NEW YORK: Metzitzah: City not telling doctors about herpes cases

The Jewish Daily Forward
September 25, 2015

New Controversial Circumcision Rite Rules: Don't Ask, Don't Tell

by Paul Berger
New York City has not only stopped requiring mohels to obtain written consent before performing a controversial circumcision rite — the city has also stopped alerting doctors and the public when it suspects that a mohel has infected a baby with herpes following the ritual, known as metzitzah b’peh or MBP.

Between January 2013 and December 2014 — when the city enforced its short-lived attempt to regulate MBP through a consent form — each time health officials identified a neonatal herpes infection linked to the practice, they reminded doctors of the care and sampling procedures to follow if infants displayed symptoms.

The alerts also brought media and public attention to the ongoing health issues related to the practice.
During that period, there were six cases in which city health officials believed that the ritual — in which the mohel uses his mouth to suction blood from the circumcision wound — infected a baby with herpes.

Since 2000 MBP has been blamed for 18 cases of neonatal herpes in New York City. Two of those babies died, and two others suffered brain damage.

But at the beginning of 2015, under pressure from the ultra-Orthodox community, the administration of New York City’s mayor, Bill de Blasio, announced the city’s intention to revoke the consent form regulation.

At a meeting of the city’s board of health September 9, when the consent form regulation was officially revoked, health commissioner Dr. Mary Bassett revealed that there had been a case of neonatal herpes infection linked to MBP this past April.

... the department’s press secretary, Christopher Miller, ...<1--gave no explanation. He later--> told the Forward in an email that the department did not issue a health alert for the April case because “we believed that awareness at the provider level was sufficiently high given all the press in recent months.”

...<1--But media attention surrounding MBP, which is practiced exclusively by a subset of ultra-Orthodox mohels, has been no greater this year than in previous years.

According to a search of news articles and transcripts on LexisNexis during 2013 and 2014, when the health department issued five health alerts — one for each month in which it became aware of a case or multiple cases — there were some 200 media stories about MBP and neonatal herpes.

>What has changed this year is the city’s approach toward MBP. During his 2013 election campaign, de Blasio pledged to replace a city regulation of MBP enacted in 2012 under former mayor Michael Bloomberg.

The regulation, which enraged the ultra-Orthodox community, required mohels to get written consent from parents before performing MBP.

The consent form, drafted by the city’s health department, warned parents that MBP poses a risk of infecting their child with herpes, which could result in brain damage or death.

Many leading ultra-Orthodox rabbis and mohels do not believe that MBP causes herpes infection in infants.

The virus, which commonly causes cold sores, is prevalent in more than two-thirds of adults in New York City.

Mohels say that by using the correct infection control practices, such as gargling with mouthwash, they can prevent the spread of the disease.

They believe that many neonatal herpes cases the city attributes to mohels were caused by a family member or a caregiver touching the circumcision wound with a finger or hand.

Yerachmiel Simins, a lawyer who represents the ultra-Orthodox community ...said that the ultra-Orthodox community has still not come to an agreement with the health department over the terms of the DNA protocol. He said that the ultra-Orthodox community has been keen to conduct DNA testing on mohels for years, but the city has “steadfastly and consistently” refused.

...Jonathan Zenilman, chief of the infectious diseases division at Johns Hopkins University, said that by allowing the ultra-Orthodox community to continue performing MBP as it did before the consent form regulation was brought into force, the city’s health department was being cowardly by acting in a “pusillanimous” fashion.
...

Earlier story

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: 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: 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: Court considers if consent form requirement needs strict scrutiny

Reuters
August 15, 2014

U.S. court revives challenge to New York City circumcision law

by Jonathan Stempel
NEW YORK (Reuters) - A federal appeals court on Friday revived an effort to block a New York City regulation that requires people who perform a Jewish circumcision ritual on infants that involves oral suction to first obtain parental consent.

A unanimous panel of the 2nd U.S. Circuit Court of Appeals said a trial judge had been too deferential to the city, which had linked the ritual to a deadly form of herpes, in rejecting a request by rabbinical groups for a preliminary injunction.

