NEW YORK: Metzitzah now virtually unregulated

the Washington Post
September 9, 2015

NYC ends consent requirement for circumcision suction ritual

by Jennifer Peltz 
NEW YORK — People who perform an ultra-Orthodox Jewish circumcision suction ritual will no longer have to get parents to sign acknowledgements of potential health risks, the city Board of Health decided Wednesday, reversing a policy that pitted health officials against religious leaders over a practice that dates to biblical times.

The vote formalized a tentative policy shift Mayor Bill de Blasio’s administration made in February. The city now distributes information about what officials see as possible risks of oral suction circumcision, but signed consent forms are no longer required.

“The Board of Health, from the start, aimed to ensure that parents had information so that they could make informed decisions,” Health Commissioner Dr. Mary Bassett said Wednesday, adding that the consent requirement “hadn’t been that effective.”

The practice is performed each year on an estimated 3,000 New York City babies, a fraction of the city’s Jewish population. The ritual, formally called metzitzah b’peh in Hebrew, entails a rabbi or another circumciser sucking blood from an infant’s circumcision wounds.

City health officials believe the practice was linked to at least 18 cases of infant herpes since 2000, though DNA testing to pinpoint the source of the infection was not done in all cases. Two babies died, and two others suffered brain damage.

In 2012, the health board passed a requirement for signed consent from infants’ parents or guardians, including acknowledgement that they understood that health officials recommended against the practice.

Some rabbis objected, seeing the requirement as an imposition on religious rights, and they urged their faithful not to comply. Those who performed the ceremony questioned any link between the practice and spreading herpes, saying they deployed herpes testing, hand-scrubbing and mouthwash to ensure it didn’t.

Rabbi Romi Cohn of Brooklyn, who says he has safely performed about 35,000 such rituals, commended the city’s change of direction.

“Oral circumcision is part of our tradition,” he said by phone after Wednesday’s vote. “I think New York will be blessed for doing the right thing.”

The matter put the health board in a difficult position, members noted.

“It is our core responsibility to protect the health of New Yorkers,” member Dr. Deepthiman K. Gowda said. “At the same time, we have to institute educational policy that actually works. ... The rollout of our previous policy actually eroded the relationship we wanted.”

But some weren’t convinced the problems merited ending the requirement.

“A very significant public health concern is served,” said Dr. Lynne Richardson, who abstained from the vote.

The city has distributed 20,000 printed copies and 22,000 email copies of a new informational brochure in English and Yiddish, Bassett said.

Earlier story

NEW YORK: Metzitzah: De Blasio stacks Health Board to get rid of consent forms

NY Times
June 9, 2015

De Blasio Puts Allies on Panel Hearing Circumcision Plan

by Michael M. Grynbaum
Mayor Bill de Blasio has installed numerous allies on the New York City Board of Health as his administration prepares to present a controversial plan that would ease the rules on a circumcision ritual linked to herpes infections in infants.

The mayor has pointed to his proposal as a way to protect public health while respecting the ultra-Orthodox Jewish community that cherishes the ritual, known as metzitzah b’peh, or oral suction.

But a planned presentation to the board in March was abruptly delayed. Since then, Mr. de Blasio has moved to shake up the health panel, filling vacant spots and replacing members appointed by his predecessor, Michael R. Bloomberg.

Three of the new board members were contributors to Mr. de Blasio’s 2013 mayoral campaign; among those donors, one is married to an unpaid special adviser to the mayor. The fourth is the president of the city’s Health and Hospitals Corporation, a position he was placed in by Mr. de Blasio.

The mayor’s proposal, which requires approval by the board and will be presented on Wednesday, is supported by ultra-Orthodox rabbis who are among Mr. de Blasio’s most important political supporters. It would waive a requirement that parents sign a consent form before the ritual, which involves sucking blood from the incision on a baby’s penis.

Instead, the mayor’s plan would create an alternative system that would test a circumciser, or mohel, for herpes, although only after a baby is found to be infected. If the circumciser tests positive, penalties would be pursued if DNA tests can prove that the mohel and the baby were infected with the same strain.

