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http://olympics.reuters.com/newsArticle.jhtml?type=domesticNews&storyID=7517861NY Officials Bar Rabbi from Circumcision RitualWed Feb 2, 2005 04:46 PM ET By Larry Fine NEW YORK (Reuters) - New York City health officials have gone to court to stop a rabbi from performing a type of ritual circumcision they believe may have led to the death of a baby boy from herpes. The baby was one of three infants found to have contracted herpes simplex virus after being circumcised by Rabbi Yitzchok Fischer, who used his mouth to draw blood from the infant's wound, a traditional Orthodox practice during the bris, or religious circumcision. The complaint filed by the department of health in Manhattan Supreme Court asked that Fischer submit blood samples to be tested for the herpes virus and no longer engage in the specific practice until an investigation was completed. The court papers, filed on Dec. 22, were reported on by the Daily News on Wednesday
(cont)"Rabbi Fischer is still performing circumcisions, but he is complying with the court's direction," his lawyer, Mark J. Kurzmann, told Reuters on Wednesday. Kurzmann described Fischer as a London-trained, "internationally known" mohel, or someone who performs circumcisions.Ten days after Fischer circumcised twins last October, one died of herpes and the other tested positive for the virus, according to the court papers. A third baby circumcised by Fisher was later found to have also tested positive for herpes, health officials said.
(cont)An affidavit submitted to the court by Dr. Susan Blank, assistant commissioner of the health department, said Fischer had performed about 350 Jewish circumcisions in the area. Blank noted that the herpes virus, which is common in adults and often causes lesions known as "fever blisters" or "cold sores" is easily transmitted but not usually a serious illness in adults. In newborn infants, however, herpes can cause severe illness and may be fatal, she said. Kurzmann suggested the infants could have contracted the infection some other way. "Rabbi Fischer is cooperating fully with the city's investigation in order to determine the true sources of the infection," Kurzmann said.
http://www.thejournalnews.com/newsroom/020305/a0103rabbinew.htmlMonsey rabbi investigatedBy STEVE LIEBERMANTHE JOURNAL NEWS(Original publication: February 3, 2005)A lawyer for the Monsey Hasidic rabbi suspected of transmitting a fatal case of herpes to a baby boy during a circumcision said yesterday that the practice of suctioning blood orally is thousands of years old and integral to the religion. But one local scholar said such unsanitized rituals actually violated Jewish law. Another rabbi saw the case as outsiders frowning on Hasidic traditions. Rabbi Yitzchok Fischer is being investigated by New York City health officials after a baby died of herpes, and two others contracted the disease. Fischer, a mohel in Rockland, the metropolitan area and Israel, uses his mouth to suck the blood from the wound caused by cutting the baby's foreskin. The centuries-old ritual, called "metzizah bi peh," is used predominantly by Hasidic Jews, who consider the practice mandatory for newborns. Most other Jewish mohels wear surgical gloves and use sterilized instruments. Many other mohels who do that part of the ritual use a medical tube to suction the blood, several rabbis said yesterday. Ritual circumcision, or bris, dates to the prophet Abraham and is said to symbolize God's covenant with the Jewish people. Fischer is not accused of violating any criminal laws. The New York City Department of Health and Mental Hygiene took civil action under its legal powers to protect the health and safety of the children and investigate outbreaks of communicable diseases. After a child died of herpes and two others were infected, the city's health commissioner ordered Fischer to undergo blood tests for herpes and stop using the mouth suction method without a tube until the issue was resolved. He continued to use the mouth suction method, so court orders were sought in December, the city's lawyers wrote in court papers. Fischer's lawyer, Mark J. Kurzmann, said yesterday that the rabbi was cooperating with the city's investigation. Kurzmann, whose son, Hillel, also is working on the case, declined to say whether the rabbi would submit to a blood test, citing medical privacy reasons. "The source of the children's herpes has not been confirmed, and it may have been an unfortunate coincidence," Kurzmann said. "This is an integral part of the religious practice for thousands of years," Kurzmann said. "There have been hundreds of thousands of babies who have undergone this ritual, and the incidence of herpes is virtually nil." Fischer, 66, could not be reached for comment at his home. Kurzmann said he would speak for the rabbi, who was trained in circumcisions by the British Milah Society. The city health department took action after being notified in November that a newborn less than three weeks old had died Oct. 26 of herpes simplex virus type 1. The infant's twin brother tested positive for the infection. Fischer performed the double bris on Oct. 16, the city's court papers state. City health department officials later learned that a Staten Island baby also tested positive for herpes after being circumcised by the rabbi in late 2003, according to the court papers. Herpes is far