required 200 hours of training to be considered an “advanced practitioner.” 

A 2013 Health Department report asserted that the law created a high density of massage establishments, mostly located downtown. Out of the 154 establishments, “Approximately 50 percent of the massage establishments have not received a violation,” the report states. “The top 25 percent of violators are responsible for nearly 75% of active massage parlor violations.” 

San Francisco Police Department records show that 120 incident reports regarding “massage establishment permit violations” were filed from 2013 to 2018. But of those, only six resulted in an arrest.

Regardless of whether illicit massage parlors are — or were — conduits for human trafficking, massage therapists argue, Tang’s legislation has been largely ineffective in stopping it. Currently, there are three health inspectors in charge of inspecting 188 massage establishments, according to a Health Department spokesperson. 

But those inspectors are only inspecting the businesses that have bothered to jump through the hoops required of legitimate massage purveyors. City inspectors are not tasked with overseeing the many underground massage operations in this city. 

And the number of underground operations may dwarf the legitimate ones. The 188 registered massage business appears to be only a fraction of those operating in the city. A basic San Francisco Yellow Pages search for the word “massage” turns up 563 results. (A basic Yelp search brings up 1,997 results.) 

The businesses following the rules, meanwhile, are the ones being punished, Combs said. As a result, “everyone is going underground.”


Combs and the seven-member San Francisco Massage Council, which was created in 2017 to advocate for massage therapists in the wake of the 2015 legislation, are in the process of urging the city to change the law. It’s an “I told you so” moment for Combs, who vehemently opposed the earlier legislation. 

More than anything, Combs and others in the industry want to change the perception that massage is inextricably linked to sexual services and human trafficking. “We are about health and wellness,” she said. “The end.” 

Combs said she’s currently working with the Office of Small Business to identify areas for policy change and then will shop them around to the Board of Supervisors. Right now, specifics on any potential legislation are unclear. 

“I believe once the supervisors see the facts, they’re going to understand that this legislation destroyed an industry that’s mostly female,” she said. “When they see that they’re going to pass common-sense legislation.” 

A body massage sign outside of 3914 24th St. Photo by Abraham Rodriguez.

Meanwhile, Pierce is still searching for a legal location. After leaving ActivSpace in April, she could not even find a place in so-called “wellness centers” that offer a slew of alternative health services like acupuncture, midwifery, and yoga — which are not subjected to the same standard as massage practitioners. 

“They said, ‘we don’t want these kinds of inspections in our space, but you’re more than welcome to work here illegally,’” she said. 

Pierce rejected that offer, and remains on the hunt. “It’s been really hard,” she said. 

Follow Us

Julian grew up in the East Bay and moved to San Francisco in 2014. Before joining Mission Local, he wrote for the East Bay Express, the SF Bay Guardian, and the San Francisco Business Times.

Join the Conversation


Please keep your comments short and civil. We will zap comments that fail to adhere to these short and very easy-to-follow rules.

Your email address will not be published.

  1. It doesn’t help that the tech industry welcomes advertisements from what is obviously illicit massage businesses even though such businesses are in violation of their own terms of service… to the detriment of the legitimate massage community.

    From the search engine (guess who?!) accepting ads that clearly indicate sensual/sexual massage, to the domain hosts/website design companies, to review sites who allow “nuru” massage listings… the tech industry is making massage industry a scapegoat
    for their collective support of sex workers.

    Their standard operating procedure is to ignore… feign ignorance, act sympathetic, and don’t adhere to their own policy or remove/ban the offenders.

    In the case of the search engine ad network, it is essentially shilling the auction process as they know there are illicit players in the auction market which drives costs up for all participants. I can’t believe that they haven’t been investigated for such practices, but I suspect that this all boils down to the Backpage/SESTA/FOSTA etc. (3rd party posting)

    They’re thumbing their collective noses at the DOJ. They’ve got so much money that even if they get investigated and fined, it’s a drop in their billion dollar buckets.

    As most MT’s will say, they don’t have a problem with the sex worker industry. It is only when they use the term ‘massage’ to describe their services that there is a problem. Don’t care what you call it, just don’t call it that.

  2. The city shouldn’t be putting the burden on the therapists, but rather go after the human trafficking, and actually catch them.

  3. The state does not license or certify massage therapist. The legislature passed the law that formed the independent CA massage therapy Council, If you are certified by CAMTC, you can not claim to be licensed.

  4. Please don’t use the terms “masseuse” or “massage parlor.” They are outdated terms. Massage Therapist is the preferred term.

  5. I live near the Tenderloin, and I can tell you that there are illicit massage parlors aplenty, open at all hours of the night. Why would the health department waste time with demanding money and all these registrations for private, independent therapists who work solo? What — are people going to human traffic themselves? For people like me, I am already state certified , insured, registered with the city treasury, and have a business license. I pay taxes and fees. All this extra special permitting crap is ridiculous; obviously it would make more sense if you were running a spa operation with multiple employees. But small, solo practices? It doesn’t make any sense at all. What the health department should do is focus on the human waste, needles, the people lying almost dead on the sidewalks, the illegal drug use, and mentally ill everywhere instead of people busting their humps to work hard and earn a living in this town and provide healing services.

  6. It’s simply stupid to try to put syndicate crime out of business by rising the costs. The legit therapists will be wiped out first. Who can better bear the costs of regulation than the criminals who charge more and pay less? Here’s how you regulate a profession and week out the ethically challenged: you require professional education (200 hours is pitiful and well below national standards) for entry. Criminals do not have the time or talent to marshall educated flotillas of prostitutes.

  7. Who can afford the regulations costs: the crime syndicates or the legitimate therapists? How stupid it is to try to regulate by mere costs instead of making professional standards the ground rule?

  8. This is nothing new to anyone who runs s business or construction project in San Francisco. The city kills you with time wasting bureaucracy, endlessly disorganized coordination among various city departments, and exorbitant fees. And then everyone wonders why only high end restaurants, tech companies, and chain stores can make it in the city. San francisco is the least business-friendly city I’ve ever experienced, and this is just one in many unintended consequences of progressive do-gooder meddlers.

    1. It means criminal “massage” syndicates can survive as well. Legit Massage Therapists are certified by the state and should not have city burdens. One thing that could be common ground would be to raise the education requirement to a national standard, which is at least 500 hours.

  9. Welcome
    To the most corrupt big city government on the west coast. There are so many massage parlors that front human trafficking in San Francisco that websites catering to clientele offer reviews of the run & tug workers by name. But sold out city hall instead goes after actual masseuses on technicalities. Hmmmmm what could possible be behind this seeming scandal? Let me get out my “Ouija for mobsters” game board and see if I can spell it out.

    1. I think you mean, “you have to pay to work”. And just how easy is it to up rot your business and your life? Please tell us.

    2. Sounds like that’s exactly what people are doing. It’s going to literally kill San Francisco’s wellness industry.