Should Mohelim Be Supervised?

The case of the Monsey mohel who may have infected three newborn boys with the herpes virus is prompting some to wonder if the field requires greater oversight.

The three boys contracted herpes simplex virus 1, the type which in adults usually causes only a mouth sore, but can overwhelm a newborn’s system. One of the babies, who was circumcised in October, died ten days later. He and his twin brother tested positive for the virus. The third is a Staten Island boy who also tested positive after being circumcised by Fischer in late 2003.

Unlike doctors and most rabbis, those who perform Jewish ritual circumcision are not required to belong to any professional organization, instead operating independently and relying on referrals for new business.

The current news centers on Rabbi Yitzchok Fischer, a man in his 60s who has worked as a mohel for decades, performing tens of thousands of ritual circumcisions in the New York area, in Israel and in the former Soviet Union. New York City’s Department of Health and Mental Hygiene has filed a civil suit against Rabbi Fischer, requiring him to give blood samples for testing and enjoining him from suctioning the requisite drop of blood by using his mouth. A court order also requires him to wear rubber gloves and take other steps to prevent infection.

Rockland County health officials say that they are now also planning to review Rabbi Fischer’s circumcisions.

Reached at his home, Rabbi Fischer declined to be interviewed, citing instructions from his attorney.

Mohelim, or Jewish ritual circumcisers, operate in an essentially unregulated field, unlike doctors, who are licensed by the state and rabbis, most of whom belong to professional organizations with set standards.

Leading rabbis and mohelim differ as to whether it would be beneficial to have mohelim more closely supervised.

The New York Board of Rabbis has recently discussed this very issue, said its executive vice president, Rabbi Joseph Potasnik. For many years it had a Brit Milah Board, which certified mohelim, but it has been defunct for the last decade, he said.

Now is the time to revive it in one form or another, said Rabbi Potasnik, and he expects that the organization will put a new Brit Milah service in place within the next six weeks.

“There needs to be strict oversight in these matters,” he said. “People rely upon some kind of verification that the mohel is fully suitable to perform the rite. That means also that there’s a malpractice policy in place. If we’re going to recommend someone for something so sacred that has this physical component, we need to be very clear we’ll only recommend someone who fulfills all of our requirements.”

However, he says, it should be the Jewish community, rather than the government, providing this oversight. “It’s always dangerous to have the state involved in a religious procedure. We in the Jewish community are the more appropriate place to define what the criteria should be and monitor to see that they are fulfilled.”

One of the last steps in a brit milah involves suctioning blood from where the foreskin has been removed. Historically, this was done orally, with the mohel directly putting his mouth on the newly circumcised penis and sucking in the blood, a procedure called metzizah b’peh.

In recent decades, however, the practice has been continued only in some elements of the fervently Orthodox community.

According to his attorney, Mark Kurzmann, Rabbi Fischer suctions by mouth only if the baby’s parents request it. Other times, he uses the techniques more commonly utilized by non-haredi mohelim, which involve suctioning through a small plastic tube, or gently wiping the area with a piece of gauze, and in the process creating sufficient suction to draw away residual blood.

Mohelim in the fervently Orthodox community say that only the most traditional method, the one cited in Jewish legal sources, is acceptable.

“Our teachers taught us to use our mouths,” said Crown Heights-based mohel Rabbi Israel Heller, who is the official mohel of Methodist Hospital in Park Slope, Brooklyn. “The saliva cleans wounds. God gave us saliva in our mouth to clean things.”

A spokesman for Agudath Israel of America, which represents the interests of the fervently Orthodox, doesn’t think that any new form of oversight is necessary. “There is a point when the government has a right to step in, when there’s a clear and present threat to the public. Then public policy can override religious rights, but I don’t think that’s what’s before us at this point,” said Rabbi Avi Shafran.

“Word of mouth is the best regulatory system, and the system has worked very well,” he said. “There should be no ban on metzizah b’peh, and no required testing of mohelim.”

According to Rabbi Tzvi Hersh Weinreb, executive vice president of the Orthodox Union and a clinical psychologist, “We don’t know the facts of this case, and I am not sure that one isolated case, however tragic, warrants a major change in the system.”

Mohelim and rabbis are concerned that the headlines about the current case might turn some people off to the idea of having their sons ritually circumcised.

“It’s the kind of thing that unfortunately plays to some people’s worst feelings,” said Rabbi Shafran. “There is an anti-circumcision crowd out there, and they certainly will seize upon it.”

Cantor Philip Sherman, a well-known Manhattan-based mohel, said he spoke with an interfaith couple and “the wife said her husband doesn’t want to do it now. I’ve had a number of phone calls this week. There is such a tremendous anti-circumcision movement out there as it is, and this will only fuel the fire.“

Way back when, drawing blood out of a wound was thought to remove impurities and was considered medically necessary,” said Cantor Sherman, who does not suction directly with his mouth and says the custom has no bearing on the validity of the brit.

Rabbi Heller said he recently performed a brit milah on the new grandson of a urologist. Present were a well-known Modern Orthodox rabbi and several doctor-colleagues of the baby’s grandfather. When he saw Rabbi Heller do metzizah b’peh, the rabbi commented negatively, but the doctors all said that it was medically acceptable, according to Rabbi Heller, since he carefully washed his hands and mouth beforehand with antiseptic.

He said that good mohelim test themselves every three months for diseases, including HIV, hepatitis and herpes. “We check ourselves more than surgeons check themselves,” Rabbi Heller said. And if he has any kind of pimple or sore in his mouth, he has another mohel perform the brit milah for him.

Rabbi Heller, who knows Rabbi Fischer and spoke with him recently, says that the Monsey mohel is “very hurt that this happened.” But it hasn’t hampered his work, said Rabbi Heller. Since the lawsuit was filed, Rabbi Fischer has performed “a few hundred brisses,” he said.

He also said that in the case of the Staten Island boy who tested positive, his mother tested for the virus. The baby who died in November had a rash in his diaper area before the brit milah, which Rabbi Fischer insisted be checked out by a pediatrician, according to Rabbi Heller. The pediatrician gave the go-ahead for the brit, he said.

Mark Kurzmann, Rabbi Fischer’s attorney, declined to comment on the medical status of anyone involved, including that of his client.

He did say, however, that Rabbi Fischer “is cooperating fully with the city’s investigation, and that he consulted with his personal physician and was advised that there was absolutely no risk of any herpes infection from his performing a brit.”