more dangerous to infants than adults because of their fragile immune systems. An outbreak of a disease is defined in the city's health code as one that has been reported in three or more instances. "The New York City Department Health and Mental Hygiene is concerned that the possible transmission of herpes simplex in infants is continuing as a result of the ... practice of Metzizah bi peh," city lawyers wrote in court papers dated Dec. 22. The mouth-suction ritual during a circumcision is not mandated by Jewish law, said Rabbi Moses Tendler, a professor of ethical medical practices and Talmudic law at Yeshiva University. Tendler, the rabbi of Community Synagogue of Monsey, also serves on the Rabbinical Council of America, an Orthodox Jewish group. Tendler said the unsanitized ritual performed by Fischer violated Jewish law. Tendler said the Talmud refers to sucking the blood from the wound, but doesn't specifically indicate using one's mouth. "I protested his use of oral suction as violating good medical practices, which he is required to do under Jewish law," Tendler said. "Jewish law has recognized there has been an increase in knowledge of hygiene and medical advances over the centuries. It is not a lack of respect for the traditions or Jewish law to use a tube." Monsey Rabbi David Eidensohn, 62, said the spreading of disease is rare through the oral suction method. He said his five sons and numerous grandsons, as well as hundreds of thousands of newborn boys, had undergone the procedure. Fischer, he said, is a respected mohel across the region and in Israel. "This represents people frowning on our traditions," Eidensohn said. "If this happened regularly or even occasionally, we would be the first to stop the practice ourselves. We don't want to kill our children. This is a tragedy for the families." Stanley J. Kogan, chief of pediatric urology at Children's Hospital at Montefiore Medical Center in the Bronx, has been performing in-hospital circumcisions for three decades. "In my 30 years of doing circumcisions, I have never had a patient develop an infection with genital herpes afterward," said Kogan, who has a private practice in White Plains and is on staff at Nyack Hospital. "That speaks to just how unusual it is." Physicians performing circumcisions are careful to clean the patient's skin before the incision is made. All instruments are sterile, and special care is taken to make sure that the tissue is treated gently to prevent trauma, he said. But occasionally, babies develop complications from circumcision, he said. "Even in the cleanest operating room under the best circumstances, you can get an infection," Kogan said. "There is never no risk with any surgical procedure." Send e-mail to Steve LiebermanFYI: For your information'Metzizah bi peh'The use of suction to remove the blood is addressed in the Talmud. Some Jews interpret it to mean a mohel should use his mouth to suck the blood.Talmud, Shabos, Page 133: "You are permitted to do all necessary acts for circumcision on the Shabos; removal of the foreskin, removal of the mucus layer underneath, apply suction, and place a bandage containing herbs."The brisThe Jewish circumcision ritual is the cutting of the male foreskin, symbolizing the covenant between God and the Jewish people.It is usually done by a mohel, a rabbi trained in circumcision. Hasidic and some other Jews use a mohel who uses his mouth to suck the blood from the wound caused by cutting the baby's foreskin.Many mohels who use the suction method use a tube.
http://www.nydailynews.com/news/local/story/277220p-237488c.htmlCircumcision rite is risky, city says BY MAGGIE HABERMANDAILY NEWS CITY HALL BUREAU A form of religious circumcision holds "inherent risks" for babies, the city health commissioner said yesterday.Dr. Thomas Frieden's comments came the day the Daily News reported that his agency is investigating whether an infant who died of herpes last year contracted the disease from the rabbi who circumcised him.Two more city babies were found to have contracted herpes after they were circumcised by the same rabbi, Rockland County-based Yitzchok Fischer.Fischer practices a ritual used mostly among ultra-Orthodox Jews called metzizah bi peh, in which the person performing the circumcision draws blood from the wound using his mouth."We do believe that there are inherent risks to this practice and we're discussing those in a respectful" way with ultra-Orthodox leaders, Frieden said.In November and again in December, the city ordered Fischer, a prominent mohel who claims to have performed more than 12,000 circumcisions, to submit to a blood test to determine whether he has herpes simplex 1 virus.Neither Frieden nor Fischer's lawyer would say yesterday whether the test had been done.The issue of metzizah bi peh has been debated in recent years within the Jewish community. Some, like Yeshiva University Prof. Rabbi Moshe Tendler, argue it's not required and too risky.But Frieden's comments touched off concern among other Jewish leaders, who said they were leery of government intervention in religious custom.Chana Ausband, a Rockland County mother, said Fischer performed her baby's circumcision. "What he's doing is following tradition. For years and years, that has not caused any problems," Ausband said. Originally published on February 3, 2005
