Tuesday, July 18, 2017

CONNECTICUT: Baby's Glans Partially Amputated - Doctor Cleared of Negligence

Particularly in the United States, suing for circumcision malpractice is an uphill battle.

About 80% of US males are circumcised from birth, and though male infant circumcision rates have fallen in the past years, to about about 56% if CDC numbers are to be believed, the practice is still quite prevalent, at about 1.3 million boys circumcised a year.

This means that male infant circumcision is viewed favorably by a considerable number of the population.

The country is exposed to a constant drizzle of news articles and "studies" saying that circumcising male infants is "beneficial," and that adverse effects of it are "negligible."

So we, as a nation, are predisposed to believe that circumcision is a benign, "harmless" procedure and that nothing could ever go wrong.

It's no surprise, then, that any adverse results that do present themselves are minimized, and those who are at fault for negligence or malpractice are often absolved, boys and men who have to live with the consequences of a circumcision gone wrong be damned.

Connecticut Mogen Clamp Case
A circumcision malpractice case is currently stirring up controversy on Facebook, where at least one user who posted the case on his timeline has been punished with a 30 day ban.

The case in question is Mahoney v. Smith, a case in Connecticut where parents sued Dr. Lori Storch Smith over malpractice for a circumcision performed at Norwalk Hospital on December 29, 2010.

During this procedure, Dr. Smith used a Mogen Clamp, and then realized that she had cut off approximately 30% of the glans of the baby's penis. The baby was subsequently transported to Yale-New Haven Hospital where he had the amputated portion reattached.

The trial began on April 15, 2015 – and the jury cleared the defendant. The verdict was appealed, and the Appellate Court ruled against the plaintiffs on July 13, 2017.

Long story short, the jury was presented with evidence, and despite the fact that the child's circumcision resulted in 30% of his glans being amputated, decided that the Bay Street Pediatrics doctor should be cleared of medical negligence.

The Devil in the Details
The parents tried appealing the court decision but were unsuccessful.

They tried to argue that  a video shown in court was unfairly allowed by the trial judge, which may have swayed or confused the jurors.

The video shows a Mogen procedure being completed successfully without any complications.

Furthermore, details that were never an issue or point of contention were addressed, namely that anesthesia and the right surgical tools to control bleeding were used. (The end result was 30% of the child's glans being severed, regardless of how much anesthesia or which tools were used.)

According to the appellate court, rather than confuse, the video likely illustrated for the jury the testimony given by the Mahoneys’ own expert witness, Dr. David Weiss, describing a circumcision using a Mogen clamp, an allegation that can't be true, given the fact that the child's circumcision was a botched surgery, not one completed successfully as shown in the video.

The problem lies in the technicality that the Mahoneys' counsel identified the video as acceptable evidence for presentation prior to the trial.

The Mahoneys are apparently at fault for not having requested to see the video before it as presented and rejected it as evidence.

According to Law360, "The plaintiffs could have asked to watch the video prior to its introduction at trial, but did not do so; nor did they file a motion in limine seeking to preclude its admission into evidence, move for a continuance after it was marked for identification or recall Dr. Weiss to serve as a rebuttal witness concerning the video," the panel wrote in a nine-page opinion.

The Mahoneys tried to argue that use of the video violated the court rules regarding disclosure of expert testimony, but the panel rejected this argument saying the plaintiffs did not specifically make those claims in their motions to set aside the verdict for a new trial.

The jury, while deliberating, wanted to see the video again. However, this request was denied because the video itself was not part of the evidence, because it was not produced as evidence and was not a recording of the actual botched surgery. (Begging the question of why it was allowed to be shown in the first place.)

The jury then requested to hear again the declaration of the expert witness, the one that presented the video. They were told they could get a  transcript but that would take about 2 days to just listen to the transcript again.

It must be asked, what was the purpose of showing a video where the procedure went how it was supposed to in the first place?

How was it significant enough to show it to the jury the first time, but suddenly not significant enough to request to see it a second?

So if your blogger read the appellation correctly, the court discouraged the jury from re-hearing this testimony. In my opinion, this is necessarily the result of judges who are already circumcised themselves, and/or have circumcised children, working with a jury whose members are likely to be circumcised/parents of circumcised children themselves, both of whom already want believe circumcision is benign and could never go wrong, and want to see this case dismissed, so that they can go back to believing circumcision is "harmless" and "good."