The consent rule, introduced under Mayor Bloomberg, was assailed by Orthodox leaders as an infringement of their religious rights. Mr. de Blasio pledged to rescind the rule, and his aides later said the consent forms had been difficult to enforce, saying that herpes infections linked to the practice actually rose in 2014.

“This approach hasn’t been working in the past, and we need a new approach to truly reduce the health risk for infants,” Mr. de Blasio’s press secretary, Karen Hinton, said in a statement on Tuesday.

Ms. Hinton added that the mayor had an “obligation to ensure that the Board of Health is fully staffed with highly qualified health experts.”

Since 2000, the circumcision ritual has been linked to more than a dozen cases of herpes infection in infants and at least two deaths. Several health organizations, including the American Academy of Pediatrics, have warned that the ritual can significantly raise the risk of an infant’s being infected.

Aides to Mr. de Blasio have sought to characterize the mayor’s plan as sound science, and they dismiss the earlier Bloomberg approach as a mockery that was ineffective and strained ties with the Orthodox community. Ms. Hinton said that the city would distribute information about the ritual.

A simple majority of the 11-member Board of Health is required to adopt the new circumcision rules.
Dr. Mary T. Bassett, the city health commissioner, has a vote. So does Pamela S. Brier, a Bloomberg appointee who supports the mayor’s plan.

Ms. Brier, the chief executive of Maimonides Medical Center in Brooklyn, has her own ties to Mr. de Blasio. About a decade ago, she created a job at the medical center for his wife, Chirlane McCray.

Dr. Thomas A. Farley, who served as health commissioner under Mr. Bloomberg and spearheaded the consent rule, said on Tuesday that he was concerned about the board’s undoing the older policy.

“This is an inherently risky procedure,” Dr. Farley said. “Focusing on one or another specific mohel is not going to address that fundamental risk.”

Mr. de Blasio’s new appointees include Karen B. Redlener, who oversees several pediatric programs at the Children’s Hospital at Montefiore. Ms. Redlener and her husband, Irwin, the special adviser to the mayor, contributed $1,900 to Mr. de Blasio’s 2013 campaign. Two of the appointees, Rosa Gil and Gail Nayowith, gave $400 and $800.

Earlier story

NEW YORK: Metzitzah: New regulations delayed

Wall Street Journal
March 9, 2015

NYC Delays Decision to Repeal Mandatory Parental Consent for Jewish Ritual

by Michael Howard Saul and Melanie Grayce West
Mayor Bill de Blasio’s administration has delayed plans to repeal a city regulation requiring parental consent before a Jewish circumcision ritual is performed.
The ritual can cause herpes infection in infants.

Last month, administration officials announced a tentative agreement with a group of Jewish leaders in which parental consent would no longer be needed to perform the ritual known as metzitzah b’peh in which the mohel, the person who performs the circumcision, sucks blood from the baby’s wound.
Administration aides initially said the proposal would be presented to the Board of Health this month. Officials said Monday the proposal is now slated to be presented to the board in June and voted on at the panel’s next meeting.

“The administration and the coalition of religious leaders are formalizing specific terms of the agreement around metzitzah b’peh,” the city said in a statement from the Department of Health and Mental Hygiene released Monday.

The parental consent policy, approved by the board in 2012 when Michael Bloomberg was mayor, drew outcries from some in the Jewish community who lambasted the regulation as an attack on religious freedom. The ritual is practiced mostly by ultra-Orthodox Jews.

A person familiar with the negotiations between the religious community and the city said Monday the delay in presenting the proposal to the board was largely related to the city working out the specifics on how public health investigations will be conducted. There were some other legal issues, as well, the person said.

Another person familiar with the matter said city officials were concerned about rushing the proposal. Officials want the proposal to be as strong as possible, this person said, because the administration is asking board members, many of whom were appointed by Mr. Bloomberg, to reverse themselves.
The delay was not a concern at all to David Niederman, the president of United Jewish Organizations of Williamsburg and North Brooklyn, and a rabbi involved in the negotiations with the city over the policy.