http://www.nyjournalnews.com/newsroom/020405/b0104mohel.htmlRockland to review rabbi's circumcisionsBy STEVE LIEBERMAN THE JOURNAL NEWS (Original publication: February 4, 2005)Rockland health officials will review circumcisions performed by a Monsey rabbi suspected of transmitting herpes to three New York City newborns while orally suctioning blood during the religious ritual. One baby died from the disease in New York City while two others tested positive for herpes. Rockland Health Department officials said yesterday that they were monitoring New York City's investigation, but plan to independently review Rabbi Yitzchok Fischer's circumcisions in the county. The city wants the rabbi to take a blood test to determine if he has herpes. Rockland Health Department Public Health Administrator Kathleen Henry said the county agency would stay in contact with New York City and evaluate the results of the city's review of the rabbi. Health Commissioner Joan Facelle said she has the legal power to protect the health and safety of county residents. Assistant County Attorney Thomas Walsh, who is assigned to the Health Department, said he didn't think the county would wait long for New York City to make a determination concerning the rabbi. "We're going to gather facts about Rockland," Walsh said. "Our No. 1 goal is to protect the health and safety of our residents." New York City officials filed court papers to prohibit Fischer from conducting the circumcisions. Fischer's techniques are not illegal. The city has taken civil action to protect the health of newborns. While the city would not comment on whether Fischer would take the blood test, the rabbi's lawyer, Mark J. Kurzmann, said he was cooperating with the city. Kurzmann declined to comment on whether cooperation meant taking the blood tests. Fischer, a mohel in Rockland, the metropolitan area and Israel, uses his mouth to suck the blood from the wound caused by cutting the baby's foreskin. The centuries-old ritual, called "metzizah bi peh," is used predominantly on Hasidic Jews, who consider the practice mandatory for newborns. Ritual circumcision, or bris, dates to the prophet Abraham and is said to symbolize God's covenant with the Jewish people. Most other Jewish mohels wear surgical gloves and use sterilized instruments. Many other mohels who do that part of the ritual use a medical tube to suction the blood, several rabbis said. Rockland health officials don't know how many circumcisions Fischer has done in the county. But several rabbis said Fischer had been performing circumcisions for several decades. Send e-mail to Steve Lieberman
http://www.nyjournalnews.com/newsroom/020605/a0106circumcision.htmlHasidic circumcision rite debated By GARY STERN THE JOURNAL NEWS (Original publication: February 6, 2005)The suctioning of blood by mouth during ritual circumcisions has long been dropped as a common practice by most of the Jewish world, but many Jews and non-Jews alike were shocked to learn in recent days that the practice remains standard in many Hasidic communities. The largely unknown practice, which has been used during the Jewish circumcision ritual for thousands of years, came to public attention last week when New York City health officials said that a Hasidic rabbi and mohel from Monsey was suspected of transmitting the herpes virus to three New York City infants he had circumcised. One of the infants died in October. Rabbi Yitzchok Fischer, a prominent Hasidic mohel, suctions blood orally during the circumcision ritual, known as a bris, in order to remove impurities. He is suspected of passing the oral herpes virus, which generally produces cold sores but can be passed to another person's genital area. Rockland County health officials said they would do their own investigation. "It is very, very rare for the mohel to suck out the blood himself," said Rabbi Tzvi Hersh Weinreb, executive vice president of the Orthodox Union, which represents Orthodox congregations in North America. "The mohalim I speak to in our community say they use latex gloves and a glass tube for suction, and they take every precaution so they do not come into contact with the baby's blood and the baby does not come into contact with their blood," Weinreb said. "This is for the protection of the baby and, frankly, for the protection of the mohel, because one never knows what the baby might be carrying from the parent." This past August, the journal Pediatrics published a study that concluded that the oral suctioning of blood during a ritual Jewish circumcision, a practice called "metzitzah," puts infants at risk of contracting herpes and should be eliminated. The study looked at eight cases of infants who contracted herpes after oral suctioning during a bris. Twelve researchers, including seven from Israel, also considered the religious and cultural traditions behind the practice. They noted that the Babylonian Talmud, completed in the fifth century, required oral suctioning in order to remove health risks to the infant. But later rabbinical authorities, the study found, modified their approach as they developed new understandings of hygiene and disease transmission. "The same consideration that led the Talmudic sages once to establish the custom of the metzitzah for the sake of the infant could now be applied to persuade the mohel to use instrumental suction," the study concluded. One of the researchers involved in the study was Rabbi Moses Tendler of Monsey, a professor of ethical