Article 181-Consent for Non-Medical Circumcision
Proposed Rules: Closed to Comments
Statement of Basis and Purpose
These proposed amendments to the Health Code are promulgated pursuant to §§ 558 and 1043 of the Charter.
· Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the Health Code all matters to which the authority of the Department of Health and Mental Hygiene (the “Department” or “DOHMH”) extends.
· Section 1043 grants the Department rule-making authority.
The amendment is also proposed pursuant to the Department’s historic power to supervise the control of communicable disease in New York City. Section 556 of the Charter provides the Department with broad jurisdiction to regulate all matters affecting health in the City of New York. The control of communicable disease is a core public health function.
Purpose of the Proposed Amendment
The purpose of the proposed amendment is to require informed consent from a parent or legal guardian when direct oral suction will be performed during his or her son’s circumcision. A written informed consent will be required, which would provide information about the risks involved, including possible infection with herpes simplex virus and its potentially serious consequences, such as brain damage and death. Knowing the risks posed by direct oral suction, a parent or legal guardian can then make an informed choice about whether it should be performed as part of the circumcision.
The proposed amendment will require practitioners of oral suction during circumcision to retain copies of informed consent forms for at least one year and to make them available to the Department upon request.
Male circumcision, which involves cutting off skin and leaving an open wound on the penis, carries a risk for infection, bleeding and penile injury to infants under 60 days of age. Therefore circumcision should be performed under sterile conditions to protect the open wound from infection. A practice known as metzitzah b’peh, involves direct contact between the mouth of a person performing circumcision and the infant’s circumcised penis (‘direct oral suction’). When direct oral suction is performed as part of circumcision, there is a risk that the person performing direct oral suction will transmit herpes simplex virus or other infectious disease to the infant being circumcised.
Between 2004 and 2011, the Department learned of 11 cases of laboratory-confirmed herpes simplex virus infection in male infants following circumcisions that were likely to have been associated with direct oral suction. Two of these infants died, and at least two others suffered brain damage. The parents of some of these infants have said that they did not know before their child’s circumcision that direct oral suction would be performed. In addition, since 2004, the Department has received multiple complaints from parents whose children may not have been infected who were also not aware that direct oral suction was going to be performed as part of their sons’ circumcisions.
The proposed amendment
A new Health Code provision, §181.21 -- Consent for direct oral suction as a part of circumcision, would require that if direct oral suction is to be performed as part of a circumcision, the person performing the direct oral suction must obtain prior written informed consent from a parent or legal guardian. The written consent would document that a parent has been given notice that direct oral suction is to be performed and that the parent has been informed of the risk of transmission to the infant of herpes simplex virus infection and other diseases. A copy of the signed consent form would have to be given to the parent or legal guardian signing the consent, and the person performing direct oral suction as part of the circumcision would have to maintain the original for at least one year after the circumcision is performed, and make it available for inspection at the request of the Department.