“The mayor has personally committed to ensure public safety in a very responsible and collaborative way with the community,” Rabbi Niederman said. “These delays, I understand, are procedural stuff with the city. I have no doubt that everyone is on the same page and that this issue is going to be resolved to the satisfaction of all concerned.”

The Wall Street Journal February 27, 2015 A Bad Call on Risky Circumcisions by the Editorial Board The herpes simplex virus, common and relatively harmless in adults, can be deadly to babies. Such infections in newborns are blessedly rare, but one thing is known to increase the risk significantly: the circumcision ritual called metzitzah b’peh, practiced by many ultra-Orthodox and some Orthodox Jews, in which a circumciser, or mohel, sucks blood from a newly cut penis with his mouth. The New York City Health Department, American Academy of Pediatrics, Centers for Disease Control and Prevention and other authorities have long warned about the dangers of the practice. The Health Department has linked it to more than 12 herpes cases, and two deaths, since 2000, and has tried to get mohels to stop doing it. That is why it is distressing to see Mayor Bill de Blasio and Orthodox leaders celebrating a deal they made this week to abandon the city’s modest effort to regulate the practice, and instead leave it to the ultra-Orthodox community to help limit the damage metzitzah b’peh does — but voluntarily, and only after babies get sick, not before. Mr. de Blasio wants to stop requiring parents to sign a waiver acknowledging the risks of metzitzah b’peh. Rabbis called that policy, begun under Mayor Michael Bloomberg, an unconscionable infringement on religious freedom. They refused to use the forms and sued the city. And so Mr. de Blasio, who has pleased the potent Orthodox voting bloc by ridiculing the policy as unenforceable while making no visible effort to enforce it, has decided simply to let the mohels do their thing, until a baby gets sick. The plan then is to do a series of DNA tests; if the baby’s mohel has the same herpes strain as the infected baby, he will be forbidden to do circumcisions. The plan needs Board of Health approval. The board should say no and take a stand for basic hygiene and common sense. Otherwise, this will be a city that requires tattoo artists to take infection-control courses and use sterile tools but tolerates an amateur surgery in which infection is fought with no more than perhaps a swig of Listerine. The administration says it will ask hospitals and doctors to distribute information about the risks of metzitzah b’peh, which should include accurate descriptions, including photographs, of the lesions and brain injuries suffered by babies whose safety their rabbis — and mayor — have allowed to be jeopardized.

NEW YORK: Metzitzah: No consent forms, mohelim tested after infection

Jewish Press
February 24, 2015

Mayor de Blasio Annuls Metzitzah B’peh Consent Form Regulation

by Jacob Kornbluh
NYC Mayor Bill de Blasio has decided to annul the regulation enforced by the Bloomberg administration on the practice of Metzitzah B’peh, JP has learned.

The city has agreed to no longer require that a mohel obtain a signed consent form before he is allowed to perform the ritual. The City will support a Board of Health consideration to repeal the health code provision regarding written consent, the mayor’s office announced Tuesday evening.

“While the de Blasio Administration continues to believe that MBP carries with it health risks, given the sacred nature of this ritual to the community, the Administration is pursuing a policy centered around education of health risks by the health care community and respect for traditional practices by the religious community,” the mayor’s office said in a statement. “Increasing trust and communication between the City and this community is critical to achieve the Administration’s ultimate goal of ensuring the health and safety of every child, and this new policy seeks to establish a relationship based on engagement and mutual respect.”

During the race for mayor, de Blasio criticized former mayor Michael Bloomberg’s attitude and enforcement of the new consent regulation on Metzitzah B’peh. He promised Jewish leaders that he will seek to find a solution the moment he will enter office. After entering office, the mayor engaged in discussions with community leaders and health officials to reach a compromise that will satisfy the Orthodox Jewish community over the Bris Milah dispute with City Hall.

