Today the de Blasio Administration reached a new tentative agreement with a coalition of Rabbinical leaders from across New York City regarding the circumcision ritual of direct oral suction, also known as metzitzah b’peh (MBP).
This new agreement fulfills the Mayor’s commitment to finding a more effective policy that protects children and religious rights in a way that more actively engages the cooperation of the community.
This agreement focuses on two key areas: maximizing awareness of parents and minimizing risk to infants.
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.
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.
Under the new policy:
• 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.
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 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 cases where an infant has HSV-1 (herpes simplex virus 1) associated with MBP, 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 the mohel tests positive for HSV-1, DOHMH, with support from and cooperation of the community, 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, by DNA match, 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.
• Rabbinical coalition 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 HSV-1.
Background:
Some New Yorkers who have their infant sons ritually circumcised also have the mohel perform direct oral suction on the wound, a ritual known as Metzitzah B’Peh. The position of New York City is that this ritual risks the transmission of HSV-1, which while rare, can lead to serious brain damage or death.
In 2012, the City adopted new Health Code provision requiring the mohel to obtain informed consent from parents acknowledging that they are aware DOHMH recommends MBP not be performed because of the risk of brain damage and death, but want the procedure to be performed anyway. Since the regulation went into effect, DOHMH has concluded that there have been six cases following MBP in New York City, including four in 2014.
A signed consent form was provided by the mohel in only one of these six cases. There are also widespread reports in news and media reports of many mohels overtly ignoring the signed consent reform requirement and pledging to continue to do so.
There are numerous published reports in the medical literature of similar cases of HSV-1 following ritual circumcision in NYC before 2000.
The biology, epidemiology, and clinical manifestations of HSV-1 indicate that herpes transmission can occur during MBP. Seventy-three percent of adult New Yorkers are infected with HSV-1, and most adults with oral herpes infection have no symptoms.
Herpes infection in newborn infants is very rare (less than15 cases among approximately 125,000 births in NYC each year), and more than half of newborns who become infected develop life-threatening disease with substantial long-term negative consequences; roughly 1 in 5 infants infected with herpes dies.
They are maintaining their biased attack on a religious practice in “warning” parents about unfounded risks associated with Bris Milah and MBP. They have not proven even one case. How is this good news that they agree not to impose illegal requirements, but instead maintain that they will “only” employ intimidation against the practice …and with the blessing of the Jewish contingent no less?! And for what reason did the Jewish contingent settle for this as if it’s in some way acceptable for the DOHMH to do this?! This is nothing more than a more “sophisticated” antisemitism. And why would… Read more »
If you are looking for a Mohel, Levi Heber has done all my children on shlichus and comes to members in our community, such a mentch, so sensitive and caring. A real shliach! Thank You Levi for giving yourself over for the mitzvah of Mila ad Lev Nefesh!!
a fan of yours
torah says a mohel who does not do mpb is retired because he puts the baby in danger. who can argue with Torah and say it is dangerous to do it.
midrash says. 1st Beis Hamikdash was in merit of removing orlah. 2nd in merit of priah, and 3rd in merit of Metzitza.
Doctors do not have this type of contact with patients in such a direct physical way. Logic!! I think mohelim need not be blindly assumed to be o.k. but have to go for testing once a year and be licensed. This can be under a special vaad .For goodness sake, even mishulochim need certificates of authenticity in many cities.
Has there EVER been a case of an infant getting this disease, in which it has been conclusively proven by DNA match, that the source of the infection has without a doubt been MBP from the mohel who did the bris milah?
This article was almost certainly taken in whole or at least significant part from a NYC press release. The fact is that this issue was raised and thoroughly investigated years ago, and it was found that there has never been a case in recorded history of a baby contracting HSV-1 from a mohel. There have indeed been several unfortunate cases in which babies contracted HSV-1 not long after their bris, but those cases involved other potential sources of the infection. There were political factions that sought to portray the cases as a result of metzitzah bapeh, but the medical data… Read more »
looking at the numbers there is an extremely low risk. of the 6cases claiming herpes after bris, 1 was tested and disproven. the others were never proven.
the biggest risk is scaring parents from giving their children a kosher bris. many parents who gave their children brissim in the past are using hospital doctors or no bris at all.
we should be teaching the benefit of bris. physical and spiritua l. metzita bpeh is shomer habris. you are risking intermariage and molestation
It may be a positive development tto form a board of registered Mohelim who would be tested on all the pertinent Halochos and a include in the by-laws a proviso that all members are medically tested for disease on a regular basis.
The city’s decision was not based on science, but on bias. There has been no scientific evidence connecting the newborn deaths to MBP. All the evidence is anecdotal, but causation was never proven.
That said, glad that the mohelim are working with the city for a compromise, and kudos to Rabbi Heber, who knows how to get things done, without hoo-hah.
Because that is simply a noose with which one day they would hang people in civil and eventually criminal court. It’s a form of subtle coercion.
Raises the most obvious solution to the problem. Was that suggestion found wanting? Is there a timing issue? Otherwise, why not require mohelim to re recertify annually with a test?
What was wrong with keeping parents aware by making them sign a consent form?!
for the same reason that not all doctors are tested before they do any procedure!!!!!!!
Thank you for all you have done !
It is very appropriate to this month of אדר
And פורים which is connected to ברית like it says ששון זו מילה
B”h, we should continue to hear only good news…
A very big yasher Koach goes to our very own Chabad mohel rabbi levi heber. Who worked tirelessly at the forefront and behind the scenes in manning sure this law was abolished. a big credit is due to him litovas klal Yisroel. Tizke lmitzvos
Why don’t they’d test all mohelim before they perform brisim on a regular basis?