Monsey rabbi investigated

Baby dies after unsanitary ritual circumcision

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.

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