The new state guidelines require mohels, or anyone performing metzizah b’peh, to sanitize their hands like a surgeon, removing all jewelry, cleaning their nails under running water and washing their hands for up to six minutes with antimicrobial soap or an alcohol-based hand scrub.
The person performing metzizah b’peh also must clean his mouth with a sterile alcohol wipe and, no more than five minutes before it, rinse for at least 30 seconds with a mouthwash that contains 25 percent alcohol.
The circumcised area must be covered with antibiotic ointment and sterile gauze after the procedure.
In addition to the rabbinical policies, the state Health Department also added neonatal herpes to the list of diseases health care workers are required to report to state officials.
That seems like really basic stuff that should already have been being done. I’ve got so many questions about this. For starters, which Orthodox signed the deal? The article quotes an attorney and alleged Orthodox spokesperson (I can’t find anything on him, and a half-dozen people in that world just told me they never heard of him) named Robert Simins, and then a quote from Rabbi David Niederman which doesn’t make it clear if it’s in reaction to the deal or whether it came from who-knows-how-long beforehand:
Rabbi David Niederman, the executive director of the United Jewish Organizations of Williamsburg, Brooklyn, and a member of the Central Rabbinical Congress of the USA and Canada, said the issue wasn’t about a lack of understanding, but about “not appreciating. People, even those who aren’t Jewish, should appreciate the fact that this is a religion that’s been around for thousands of years.”
- Depending on which Orthodox signed the deal, what do the rest say, especially given that we know there was some rift on the issue, at least between Agudath Israel and the Satmars?
- How on earth would the state enforce these regulations, and what possible penalties could there be for non-adherence?
- What will the state’s deal mean for New York City, where Health Commissioner Thomas Frieden has joined a number of medical experts in saying there’s no way to reasonably reduce the risk of infection, so long as circumcisers continue to use direct oral contact?
- What will all those health experts [1, 2] think about these procedures?
- Does the state’s requiring reporting of neo-natal herpes overlap with the city’s proposed requirement, and if so/not, what are the differences and similarities?
- Does this mean some acknowledgement from some Orthodox that metzitzah as previously conducted was dangerous, when some vehemently protested that it wasn’t?
- How did the state reach these conclusions, how much does it think it will reduce the risk of infection, and what does it assume to be the remaining risk if these procedures are followed fully? What’s the risk if they’re only partially followed? How much do these procedures differ from those followed by the mohels whom the city claims infected a number of babies?
- If the state can impose these kinds of regulations, presumably a wholesale ban wouldn’t have been entirely impossible, so why did the city keep saying that it was?
- Getting back to the root of the story, what does this mean for the mohel, R’ Yitzchok Fischer?
Check out the full metzitzah archives.
UPDATE: Questions from comments on Hirhurim:
- Zackary Sholem Berger, who’s either in medical school or recently graduated, writes: “I’m no expert in infectious disease, but I wonder about the precautions listed. They would probably help reduce bacterial infections, but what people are worrying about these days is neonatal herpes. Antibiotic ointment won’t do much to counter that.” Interesting, if true. Points to questions above about the procedure.
- Gil writes: “The most significant part is that when a case is reported, the mohel is required to submit to DNA testing and can be barred from future circumcisions.” Interesting claim, but that’s nowhere in the news story, so I don’t know where Gil gets that information from, and wouldn’t believe it until I get it from a real source. What’s odd is that if it’s true, it acknowledges some likelihood of infection through the procedure even with these regulations in place. Also, such a regulation would mean that the state is only doing so much to keep mohels from infecting the first time; it’s the repeat incidents such a regulation would stop. Third, and most significantly, everything we’ve heard from medical experts indicates it’s wrongheaded to assume that only certain mohels will cause an infection; that it’s completely owing to chance that this or that mohel happens to infect a child at any given time, because there’s no adequate testing available to ensure the mohel isn’t shedding the virus at the time of the circumcision.
UPDATE: Gil corrects me, citing this paragraph I missed:
If a baby who underwent metzizah b’peh does contract herpes, the mohel, the infant’s parents and health care workers will be tested. If the mohel has the same viral strain as the baby, the mohel will be barred from conducting any future circumcisions.
This is very interesting, particularly as it relates to Fischer, but as I said above — the medical experts who’ve spoken publicly and the city’s health department have both said that this wouldn’t really do much. It’s a very odd policy, in light of what we’ve been told about the medical realities, and it’s also quite a novel one if it’s coming from the Satmars, who would now be jettisoning Fischer with this policy (interestingly, the Agudah, which was not included in this policy, was the group advocating that mohels who’d shown themselves to be likely to infect should be kept from the practice).