The three-judge panel directed U.S. District Judge Naomi Reice Buchwald in Manhattan to instead use "strict scrutiny" to see if the regulation infringed the plaintiffs' free exercise of religion, violating the First Amendment.

At issue was the ritual metzitzah b'peh (MBP), in which a mohel who performs a circumcision uses oral suction to draw blood away from a wound on an infant's penis. The procedure is sometimes performed in ultra-Orthodox communities.

In September 2012, the New York City Board of Health voted to require mohels to obtain advance consent in which parents acknowledged the risk of herpes infection linked to the ritual.
...

The Central Rabbinical Congress of the United States and Canada, the International Bris Association and some rabbis sought to halt enforcement, but Buchwald denied the request, saying the regulation addressed "legitimate societal concerns."

Circuit Judge Debra Ann Livingston, however, wrote for the 2nd Circuit that the regulation was not neutral toward religion because it "purposefully singles out religious conduct performed by a subset of Orthodox Jews," and applies exclusively to them.

As a result she said Buchwald should have not reviewed simply whether there was a rational basis for the regulation.

"The Department (of Health) may have legitimate reasons for addressing HSV infection risk among infants primarily, if not exclusively, by regulating MBP," Livingston wrote. "On the present record, however, the plaintiffs have made a sufficient case for strict scrutiny by establishing that the risk of transmission by reason of metzitzah b'peh has been singled out."

The 2nd Circuit did not rule on the regulation's constitutionality.

The city's law department had no comment on the decision.

In a joint statement, the plaintiffs called the decision a "great victory," and said they remain ready to work with city officials "to protect our children's health while fully respecting and accommodating our religious practice."

The case is Central Rabbinical Congress of the United States and Canada et al v. New York City Department of Health & Mental Hygiene et al, 2nd U.S. Circuit Court of Appeals, No. 13-107.

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

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

NEW YORK: Hypospadias - rabbi botches circumcision

Courthouse News Service
December 5, 2013

Mom Claims Rabbi Botched Circumcision

by Nick Divito
BROOKLYN (CN) - A rabbi botched the bris of an infant who had a birth defect involving his penis, and then failed to preserve the foreskin, the boy's mother claims in Kings County Superior Court.

Rabbi Eliyahu Shain performed the bris on Benjamin Altman in December 2009 at New York University Medical Center's Pediatric Associates of New York City.

But the boy's mother, Staci H. Altman, says the mohel failed to recognize that the boy had hypospadias, a medical condition where the urethra develops [no, emerges] on the underside of the penis.

[Hypospadias is an absolute contraindication for circumcision.]

Since then, the boy's permanent injuries have caused him to suffer "great physical pain and mental anguish and loss of enjoyment of life," according to the lawsuit.

The circumcision was allegedly performed "outside of a hospital or appropriate medical facility," ...

The boy's mother seeks unspecified actual and punitive damages for negligence.

...

NEW YORK: Western US circumcision rate falls dramatically

New York Times
August 22, 2013

Circumcision Rates in U.S. Drop Drastically in Western States

by Hope Reeves

¶ The percentage of male newborns who are circumcised in United States hospitals has dropped drastically. Over a 32-year period, the number of male newborns circumcised in the hospital decreased nationally to 58.3 percent in 2010 from 64.5 percent in 1979, according to new data from the Centers for Disease Control and Prevention.

¶ But while that 10 percent decrease over all is statistically significant, the authors of the report say, what leaps out of the data is a 37 percent drop in the West. In that 13-state part of the country, the rate of newborns receiving routine circumcisions at birth fell to 40.2 percent in 2010, by far the lowest rate in the country, from 63.9 percent in 1979. That decline accounts for virtually all of the shift nationwide.

¶ In the Northeast the overall trend was flat across the 32 years, with a high of 69.6 percent in 1994 and a low of 60.7 percent in 2007. Rates in the Midwest had dropped 3.3 percentage points over the period studied, with a high of 82.9 percent in 1998 and a low of 68.8 percent in 2009. The South’s rate increased 2.6 percentage points and ranged between 66.1 percent in 1995 and 53.8 percent in 1988.

