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Proposal by College of Physicians and Surgeons to have all circumcisions performed in medical clinics “cut off” before it could go anywhere

By BERNIE BELLAN It began with an emailed message sent out by Jewish Federation CEO Elaine Goldstine to members of the community on July 13.
In her message, Goldstine informed recipients that the College of Physicians and Surgeons of Manitoba had issued a draft proposal that, if accepted, would prevent any circumcisions from being performed anywhere other than in a “medical clinic”.

The proposal, however, did not include any specific reference to the Jewish tradition of “brit milah”, which has traditionally been performed in a home setting.
According to Goldstine, “If brought into force, this draft as it is currently worded would therefore make the performance of a brit milah by a physician outside of a medical clinic a violation of the College’s Standard of Practice.

 Even though the Draft Standard by the College has been in the public domain for approximately one month, the Jewish Federation was only made aware of its contents yesterday” (July 12).
Further, according to Goldstine, “

The Jewish Federation immediately reached out to the College of Physicians and Surgeons of Manitoba to discuss the matter. Based on those discussions, this was unintentional.”

Subsequent to Goldstine’s email to members of the Jewish community, the Winnipeg Council of Rabbis sent a letter to the College of Physicians and Surgeons, also indicating strident opposition to what was perceived as the College’s new policy governing circumcisions.
In the letter, which was penned by Rabbi Allan Finkel of Temple Shalom, the Council enumerated a number of points, all of which detailed the long history of circumcision within the Jewish community.

B’nai Brith Canada also joined in the opposition to the College’s proposal, noting that “If enacted, this would constitute a significant infringement on the important Jewish lifecycle event of brit milah. Jewish circumcisions are typically family events hosted in homes or synagogues, involving a celebratory meal, blessings and speeches. None of these can practically take place in a medical clinic or hospital.
“In correspondence with B’nai Brith, the CPSM has clarified that pursuant to Manitoba law, non-CPSM members can also perform ritual circumcisions and would not be bound by the proposed Standard of Practice. But the main mohel, or Jewish circumciser, in Manitoba is a CPSM member, and the mooted change would have the effect of preventing any future Manitoba mohel from performing traditional Jewish circumcisions while maintaining a medical practice, which is standard across Canada.
“There is no evidence that the CPSM specifically consulted the Jewish community about the proposed change, despite its obvious impact on Jewish life in Manitoba. It is also not clear what prompted the proposed restrictions, and B’nai Brith is not aware of equivalent strictures in any other province.”

A perusal of laws as they apply in other countries did not turn up any other jurisdictions which require that circumcisions be performed only within a medical clinic.
We wondered what may have led to the College of Physicians and Surgeons, perhaps unintentionally but with drastic implications nonetheless, wanting to regulate the practice of circumcision in a way that had never been ordered previously?

As background to the College’s apparent radical policy directive, Myron Love sent me a story that was originally reported by the CBC in December 2018. In that story a CBC journalist reported on two botched circumcisions that had been carried out by a Dr. Ejaz Ahmad. The CBC report noted that:
“Two boys almost bled to death from botched circumcisions performed by a now-suspended Winnipeg doctor.
“Dr. Ejaz Ahmad pleaded guilty to professional misconduct on Oct. 15 (2018) for performing circumcisions on

as many as 18 pediatric patients in 2016 and 2017, when he lacked the training and know-how to do the procedures.
“Several of his young patients ended up in the emergency room with complications.
” ‘It is disturbing any time a physician practises and performs procedures that they are not competent to do,’ said Dr. Anna Ziomek, CEO and registrar of the College of Physicians and Surgeons of Manitoba, in an interview Thursday.
“Among the complications, two boys were rushed to hospital with potentially life-threatening bleeds, one after a portion of his penis was amputated and the other with arterial bleeding.
“Other boys experienced complications like swelling, pain, embedded gauze from improper wound care, possible infections and disfigurement.
“At least one boy’s penis was left so deformed he required a revision surgery.
“Ahmad admitted to using an inappropriate technique and lacking knowledge, skill and judgment. He acknowledged he provided anesthetic at a ‘non-specific dose,’ used only alcohol swabs to sterilize the surgical site and did not suture after circumcision.”

But, here’s a crucial part of the story: “The circumcisions were performed at Ahmad’s private clinic.”
One wonders, therefore, how the College’s proposal to require that all circumcisions be performed within a medical clinic would have made any difference if a physician is not fully competent to perform those procedures, as was evidently the case with Dr. Ahmad?
Apparently the storm that resulted from the initial disclosure by Elaine Goldstine in her email to community members that the College was considering ordering that all circumcisions in future be performed within a medical clinic led to a quick reversal on the College’s part.
By Friday, July 16, the College had posted a notice on its website indicating a complete abandonment of its proposal. Here is what that notice said, in part:
“We recognize that as currently written, the standard would implicate a practicing CPSM (College of Physicians and Surgeons of Manitoba) member performing a male circumcision outside of an appropriate medical facility. That was not the intention in drafting the standard…

“The standard will be amended. The standard will not infringe on any human or religious rights and freedoms whatsoever. The role of CPSM is to protect the safety of the public, and we will continue to strive to achieve this through appropriate regulation of the medical profession.
“At a minimum, the working group will add an exemption in the standard for male circumcision performed in a religious ceremony or tradition, particularly respecting low-risk neonatal circumcisions…
“CPSM established a working group in 2020, tasked with developing a new standard of practice for performing specific procedures in office-based practice settings, including male circumcisions.
“The working group did not consult with the Jewish community in its early development of the draft Standard; however, that is precisely the purpose of the current public consultation, and we are grateful for the feedback received.”

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