At a get-out-the vote rally in Williamsburg two days before the Democratic primaries for mayor, Satmar (Ahronim) community leaders declared that de Blasio pledged to eliminate the consent forms required for Metzitzah B’peh. As first reported by JP, one community leader told the crowd assembled that de Blasio was “the first one in politics to come to our defense on the issue of Metzitzah B’peh. And he’s the only candidate that recommitted himself now to guarantee that we as Orthodox Jews can practice [it] without compromise.”

After Mr. de Blasio has finished his speech, Rabbi Moshe Indiq approached the microphone and said he’d been asked “to announce to our community” that Mr. de Blasio was “the only mayor candidate that promised … it will be eliminated!”

According to the new deal reached with a coalition of Rabbinical leaders from across New York City, the administration will ask hospitals, obstetricians and pediatricians who serve the community to distribute information about the health risks associated with and MBP. Health care providers will also provide parents with contact information for the Department of Health and Mental Hygiene (DOHMH) for parents who seek additional information.

Additionally, the community will direct mohelim to continue to respect the wishes of any family that has chosen to not have MBP performed on their son.

In return, the rabbinical coalition has pledged, for the first time, to cooperate with the DOHMH in identifying the mohel in question and asking the individual to undergo testing in cases where an infant has HSV-1 (herpes simplex virus 1) associated with MBP.

In cases where the mohel tests positive for HSV-1, DOHMH will conduct DNA testing to attempt to definitively establish the source of the baby’s infection as part of a comprehensive investigation of any other possible sources. If the mohel is found to have infected the infant with herpes, he will be banned for life from performing MBP by DOHMH, with support from and cooperation of the community.

The community has also agreed to engage in campaign to have every mohel who performs a circumcision or MBP take steps to lessen the risk of transmission of herpes.

NEW YORK: Metzitzah: Rockland adopts own protocol

Capital (New York)
Janauary 9, 2015

Rockland takes a new tack on risky circumcisions

by Dan Goldberg 

While New York City remains stalled in its efforts to come up with a better way of regulating a controversial circumcision ritual practiced by some Orthodox Jewish sects, Rockland County health officials made a deal with a local community to create a protocol to assess and mitigate risks associated with the practice.

The ritual, called metzitzah b'peh, involves a mohel—the practitioner of the circumcision ritual—suctioning blood from a baby's wounded penis with his mouth. The practice of placing mouth to open wound has been linked by city health officials to the spread of Herpes Simplex Virus-1 to babies.

The protocol worked out in a nonbinding agreement between health officials and community leaders in Rockland County—home to one of the state's largest concentrations of ultraorthodox Jews—is as notable for what it doesn't attempt do to as what it does.

It doesn't alter the ritual, or require parents of boys undergoing it to sign a waiver acknowledging the dangers of the practice, as New York City currently requires. It also doesn't immediately eliminate the risk of babies contracting herpes from infected mohels.

But it does, by securing the cooperation of a deeply religious community that is sometimes hostile to regulation by secular authorities, allow for testing and data-gathering to identify and ban mohels who infect circumcised babies with herpes.

Per the agreement between the county health department and community leaders, if a mohel is found to be the direct source of a baby contracting HSV-1, then that mohel would be permanently banned from performing the ritual, according to Dr. Oscar Alleyne, the county's director of epidimiology.

The Rockland health department has so far tested eight babies who presented with herpes symptoms after circumcision, Alleyne said. Of those, three had the virus. In two cases, the Rockland health department concluded the mohel was not responsible. One case was inconclusive.

“From Rockland County's perspective, the individuals who did the metzitzah b'peh were not the ones who matched, and that tells us we have to look at the bigger picture,” Alleyne said.

It's a very small sample, but the effort attempts to address, however imperfectly, the health-based concerns about the practice.

Of the cooperation with the Orthodox community, Alleyne said, “That in and of itself was a major breakthrough."

Under the system set up in Rockland, if a state lab determines a circumcised baby has HSV-1, county officials work to identify all the potential point sources that come into contact with the infant. Those individuals are then swabbed and tested to see if they have HSV-1 and if their strain matches the infant's. Because the virus is not always detectable, the county conducts 60 swabs over a period of 30 to 60 days to try and ensure that nothing is missed.