¶ The authors cannot explain why the numbers dropped so precipitously in the West, which comprises Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming, because the analysis did not factor in contextual data. (These figures do not represent circumcisions performed outside of the hospital setting — e.g., ritual circumcisions — or any following discharge from the birth hospitalization.)

¶ “That question is beyond the scope of this report,” Maria Owings, the lead author, said.

¶ But it remains an intriguing question. Why would that part of the country differ so much from the rest? Have parents there developed a new attitude toward circumcision and, if so, why?

[What needs to be explained is not why the rate has fallen in the West, but why it has failed to fall in the rest of the country.]

¶ The high-profile 2010-11 attempt to get a bill criminalizing the procedure on a San Francisco ballot might have provided an opportunity for opponents of the procedure to reach parents. The initiative — called the Prohibition of Genital Cutting of Male Minors — was ultimately quashed, but it did get 12,000 supporting signatures.

¶ “San Francisco is a bastion for new thinking and individual rights, which draws many people to the region; however, the entire West Coast — Washington, Oregon — also have very low infant circumcision rates,” said Lloyd Schofield, the leader of the San Francisco movement. “Certainly much of this comes from basic awareness and less insistence on the procedure from the medical industry.”

¶ Mr. Schofield said that “a huge driver of the decline” was the nonpayment for the procedure by private insurers, “but in particular coverage was removed from Medicaid here decades ago.”

¶ “When the money is gone,” he said, “it no longer serves a purpose … funny thing about that!”

¶ Marc Stern, a lawyer for the American Jewish Committee who worked against the initiative, suggested that, among other things, the larger population of immigrants from countries that do not routinely circumcise could account for the low rates in the West. “Different cultures in Asia and the Americas and different attitudes towards circumcision may help explain the West’s differential,” he said.

¶ Douglas Diekema, a member of the American Academy of Pediatrics’ task force on circumcision and a professor of pediatrics at Seattle Children’s Hospital, echoed Mr. Stern’s theory that the difference in circumcision rates could be a result of demographics, but he had another theory, too.

¶ “The West Coast has more immigrants from populations that don’t circumcise as commonly as we do in the U.S.,” he said. “The Hispanic culture is one of those, and since the West and Southwest are taking on” more Hispanics, one could assume there would be a drop.

¶ At the same time, Dr. Diekema said, West Coast residents tend to be more progressive.

¶“Ever since the founding of this country, the West Coast has attracted people who walk to the beat of their own drummer,” he said. “People here are more likely to question the standard and go a different way.”

NEW YORK: US circumcision rate falls

New York Times
August 22, 2013

U.S. Circumcision Rates Are Declining

by Nicholas Bakalar

The percentage of newborns who are circumcised in the United States declined to 58.3 percent in 2010 from 64.5 percent in 1979, according to a new analysis from the National Center for Health Statistics. The report is based on annual surveys of about 450 hospitals nationwide.

But rates varied over the period. They went down during the 1980s after a task force of the American Academy of Pediatrics found that there were no medical benefits to the procedure, then rose during the ’90s after the medical group revised its position, claiming there were potential benefits. In 1999, the A.A.P. changed its view again, stating that despite potential benefits, there was insufficient evidence to recommend routine circumcision. That announcement was followed by another slight decrease.

There are regional variations as well. In 2010, about 71 percent of babies in the Midwest were circumcised, 66.3 percent in the Northeast, 58.4 percent in the South, and 40.2 percent in the West.

The lead author of the report, Maria Owings, a health statistician with the center, emphasized that the report includes no explanation for the numbers. “We didn’t factor in any other contextual information that would shed light on the reasons for the regional variations or the variations over time,” she said. And, she added, “The N.C.H.S. doesn’t take an advocacy position.”

NEW YORK: Metzitah "without consent": Another herpes case

The Jewish Press
April 3, 2013

Mother Blames Mohel for Baby's Herpes after Circumcision

by Tzvi Ben-Gedalyahu

The question of the safety of the controversial ritual of sucking the baby’s blood after the foreskin is cut in a circumcision has again been raised following another case of Herpes.

