|
Monsey rabbi investigated
By STEVE LIEBERMAN
THE JOURNAL NEWS
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."
'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 bris
The 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.
Circumcision rite is risky, city says
BY MAGGIE HABERMAN
NEW YORK DAILY 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
Rockland to review rabbi's circumcisions
By STEVE LIEBERMAN
NEW YORK JOURNAL NEWS
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
Hasidic circumcision rite debated
By GARY STERN
THE JOURNAL NEWS
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."
The bris
The 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.
After infant's death from herpes, scrutiny turns to circumcision rite
By JTA
Jerusalem Post
Feb. 9, 2005
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."
| 