The agreement also requires mohels not to perform the ritual on other babies while testing is taking place, and Rockland health officials are discussing additional measures that can make the practice more hygienic.

The community has agreed, according to Alleyne, that if a mohel is found to be the cause of infection then he will voluntarily stop performing anywhere in the world for the rest of his life.

The agreement between Rockland and the Orthodox communities there—the largest communities are in Monsey and New Square—is similar to one that was discussed with the New York City health department in 2006. That plan was rejected by the city, according to court documents.

By only testing mohels after the fact of an infection, the system can reduce but never actually eliminate the health risk. And it leaves in place a ritual that is unhygienic and, according to New York City health officials, among others, inherently dangerous.

But Alleyne says it is clearly the best option available to the county.

“We are a health department," he said. "We can't legislate the procedure. We don't have the ability to do so and there is the question of how efficacious it would be anyway. But there are ways for us to encourage practices to be safer.”

New York City's efforts to reckon with metzitzah b'peh would seem to bear him out, in terms of the difficulty of imposing a more aggressive system of regulation.

The issue has been a live controversy in New York City since the Bloomberg health department first sought to regulate the practice by requiring that parents sign a consent form acknowledging that the city health department does not believe the ritual is safe.

The regulation was challenged in court. Attorneys representing the Orthodox sects said the city's health department was overestimating the dangers, and that there was insufficient evidence to prove metzitzah b'peh is dangerous enough to warrant a public health intervention.

Mayor Bill de Blasio promised to address the consent-form arrangement—which the neither the city nor the Orthodox sects affected by it were happy with—on his first day in office. But he has yet to address the topic in any meaningful way.

Marti Adams, a spokeswoman for the mayor, told Capital the administration plans to unveil a policy "soon," but did not detail what that policy would be.

"The administration is working to develop a new, more effective policy that protects children and protects religious rights in a way that the community is comfortable with, and accepting of, and will participate in," Adams said. "We expect to announce this new policy soon.”

The city's efforts to regulate the ritual are complicated politically by the resolute opposition of the Orthodox sects who support unfettered metzitzah b'peh, but legally, by courts rulings that have made it clear that the practice can't simply be banned for being distasteful.

A federal appeals court ruled any city effort to infringe upon the practice must pass the “strict scrutiny” test, meaning the government must prove the law serves a compelling state interest and that it was written in the least burdensome way possible. The case was sent back to the lower court and has not yet been heard.

The city's health department has for years warned the practice can spread HSV-1, which is common in adults but can be dangerous for newborns.

City health officials have linked 17 cases of neonatal herpes to direct oral suction in the last 15 years. Of those, two have died and two more suffered brain damage.

The city maintains the timing and placement of the lesions is indicative of a virus that was caused by oral suction, and produced several expert witnesses who supported the claim.

Dr. Anna Wald, who assisted in drafting guidelines on the management of H.S.V. infection for the Centers for Disease Control and Prevention, said the evidence linking direct oral suction with neonatal infection is “strong, consistent, and more than biologically plausible.”

The health department argues that there are multiple lines of evidence supporting their assertion. Specifically, health officials say that no other explanation makes sense.

"Any hypothesis to explain these infections needs to explain why these infections are HSV-1, not HSV-2, occur on the genitalia, occur in newborn baby males but not females from Jewish families practicing direct orogenital suction, are clustered in a single Brooklyn zip code where there are no female infant herpes infections, have occurred in babies born to women who do not have HSV-1 infection, and occur within a time frame consistent with transmission during circumcision," said Jean Weinberg, a spokeswoman with the health department.

But without reaching an agreement with the mohels the way Rockland did, the city can't do the tests necessary to prove beyond a reasonable doubt that infected mohels cause the spread of the disease.
That's why city officials use phrases such as “the location … timing of signs and symptoms are consistent with” metzitzah b'peh.

Between 2006 and 2011, the city reported 84 cases of neonatal herpes. Among those, 30 boys had HSV-1 or untyped HSV infection, and five of these boys had confirmed or probable direct orogenital suction.‎ (The disease can also be passed on to babies by family members or other caregivers.)
...

