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Exclusive: Protocol On Controversial Bris Practice Was Rescinded In 2007

Exclusive: Protocol On Controversial Bris Practice Was Rescinded In 2007


The medical protocol adopted by the New York State Department of Health and the haredi community in 2006 to prevent the transmission of neonatal herpes from a controversial circumcision practice was rescinded less than a year later, The Jewish Week has learned.

A spokesman for the state health department confirmed to the paper Thursday afternoon that the protocol was rescinded when the administration of Gov. Eliot Spitzer took office in 2007 from outgoing Gov. George Pataki.

“With the change of the administration [in January 2007], there was a new health commissioner [the late Richard F. Daines] and he basically rescinded the protocols,” Peter Constantakes, the spokesman, told The Jewish Week. It is unclear whether notice that the protocols were rescinded was ever disseminated to the haredi community, where the metzitzah b’peh practice is in widespread use.

The practice, whereby a mohel suctions blood from the circumcision wound directly by mouth, has come under increased scrutiny this week after an infant died at Maimonides Hospital in Brooklyn from herpes simplex virus Type 1. The death, which occurred in September 2011 and is now being investigated by the Brooklyn District Attorney’s office as a possible criminal matter, was linked by health officials to the ritual practice.

The protocol was the result of an agreement between the state department of health, headed by Pataki appointee Antonina Novello, and a “broad array” of Orthodox rabbis in the wake of the death of an infant who contracted herpes in 2004. That death was also tied to a mohel, Yitzchok Fischer, who performed the metzitzah b’peh ritual.

When asked for comment earlier this week about the recent death, David Zwiebel, executive vice president of the fervently Orthodox umbrella group Agudath Israel, alluded to the protocols and noted that, “We have no information whether the mohel [in the new case] took the precautionary hygienic steps outlined in the DOH Protocol, whether an investigation was done to determine the cause and source of the child’s infection, or what any such investigation may have determined,” Zwiebel said. “Until we know those things, I think it is premature for us — or anyone, for that matter — to offer public comment.”

Reached late Thursday afternoon and asked if he had been informed that the protocols had been rescinded, Zwiebel said: “No. Nor was anyone else. One might imagine that if an agreement to which various parties are signatories gets rescinded, those parties would be informed. Never happened.”

The Jewish Week did obtain online a 2010 form letter from the state health department intended for rabbis, informing them about a mohel whose practice of metzitzah b’peh had been restricted in July 2007. The letter also referred to enclosed brochures, in English and Yiddish, about “how to protect your infant against herpes.” The letter made no mention of the protocol, which apparently was no longer in effect at the time.

The Jewish Week has learned that the mohel in question was Yitzchok Fischer. According to the state health department, Fischer was involved in the infection of another infant, who was admitted to a hospital with clinical diagnosis of neonatal herpes on May 21, 2007 “with lesions that appeared two days after a circumcision that was conducted on May 16th, 2007” performed by Fischer using metzitzah b’peh. Based on that, the health department ordered Fischer to stop practicing metzitzah b’peh.

The 2006 protocols outlined guidelines for the practice of metzitzah b’peh and steps the state health department would take if an infant were to become infected with the herpes simplex type 1 virus “on or after April 28, 2006 within a compatible incubation period following metzitzah b’peh.”

According to the protocols, the state health department was to conduct an “investigation without prejudging the cause,” during which time (up to 45 days), the mohel was to stop practicing metzitzah b’peh. If, during that timeframe, the mohel could not be ruled out as the source of the infection, in order to continue the practice of metzitzah b’peh, he would have been required to take one of three options, at his discretion: continue abstaining from the practice until he could be ruled out as the source of the infection; agree to take anti-viral medication for the rest of his life; or do so every day for three days before the circumcision.

The issue of enforcement was not directly addressed but the protocols stated that the it was “the mutual expectation” of the signatories that the “RABBIS will inform members of their congregations about this issue on an ongoing basis.”

At the time the protocols were signed, they were the subject of heated controversy, as doctors and other medical experts claimed that the practices they outlined — including requiring mohels to sanitize their hands and rinse their mouths with mouthwash — did nothing to guard against the transmission of the herpes virus. Indeed, even the city’s health commissioner at the time, Dr. Thomas Frieden, expressed serious reservations about the sufficiency of the guidelines and wrote a letter to Novello outlining what he deemed to be “fundamental concerns” with the protocol.

Asked whether the state health department would have a role in the current investigation, Constantakes told The Jewish Week that, while his office will continue to be informed about it, “Right now it looks like, with the [Brooklyn] DA taking over, they will probably take the lead.”

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