This year’s second case of herpes resulting from the “metzitzah b’peh” custom immediately after circumcision was reported in New York, and the mother of the baby has blamed the mohel for performing to rite without her consent.

The baby survived after contacting the disease following the ritual of the mohel sucking a bit of blood after the circumcision, a custom that is practiced mainly by the Haredi orthodox community in the United States but which is common throughout Israel.

Controversy over the procedure and numerous reports of Herpes prompted the New York City Department of Health and Mental Hygiene to require parents to sign a consent form before the procedure can be performed.

The mother of the baby said she the mohel did not ask her for permission.

NEW YORK: Metzitah Are hospitals hiding herpes?

The Daily Forward
April 1, 2013

Are New York Hospitals Hiding Herpes From Metzitzah B'Peh Circumcision Rite?

Refuse To Respond to Claims Made by Yeshiva U. Rabbi

bySeth Berkman

Are some New York City hospitals and the city’s Department of Health suppressing disclosure of cases in which a dangerous herpes virus is being transmitted by mohels to newborns?

Representatives from New York Presbyterian Hospital/Columbia University Medical Center refused to respond to this allegation — made specifically about their own hospital — by a senior rabbinic authority at Yeshiva University recently. The city’s Department of Health and Mental Hygiene also declined to respond to the charge despite multiple requests.

As his source for the allegation, Rabbi Hershel Schachter, the influential YU rabbinical leader who made the charge publicly, cited his own daughter who, he said, works as a nurse at New York Presbyterian.

In a public lecture last February in London, Schachter, who is a rosh yeshiva, or senior chief rabbinic authority, at Y.U.’s Rabbi Isaac Elchanan Theological Seminary, claimed that his daughter’s hospital treated three cases per year of Hasidic babies infected with herpes. The infections were “obviously because of metzitzah b’peh,” Schachter told his audience. The remarks were first posted March 14 on the website Failed Messiah.

The Hebrew term metzitzah b’peh, often shortened to MBP, refers to a procedure practiced by some ultra-Orthodox mohels as part of a male infant’s circumcision rite in which the mohel orally sucks the blood away from the infant’s genital area after cutting away his foreskin. The practice can infect newborns with Herpes Simplex Virus Type 1, according to medical authorities, a virus that, while not serious for adults, can be fatal for infants, or cause permanent cognitive or physical harm.

Since 2004, the New York City Department Of Health And Mental Hygiene has reported 12 cases, with two deaths. Schachter cited his daughter as claiming that there are, in fact, about 15 such cases per year in the city, including the three cases or so she claimed per year at her own hospital.

Schachter said his daughter explained that the hospitals do not report these cases because Hasidic clients would not return if they were made public.

Mohels from outside the ultra-Orthodox community use a sterile pipette for this purpose. But many ultra-Orthodox mohels consider direct suction of the genital area by mouth to be mandated by the Talmud as part of the religious rite.

In contrast to New York Presbyterian and the New York City Department of Health, Maimonides Hospital in Brooklyn, which has perhaps the largest clientele of Orthodox patients in the city, strongly denied Schachter’s allegation.

Eileen Tynion, assistant vice president, public relations for Maimonides, wrote in an email that, “Like all hospitals, Maimonides is required to report cases of infant herpes to the DOH, and we remain in compliance at all times with that requirement.” In September 2011, a two-week old boy died at Maimonides after contracting herpes following MBP, according to the city medical examiner.

Efforts to reach Schachter and his daughter were unsuccessful.

The ultra-Orthodox umbrella group Agudath Israel of America, which has filed a lawsuit against the city’s effort to regulate MBP, also declined to comment on Schachter’s allegations.

Schachter’s remarks on the issue were part of a broader talk he gave to an audience of British rabbis that has sparked intense controversy. During the lecture, Schachter also said that allegations of child sexual abuse within the Orthodox community should not be directly reported to law enforcement authorities; instead, he said, they should first be brought before a special panel of Torah scholars who are also psychologists to determine their validity. He voiced caution about sending cases to law authorities because such action could result in a Jew being sent to a state prison, where he could be locked up “with a shvartze, in a cell with a Muslim, a black Muslim who wants to kill all the Jews."