Earlier story

NEW YORK: Metzitzah: Mayor De Blasio to move "soon"

Capital New York
January 7, 2015

De Blasio to act ‘soon’ on circumcision ritual

by Dan GoldbergJan The de Blasio administration says action is coming soon on the mayor's long-stalled vow to address the controversial circumcision practice known as metzitzah b'peh, promising a policy that will protect children while respecting religious rights.

The religious ritual as practiced by some Orthodox Jewish sects involves a mohel—a person who performs circumcisions of 8-day-old boys—suctioning blood directly from a wounded penis with his mouth.

Health department officials believe the practice can spread herpes simplex virus-1, which is common in adults but can be especially dangerous for infants. The communities that practice metzitzah b'peh have fiercely resisted city attempts, going back before the de Blasio administration, to regulate it.

The city's health department currently requires parents to sign a consent form acknowledging that the health department recommends against performing the practice, a Bloomberg-era policy that was challenged in court. Attorneys representing the Orthodox sects said the city's health department was overestimating the dangers, and that there is insufficient evidence to prove metzitzah b'peh is dangerous enough to warrant a public health intervention.

Mayor Bill de Blasio promised to revisit the consent-form rule on his first day in office, but has so far not addressed the topic.

 

Mayoral spokeswoman Marti Adams said the administration plans to announce a new policy, but did not detail what that policy would be or exactly when it would be revealed.

"The administration is working to develop a new, more effective policy that protects children and protects religious rights in a way that the community is comfortable with, and accepting of, and will participate in," Adams said. "We expect to announce this new policy soon.”

In 2014, the health department reported four cases of neonatal herpes it believed were linked to the practice.

Earlier story

NEW YORK: Metzitzah: Another baby has herpes

Capital (New York)
Deceber 23, 2014

City reports new case of herpes after metzitzah b'peh

by Dan Goldberg
The city's health department reported that another infant has been diagnosed with neonatal herpes following the Jewish circumcision ritual known as metzitzah b’peh.

There have now been four reported cases in 2014, and though Mayor Bill de Blasio promised to address the issue on "Day 1" of his term, there have been no policy changes during his first year in office.

Metzitzah b’peh involves a mohel sucking the blood directly from the wounded penis and has been roundly criticized by public health experts and by most authorities in the Jewish community.

While some in the Orthodox community contend this is the only acceptable way to perform a circumcision, or Brit Milah, many authorities condone squeezing the blood out or using sterile pipette to suction the blood, which decreases the chance of infection.

This is the 17th case since 2000, the health department said. Of those 17, two infants have died and at least two more have suffered brain damage.

The most recent case involved a boy born in November. Twelve days after his circumcision, the baby was brought to a pediatrician’s office because of concerns about fussiness after feeding, according to the health department. The boy had a “cluster of papules” on his penis and was sent to a dermatologist who then sent the boy to the emergency room.

The location of the lesions, timing of signs and symptoms, and laboratory identification of HSV-1 are consistent with transmission of the herpes virus during direct contact between the mouth of the ritual circumciser and the newly circumcised infant penis, the health department said.

Circumcision usually occurs on the eighth day of life, a time when an infant's immune system is not fully developed. While many adults can have mild cases of herpes, the virus can be far more dangerous if contracted by a newborn.

Dr. Thomas Farley, the city health commissioner under former mayor Michael Bloomberg, "strongly advised" the practice "never be performed."

In 2013, the Bloomberg administration instituted a rule that required mohels to obtain written consent before performing metzitzah b’peh. The consent form contained the warning that “the New York City Department of Health and Mental Hygiene advises parents that direct oral suction should not be performed.”

The policy, which did nothing to prohibit the practice, enraged many in the Orthodox community who felt their religious freedoms were being violated.

The regulation, according to reports in The Jewish Daily Forward, was rarely enforced, and in August a federal appeals court ruled it must pass a stricter constitutional test than was applied by the lower court.

During a Democratic mayoral primary debate in 2013, de Blasio was asked if he approved of the consent form, and he criticized Bloomberg for not engaging in a dialogue with the “community.”