medical practices and Talmudic law at Yeshiva University, often called the flagship of modern Orthodoxy. Tendler last week said the Talmud requires that blood be sucked from the wound during circumcision, but not that it be done by mouth. Rabbi Gerald Chirnomas from Boonton, N.J., a prominent mohel in the Greater New York region, said the practice of orally suctioning blood was the norm for centuries. "When a person cuts a finger, what's the first thing they would do?" he said. "Suck out the blood so any possible contamination is sucked out. The rabbi applied the same thinking to this practice." Health concerns about the practice are known to have come up from time to time, Chirnomas said. During the mid-19th century, for instance, the Polish government forbade the practice when a popular mohel had a tooth abscess and an infant died. By the time Chirnomas, a Conservative rabbi, was trained as a mohel decades ago by two Orthodox mohalim in Jerusalem, the practice of oral suctioning had been largely replaced by the use of a glass tube to suck away the blood. These days, Chirnomas, who has performed some 14,000 ritual circumcisions, uses a gauze pad to soak up the blood. "Using the mouth was done for thousands of years," he said. "But it is important that people realize that within the general Jewish community, this practice is not followed. Within the very Orthodox community, the Hasidic community, they do not accept this change. Traditions die hard." Rabbi Avi Shafran, director of public affairs for Agudath Israel of America, an advocacy group for Orthodox Judaism, said that while the practice of suctioning blood by mouth is rare, Hasidic communities that believe it is important are unlikely to give it up. "In most communities, it is not done this way, but in many it is a religious tradition of many generations," he said. "I understand that what may have happened in this case is exceedingly rare. Pediatricians in communities where this is done as a matter of course have told us that they have never seen a case like this, ever. Jews have been circumcising their sons for quite a while, and this is getting attention because it is so unusual." Two of the infants who contracted herpes after being circumcised by Fischer, including the one who died, were twins. The double bris was performed on Oct. 16. New York City health officials later discovered that another boy tested positive for herpes after being circumcised by Fischer in 2003, according to court papers. Fischer is not accused of any crimes, but in a day when there is great concern about sexual molestation of children, many may wonder how an adult can legally put his mouth on a child's genitals. Vincent Bonventre, a law professor at Albany Law School, said that courts often allow exemptions to general laws for religious practices. "Cases are more difficult when there is a direct conflict between law and religion, like when a religion requires an act that is forbidden by law," Bonventre said. "When the government's interest is not paramount, the courts generally hold that you can't require an individual to violate their religion." Send e-mail to Gary Stern The brisThe Jewish circumcision ritual is the cutting of the male foreskin, symbolizing the covenant between God and the Jewish people.It is usually done by a mohel, a rabbi trained in circumcision. Mohels who suction blood from the wound generally use a glass tube.
http://www.jpost.com/servlet/Satellite?pagename=JPost/JPArticle/ShowFull&cid=1107919264183Feb. 9, 2005After infant's death from herpes, scrutiny turns to circumcision riteBy JTA The death of one infant boy from herpes and the infection of two others has focused attention on an ancient practice that is still used in some fervently Orthodox communities as they circumcise babies. New York City health officials are investigating whether the mohel who operated on the three boys had infected them. The city's legal department has been granted a temporary restraining order against Rabbi Yitzhak Fischer until the investigation is complete. Fischer practices a custom called metzitzah b'peh — loosely translated as oral suction — that is considered an integral part of the brit milah in parts of the Jewish world, though it is met with shock and distaste in others. It's not known if Fischer carries the herpes virus, but the restraining order forbids him from practicing metzitzah b'peh, and demands that he wear surgical gloves when he performs a circumcision. The Talmud describes the process of removing the baby boy's foreskin in three steps: The foreskin is cut, the mucous layer underneath is removed with a flick of the mohel's fingernail and then the blood is removed through oral suction. Often the first two steps are combined, and the fingernail motion is abandoned in favor of a surgical clamp. In the third step, the mohel traditionally takes a sip of wine in his mouth, quickly sucks the blood off through the wine and spits the mixture into a bowl to be discarded. That is metzitzah b'peh. In some parts of the Orthodox world — mainly but not exclusively among Chasidim — metzitzah b'peh is still practiced. Among other Orthodox Jews, however, metzitzah b'peh is considered unacceptable, and among more liberal Jews it's unthinkable. Fischer can do the brit either way, said his lawyer, Mark Kurzmann. He can use his mouth directly or he can suck the blood through a thin glass pipette. "It depends on