[So he can hardly be accused of being motivated by antisemitism. How similar are his and the Roman Catholic Church's approches to child abuse by their members!]

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NEW YORK: Metzitzah: Federal court upholds consent form

They just don't give up, do they?

Jewish Daily Forward
February 22, 2013

Federal Court Refuses To Block New York Circumcision Consent Form Law

Rejects Metzitzah B'Peh Motion Filed by Orthodox Groups

by Seth Berkman

Proponents of metzitzah b’peh, the controversial circumcision ritual, were denied a request for an emergency stay in the enforcement of a recent New York City law that regulates the procedure. The decision was handed down by the United States Court of Appeals for the Second Circuit.

The motion, filed by the Central Rabbinical Congress of the USA & Canada, Agudath Israel, the International Bris Association and a group of rabbis, failed “to meet requisite standards,” according to the court.

...

Recent studies by the New York City DOHMH have revealed 12 area infants who have contracted herpes after circumcision, with two of the infants dying soon after.

NEW YORK: Metzitzah: Sandy causes delay in hearing injunction

Gestetner News
November 10, 2012

Due to Sandy 'Metziaza Be'Peh' Hearing Postponed, Injunction Extended

A Manhattan court has postponed a hearing against the new requirement that parents whose children undergo ritual Jewish circumcision in New York City sign a consent form before the “metzizah be’peh” aspect of the Jewish bris ceremony can be performed. The hearing, part of an action brought by rabbinical groups against the requirement, was delayed last weekend, the court said, because Hurricane Sandy has caused a backlog of cases, and the courts must dispose of old cases before starting new hearings. As a result, an injunction against the enactment of the consent rule has been extended.

The New York Board of Health and Mental Hygiene in September approved the regulation,
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NEW YORK: Metzitzah: Rabbis granted delay in parental consent forms

Wall Street Journal
October 16, 2012

City's Circumcision Regulations Delayed

By Sean Gardiner
A city Department of Health regulation that would force rabbis to obtain written permission before performing a controversial circumcision won’t go into effect in several days as planned.

The city agreed to a brief stay in the enforcement of the regulation regarding the circumcisions–in which the mouth is used to remove blood from the incision wound–so that the plaintiffs who filed a lawsuit last week in Manhattan federal court can submit a motion for a preliminary injunction.

Under the regulation, the rabbi or other person performing the metzitzah b’ peh would need to obtain a signed permission form from parents of the infant warning that the procedure could expose their infant “to risk of transmission of herpes simplex virus infection or other infectious diseases.”

Since some of those who perform the ritual don’t agree with that warning, the lawsuit argues the regulation violates their constitutional rights to free speech and freedom of religion.

The implementation of the city’s regulation, originally set to begin Oct. 21, has been pushed back until Nov. 14, said Hank Sheinkopf, who is representing the groups that sued.

City health officials have argued that the practice has lead to 11 confirmed cases of infants contracting herpes simplex virus. Two of those babies died and two others suffered brain damage, city officials said. Some of the parents of those children were not aware that direct oral suction would be performed, city officials said.

The Health Department is working with the Law Department on a response that will be filed this month.

Earlier story

NEW YORK: Metzitzah: Rabbis file suit against parental consent forms

NY TImes
October 11, 2012

Suit Is Filed Over Move to Regulate Circumcision

By Marc Santora
Several Jewish groups filed a lawsuit on Thursday seeking to prevent New York City from enforcing a rule on circumcisions, arguing that the regulation would violate religious freedoms.

The city Board of Health passed a regulation in September that required written parental consent before a ritual circumcision could be done. In the procedure, common among ultra-Orthodox Jews, the person performing the circumcision uses his mouth to remove blood from the incision.

The oral contact, known in Hebrew as metzitzah b’peh, is considered dangerous by public health officials, because of the possibility of spreading diseases, specifically herpes. Failure to comply with the regulation could result in warnings and fines.