“I would start over,” de Blasio said. “Change the policy to find a way to protect all the children but also respect religious tradition in an appropriate manner and come in Day 1 to City Hall with a new policy that's fair.”

De Blasio has not changed the policy.

When introducing Dr. Mary Bassett, his choice for health commissioner, de Blasio said he intended to leave the Bloomberg consent policy in place until some better policy could be found.

“I've said we will keep it in place while searching for a solution that is more effective,” de Blasio said at the time. "The current approach can be better and that's what we are going to figure out a way to do—with the community.”

De Blasio has not changed the approach.

His office did not immediately respond to a request for comment.

Earlier story

NEW YORK: Metzitzah: Two mohelim stopped after babies get herpes

The Jewish Daily Forward
August 8, 2014

2 Mohels Banned After Infants Contract Herpes in Circumcision Rite

Just One Consent Form Collected by City in Two Years
by Paul Berger
New York City has banned two mohels from performing a controversial circumcision rite after they were suspected of infecting babies with herpes.

But the city's health department will not reveal their names.

Five infants have contracted herpes since September 2012, when the health department passed a regulation requiring mohels to get written consent from parents before using their mouth to suction blood from a circumcision wound - a religious rite known as metzitzah b'peh, or MBP.

MBP can transmit a strain of herpes from the mouth of a mohel to the infant and is potentially fatal to newborns, whose immune systems are underdeveloped. Infants who contract the disease can also suffer brain damage. The MBP rite is common in the ultra-Orthodox community.

In the past, some parents whose babies contracted herpes have refused to identify their mohel to city health officials. Of the five cases since the autumn of 2012, the health department has been able to identify just two mohels.

Only one of those mohels obtained written consent before performing the circumcision.

"In all of the cases, we have asked whether there were forms and, in the two cases where we were able to identify the mohel, we have requested them from him," a health department spokeswoman told the Forward on July 24. Of these two cases, one had a form, which he provided, the spokeswoman said. The other one did not. "The department issued orders banning both mohelim" from practicing MBP, she said.

The spokeswoman would not name the mohels, citing privacy concerns. She also did not respond to several emails asking how the ban would be enforced and how the public could know the mohels in question were banned if their names were not made public.

More liberal Orthodox Jewish leaders do not support the MBP practice and deplored the latest news about its consequences. "I would hope that any mohel who unfortunately has transmitted a disease via metzitzah b'peh would stop practicing metzitzah b'peh because of the safety of our children," said Rabbi Leonard Matanky, president of the Modern Orthodox Rabbinical Council of America.

But Matanky stopped short of calling for the health department to release the names of the banned mohels. The rabbinic leader said it would be presumptuous of him to comment, because he did not have enough information about the cases or the legal reasoning behind the city's decision.

Earlier story

ONTARIO: OK for doctor to suck baby's penis blood (through a tube)

National Post (Canada)
July 9, 2014

Doctor cleared after complaint over
Orthodox Jewish practice of sucking
blood from baby's penis at circumcision

by Tristin Hopper
A Toronto doctor who employs the traditional Jewish practice of orally sucking blood from a baby’s penis following circumcision has been cleared by Ontario’s physician review board after an anti-circumcision activist filed an official complaint accusing him of religious bias and “sexual motive.”

The ritual of orally suctioning blood from a circumcision wound, sometimes through a plastic tube, is known as metzitzah b’peh and is practised almost exclusively among Orthodox and ultra-Orthodox Jewish circles.

“There is no information to support the … contention that there was a sexual motive to the method by which the [doctor] performed ritual circumcisions,” reads a decision document published Tuesday by the Health Professions Appeal and Review Board.

The Board ultimately concluded that the original complaint, which was linked to a Seattle-based anti-circumcision group, was obviously meant as “a broadsided attack on the practice of circumcision.”

“I’m pleased with the decision, but I’m not going to comment,” Dr. Aaron Jesin, a family practitioner who has performed more than 10,000 circumcisions, told the National Post by phone on Wednesday.
Metzitzah b’peh has become the subject of heightened controversy in recent years after it was linked to numerous cases of herpes infection in New York City.

