More than half of male newborns in America are circumcised before they leave the hospital. As with any medical procedure, if it results in injury, the medical professional involved could face discipline by licensing authorities in Pennsylvania and other states.
No comparable state oversight, however, governs the same procedure when it's conducted by a religious practitioner with no medical license. And that, says a Pittsburgh lawyer suing over a catastrophic injury suffered by a newborn in April 2013, needs to change.
The lawsuit, pending in the Allegheny County Court of Common Pleas, is seeking damages from Rabbi Mordechai Rosenberg for alleged negligence and inflicting of emotional distress on the boys' parents, who witnessed what the lawsuit called a "gruesome and torturous event." Rabbi Rosenberg has since 1990 worked as a mohel, the traditional term for one who performs circumcisions as part the traditional Jewish rite of passage.
"I think that mohels or any non-medically trained individual who is going to do a circumcision should be regulated by the state in terms of their competence, their education, their technique, their sterility, everything you do during a circumcision," said attorney Neil R. Rosen, representing the injured boy's parents.
Mr. Rosen, who is Jewish, said the government has no business regulating the religious aspects accompanying the procedure -- such as when it's done or what prayers are said -- but that it should oversee the procedure itself.
"I know this is controversial," he acknowledged.
In fact, debate has followed attempts around the country and world to regulate or even ban male circumcisions, the cutting off of the foreskin of a boy's penis. In Jewish tradition, it is called a bris and is performed when the boy is 8 days old (but can be delayed by bad health). It hearkens back to circumcision of Abraham and other biblical patriarchs as a sign of their covenant with God.
The practice, also traditionally a rite of passage among Muslims and some indigenous groups, became a common medical practice in 20th-century America as well.
The American Academy of Pediatrics says the procedure has benefits, such as preventions of some infections, that outweigh potential risks. It says complications of any sort are infrequent and that catastrophic ones are too rare to review statistically. But critics dispute the academy's findings and say adults cannot ethically decide on a painful and irrevocable procedure for an infant.
The national rate of hospital circumcisions of newborn males declined from 65 to 58 percent between 1979 and 2010, according to the U.S. Centers for Disease Control and Prevention. Much of the decline in that rate -- which doesn't account for religious or other later circumcisions -- took place in Western states, while rates in other U.S. regions held relatively even.
Rabbi Rosenberg's website continues to advertise his services. It says he has been performing circumcisions since 1990 and was trained and certified by Israel's supervisor of mohels.
The plaintiffs -- a young couple identified only by their initials to protect the boy's identity -- hired him to circumcise their son, gathering with family for what was to be a joyous and common ritual at the Tree of Life synagogue in Squirrel Hill.
The suit said Rabbi Rosenberg "suffered from an impairment of his ability to think and process thoughts clearly" and recklessly failed to use the shield normally employed to protect against catastrophic injury. Mr. Rosen said Rabbi Rosenberg severed the organ and that the boy's grandfather, himself a doctor, immediately called Children's Hospital of Pittsburgh of UPMC and alerted them to assemble a reconstructive surgery team.
Mr. Rosen said the baby's entire blood supply had to be replaced via transfusion and that doctors took heroic measures in reconstructive surgery and afterward. It included therapy involving blood-drawing leeches, whose saliva is seen as stimulating healing.
Despite successful surgery, "this young child is at risk for unimaginable problems in the future," Mr. Rosen said. "He's just a baby. He's home, and he is at risk for awful problems."
Rabbi Rosenberg declined to comment in an interview. A court filing by his attorney acknowledged the injury but denied negligence. "Rabbi Rosenberg performed the bris milah in a careful and competent fashion, with the care and skill normally exercised by Mohels under the same or similar circumstances," it said.
Rabbi Rosenberg continues to be recognized by the American Board of Ritual Circumcision, according to its chairman, Rabbi Romi Cohn of New York City. He said it is "very, very seldom" that such injuries occur and that a certified mohel needs to undergo extensive training, an examination and perform three circumcisions in the presence of board members.
The board is mainly associated with Orthodox or most strictly observant practitioners of Judaism. The other major branches, Conservative and Reform, also have organizations that train and certify mohels and in some cases recruit doctors to learn and perform the procedure's religious aspects.
Such groups are voluntary and, while they can exclude someone from membership, they cannot sanction a mohel in the way that a state licensing board can.
The Pennsylvania Board of Medicine has the authority to investigate, sanction or revoke the license of a health-care professional for negligence in the performance of any medical procedure, including circumcision. It can also investigate those performing medical care without a license and refer a case to prosecuting authorities. But with a rite such as circumcision, "you have to balance religious freedom protections against public health and safety," said Department of State spokesman Ron Ruman.
There have been efforts to regulate circumcision in the United States and abroad.
An attempt to get San Francisco to ban circumcisions by referendum was blocked by the California Legislature in 2011. New York City faces a court challenge over its requirement that parents sign an informed-consent form about a practice in some Orthodox communities in which the mohel orally suctions blood from the wound, which the department has linked to some severe and even fatal viral infections. But that does not regulate the circumcision itself.
More serious efforts have taken place in Europe. After a German judge ruled in 2012 that circumcision was a criminal act of bodily harm, individuals brought complaints against mohels, and the German parliament passed a bill legally protecting infant circumcision in religious rites. The Parliamentary Assembly of the Council of Europe adopted a resolution last year putting ritual circumcision in a category of other acts it called "violations of children's physical integrity" and called on member states to regulate how they are performed.
Critics of such measures say that attempted curbs on an ancient Jewish rite are freighted with anti-Jewish or anti-Muslim overtones. "Their agenda is not protecting babies," Rabbi Cohn said. "They have ulterior motives."
Gregg Roman, speaking for the Community Relations Council of the Jewish Federation of Pittsburgh, said that "any proposal to ban circumcision is an affront to religious liberty and to parents' right to raise their children according to their traditions. Any proposal to ban male circumcision is an expression of intolerance and discrimination against centuries-old religious practice. A ban that specifically targets a religious practice of Jews and Muslims and that has been proven to be medically beneficial is a violation of the First Amendment."
A statement by the Anti-Defamation League cautions against using the case of Rabbi Rosenberg to justify such measures.
"The covenant of circumcision [brit milah] is a religious ceremony performed for millennia by Jews throughout the world," it said. "The incident in Pittsburgh is a tragic anomaly and the responsible party should be subject to civil liability. However, constitutional religious free exercise and prohibitions on government entanglement with religion bar official regulation of this ceremony. It is the job of the Jewish community to ensure that only trained and reputable mohels perform this sacred rite."
But Mr. Rosen said the options to stop an incompetent mohel are limited. He could voluntarily stop practicing, a synagogue could bar him from its premises, or "if the public is sufficiently educated about the incompetence of a particular mohel, then they won't hire that mohel to do a bris."
Otherwise, Mr. Rosen said, families can only seek legal redress after an injury. "When you do something as bad as this, in our legal system, like it or not, you step up to the plate and take responsibility," he said.
Peter Smith: email@example.com, 412-263-1416 or Twitter @PG_PeterSmith.