From 2000 to 2011, 11 babies contracted herpes, most likely as a result of the practice, and two of them died, according to the city’s health department. This spring, the Centers for Disease Control and Prevention also declared that the procedure created a risk for transmission of herpes and other pathogens, and was “not safe.”

In the lawsuit, filed in Federal District Court in Manhattan, several rabbis and Jewish organizations — including Agudath Israel of America and the International Bris Association — argue that the practice has been used safely for thousands of years among Jews and that the regulations are unconstitutional.

“Not only is the Department of Health wrong about metzitzah b’peh, it is trying to enforce its erroneous opinions on the people of New York City,” said Hank Sheinkopf, a spokesman for the groups suing the city. “By essentially starting a public intimidation campaign that forces private citizens to spread the government’s beliefs, they are shaking the core of our democracy. We believe the courts will stop this overzealous government overreach and keep them out of our speech and religion.”

Dr. Thomas A. Farley, commissioner of the city health department, issued a statement on Thursday citing the danger posed by the procedures and arguing that the measures were necessary for public safety.

“The city’s highest obligation is to protect its children,” he said in the statement. [To fulfil that obligation it should age-restrict circumcision.] “The health department’s written consent requirement is lawful, appropriate and necessary.”

NEW YORK: Metzitzah; Board of Health unanimous - parents must be warned

The Jewish Daily Forward
September 13, 2012

N.Y. Board Orders Forms for Circumcision Rite

Health Officials Mandate Parental Consent for Metzitzah B'Peh
By Seth Berkman
 
The New York City board of health has voted unanimously to require parents to sign a consent form before allowing a mohel to perform metztizah b’peh, direct oral-genital suction during circumcision.
The vote was 9-0 to require parental consent for direct oral suction, a practice employed only by ultra-Orthodox mohels that can lead to transmission of a strain of herpes to which infants are especially vulnerable. Though transmission rates are believed to be low, If infected, babies can suffer brain damage or even death.

“We’re not banning the procedure, we’re not regulating how circumcisions are performed,” Jay K. Varma, deputy commissioner for disease control for the health department said after the meeting. “We’re simply requiring that people understand there is a risk, and if people want their baby to be circumcised, they have to understand that this procedure might potentially transmit an infection that is both serious as well as life threatening.”

There are no mandatory penalties imposed if the waivers are not signed. But the health commission may impose penalties at its own discretion. Varma said the department would respond to public complaints and investigate the claims, and that repercussions could range from a phone call or a formal warning letter, to fines of up to $2,000 for each violation.

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Earlier story

NEW YORK: Metzitzah - lawsuit against consent forms?

JTA
September 11, 2012

Agudath Israel contemplating lawsuit against N.Y. over circumcision ritual

NEW YORK (JTA) -- Agudath Israel of America reportedly is planning to sue the city of New York if its health department passes a law requiring parental consent for the circumcision ritual known as metzitzah b'peh.

The New York Jewish Week reported the development based on an email forwarded to the news outlet sent originally from the account of Agudah's general counsel, Mordechai Biser. According to the e-mail, the haredi Orthodox group is seeking a New York law firm that would work pro bono or on “a reduced rate basis” to bring “a lawsuit against the City of New York to prevent the City from issuing a regulation that would require written parental consent for an aspect of bris milah (‘metzitzah b’peh’).”

The city is expected to pass the measure this week requiring parents to sign off before the direct oral suction procedure. ...

A statement by the Orthodox Rabbinical Council of America on Monday noted that "Many Jewish legal authorities have ruled that direct oral suction is not an integral part of the circumcision ritual and advocate the use of a sterile tube to preclude any risk of infection." Like Agudah, however, the RCA expressed opposition to the proposed measure, citing "concern about government regulation of religious practices."

“There is no safe way to perform oral suction on any open wound in a newborn,” Samantha Levine, a spokeswoman for New York Mayor Michael Bloomberg, told The Jewish Week via e-mail Monday, citing leading medical authorities.

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