According to New York City health officials, the ritual practice infected 11 boys with neonatal herpes between 2004 and 2011, with fatal implications for two of them.

As the operator of the Jesin Circumcision Clinic, Dr. Jesis performs ritual circumcisions upon request, but told investigators he has a “strong personal stance” against performing metzitzah b’peh with direct oral contact, and said he prevents the risk of infection by using a sterilized plastic tube to suction the blood.

Reviewers later concluded that this provided “adequate protection” against infection.

In a 2012 edition of the Canadian Jewish News, Dr. Jesin was quoted in an article about oral suction.
“If you believe metzitzah b’peh is … [Jewish law]” he told a reporter, “then you will feel very strongly that it’s the only way.” [And the relevance of this to the practice of medicine is...?]

‘It was obvious that he and the Applicant were using the complaint procedure to launch a broadsided attack on the practice of circumcision, whether ritual or non-ritual’

Within four months, the article caught the eye of a complainant identified only as “D.S.” In a letter to the College of Physicians and Surgeons of Ontario, he alleged that Dr. Jesin was no longer fit to practise medicine “due to personal bias surrounding his religious beliefs.”

The letter added “although it might be presumptive for me to say so, I will say to you that given the nature of this breach, one cannot rule out sexual motive.”

In follow-up letters, D.S. would go even further, calling for a full-scale inquiry into Ontario’s “ritual amputation activities,” and claiming that the practice was counter to the Charter of Rights and Freedoms.

A further submission by D.S.’s lawyer claimed that no certified medical doctor should be allowed to engage in the “unnecessary amputation of healthy genital tissue from a child who cannot consent to the procedure itself, let alone consent to a sub-standard version.”

Although the letter-writer is never named, his lawyer identified himself as the executive director of the group Doctors Opposing Circumcision, a position long occupied by Seattle lawyer John V. Geisheker.

A detailed review by the College of Physicians and Surgeons of Ontario — as well as its provincial watchdog — ultimately dismissed the complaints against Dr. Jesin outright, claiming the whole process had been meant as a kind of political protest.

“It was obvious to the Board that he and the Applicant were using the complaint procedure to launch a broadsided attack on the practice of circumcision, whether ritual or non-ritual,” read Tuesday’s decision document.
[So? Would a complaint about cruelty to animals be ruled out because it came from a vergetarian group?]

The College, in particular, wrote “this is not the proper forum for addressing the issue of male circumcision.” [Then what is?]

Earlier story

NEW YORK: Metzitzah: Another baby gets herpes

Vos Iz Neias
January 29, 2014

New York, NY - NYC Health Dept. Issues "Alert" To Medical Community After New Case Of Neonatal Herpes From MBP

by Glen Silver
New York, NY - The New York City Department of Health and Mental Hygiene has issued an “alert” to the city’s medical community following a January 2014 case of neonatal herpes following the Jewish circumcision ritual metzitzah b’peh, or MBP.

According to the document, the newborn was the product of a full term pregnancy and underwent the MBP ritual on his 8th day of life, after which a doctor conducting a routine check-up the following week noticed a rash on the child.

After a series of unsuccessful treatments, HSV-1 (herpes simplex virus, type 1) was suspected and specimens were collected and sent off to the New York State Wadsworth Center Laboratories.

The child was hospitalized for treatment after the diagnosis of HSV-1 was confirmed.

According to the release it is the 14th laboratory-confirmed case of MBP-related HSV-1 on record at the Health Dept. since 2000, two of which resulted in death—-while yet another two young boys suffered brain damage.

The issue of MBP has continued to be a hot-button topic for New Yorkers, more specifically New York’s Jewish community after former-Mayor Michael Bloomberg’s implementation of parental consent forms sparked outrage.

At a January 16 news conference, new Mayor Bill de Blasio doubled down on his campaign promise to work with Jewish community members and religious leaders to actively seek an alternative to the consent forms, but said that for the time being they will remain in place.

Earlier story