the preference of the parents, and that depends on their particular religious community," Kurtzmann said. He added that "tens of thousands" of circumcisions using metzitzah b'peh have been done in the last seven years, with very few adverse results. Not true, concluded researchers writing in the August 2004 issue of the medical journal Pediatrics. "Ritual Jewish circumcision that includes metzitzah with direct oral-genital contact carries a serious risk for transmission of HSV" — herpes simplex virus — "from mohels to neonates," the article said. "Oral metzitzah after ritual circumcision may be hazardous to the neonate." Signed by 12 medical doctors and Ph.D. researchers, the paper examined the cases of eight young babies who had developed herpes within two weeks of their circumcisions. The only disease vector shared by all the babies was the mohelim, all of whom tested positive for the herpes virus and all of whom had performed metzitzah b'peh. One of the researchers was Rabbi Moses Tendler, who holds a doctorate in biology and teaches biology at Yeshiva University, teaches rabbinical students at Y.U.'s seminary, specializes in Jewish medical ethics and also is a pulpit rabbi. Tendler minced no words when discussing metzitzah b'peh. "What people don't understand is how widely disseminated the herpes virus is. Statistics say that 80 percent of the adult American population carries it, as you well know from how many people in their lives acquire a cold sore," he said. "It's an omnipresent danger, and for an infant, in the early days before his immune system kicks in, it's not necessarily localized. It can be a systemic infection. "I'm particularly disturbed that once this information becomes available, the mohelim don't do what they're told," Tendler continued. "When the AIDS epidemic started, the great rabbinic scholars of their day concluded that the mohelim should use a sterilized glass tube so they could avoid catching AIDS from the baby. It never occurred to them to think that the baby could catch something from them." Rabbi Daniel Korobkin, rabbi of Kehillat Yavneh in Los Angeles, is Orthodox and a mohel. "I will perform a routine brit only with completely antiseptic material, making sure that I never come in direct contact with a child's blood," he said. "The only exception was my own children. If a parent asks me to do it, I refuse," he continued. "I do give the father the option of doing it himself, though. Most are too squeamish, but a few want to do it." Korobkin trained as a mohel in 1990 in Jerusalem; by then, he said, the dictate to avoid metzitzah b'peh had been in place for some time. In fact, he added, the precedent for avoiding direct contact with the baby's blood can be traced to an outbreak of disease in the early 19th century; until then the practice was widespread. Then the great sage known as Chatam Sofer decreed that such contact could expose the child to danger. The Shulchan Aruch — the authoritative medieval compendium of Jewish law — "takes great pains to instruct every mohel to make sure that his utmost priority is the safety and welfare of the child," said Rabbi Tzvi Hersh Weinreb, executive vice president of the Orthodox Union. "I think it's fair to say that there are a substantial number of Orthodox rabbis who find nothing objectionable whatsoever" in using a pipette, Weinreb said. As an umbrella organization, the Orthodox Union doesn't have an official policy on ritual or religious matters. If pressed for a personal recommendation on which method to use, however, Weinreb said that for safety's sake he would suggest following Korobkin's lead. Rabbi David Zweibel, executive vice president for public affairs at Agudath Israel of America, a fervently Orthodox umbrella group, said his organization is dedicated to supporting the range of religious expression found among its constituent groups. Orthodox Jews whose traditions come from the German community never use metzitzah b'peh, he said, but it's common in many of the Brooklyn-based Chasidic communities that trace their roots to eastern Europe. He added that it hasn't been proven that the babies had contracted herpes from Fischer, suggesting that other means of transmission were possible. The question of whether metzitzah b'peh should be done depends on whether that stage of the brit is considered an integral part of the procedure or simply medical aftercare, Zweibel said. Communities that consider it integral often consider themselves bound to use traditional methods, such as metzitzah b'peh, he said, while those that do not consider it integral are free — in fact, obligated — to use modern, sanitary methods instead. Tendler said that in his Monsey, N.Y. community the practice of metzitzah b'peh is spreading, as is cutting the foreskin and removing the mucous layer in two discreet actions. The use of the surgical clamp is coming under fire as well, he said. There is a religious requirement to perform a brit milah painlessly, which means as quickly and as antiseptically as possible, Tendler said. "This is a requirement of Jewish law, not of medicine only," he said. "Metzitzah is strictly medieval medicine, and it should have given way to modern medicine. "We have a tradition that says that when it comes to medicine, you don't look into the Talmud. You seek the most competent physician to tell you what to do."
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