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: 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