In the end, a child's glans was partially amputated, and the jury believed the doctor wasn't negligent and performed the circumcision "properly" because that's what they saw in a video.

And it's the parents' fault for not requesting to see the video before it was presented.

The details can be read here.

It Doesn't Matter
 A Mogen clamp; the circumcision clamp used in this case

We can go on and on quibbling about the details in this case, how the judges, jury, lawyers handled it etc., but that is beating around the bush.

The fact is a mogen clamp was used in 2010, when it was already clear that there is potential for injury even in the best case.

I have already written numerous posts on this before, but the Mogen Clamp is notorious for glans amputations.

Common Mogen Problem: The circumciser is blind to the
conditionof the child's glans. Some or all of the glans is pulled up
along with the foreskin, resulting in partial or full glans amputations.

Back in August, 2000, the FDA issued a warning regarding the potential for injury employing the use of the Mogen and Gomco clamps, after 105 reports of injuries between July 1996 and January 2000.

On July of 2010, six months before this botched procedure, an Atlanta Lawyer won a $10.8 million lawsuit for the family of a baby whose glans was amputated during a Mogen clamp circumcision.

Mogen Circumcision Instruments of New York was already $7 million in default on another lawsuit, and was thus forced out of business.

Another baby, born on March of 2010 (9 months before this botched circumcision) also had the glans of his penis removed during a Mogen clamp circumcision. His parents filed a lawsuit on April of 2015.

The FDA warning was later archived, but remained accessible on their website for some time.

(Incidentally, your blogger tried accessing that warning today, but it is nowhere to be seen. The failed search even offers to search the FDA archive, but this is also a dead end. Fortunately, a copy of the warning can be found archived on the CIRP webpage.)

AAP Silent
In 2012, the American Academy of Pediatrics issued their policy statement on circumcision, in which they make the self-contradictory statement that “the benefits outweigh the risks”, but that “the benefits are not enough to recommend circumcision.”

Dr. Andrew Freedman from the task force said that “there are modest benefits and modest risks."

In their statement, the AAP tries to minimize the risks and complications of male infant circumcision, including the most catastrophic risks, which include partial or full ablation of the penis, hemorrhage and even death. Reported incidences of adverse effects of circumcision are dismissed as "case reports" because of the lack of statistics.

The AAP admits in their 2012 statement that "the true incidence of complications after newborn circumcision is unknown."

The AAP policy statement on circumcision is turning 5 years next month.

Will they reaffirm it?

Will they present a new one?

Are they even trying to document the actual number of catastrophic injuries?

The fact is, physicians and hospitals are not required to report adverse outcomes of circumcision procedures.

It's also a fact that the AAP is first and foremost a trade union, whose primary interest is the welfare of their members, a great deal of who profit from the business of male infant circumcision.

Something tells me they're not interested in conducting investigations that could prove devastating to their members.

The bottom line is that male infant circumcision is elective, cosmetic non medical surgery whose risks and complications are no longer deniable.

Are parents being warned of these risks?

But more importantly, can doctors get away with reaping profit performing non-medical surgery on healthy, non-consenting individuals?

Were it the amputation or extraction of any other part of the body, the medical fraud would be undeniable.

Why is it that doctors who perform male infant circumcision get a free pass?

Related News Articles:
Schmidt Law - Mogen Clamp Circumcision Lawsuit Filed for Penis Amputation

AJC - Atlanta lawyer wins $11 million lawsuit for family in botched circumcision

WCPO Cincinnati - Cincinnati protesters demand end to circumcisions at Good Samaritan Hospital

Journal of Perinatology - Pain During Mogen or PlastiBell Circumcision

Related Posts:
Mogen Circumcision Clamp Manufacturers Face Civil Lawsuit

The Ghost of Mogen

CINCINNATI: Intactivists Protest Circumcision "Experiment" at Good Samaritan Hospital

AFRICA: Botwsana to Implement Controversial Infant Circumcision Devices

Monday, July 10, 2017

MEDICAL FRAUD: First Choice Pediatrics Brazenly Misquoting AAP to Push Circumcision

Sometimes you've got to help the AAP along.

You see, in their 2012 statement on circumcision, the AAP did everything they could to vindicate male infant circumcision, but in the end stopped short of a recommendation because in their own words, "the benefits [of male infant circumcision] aren't great enough to recommend" it.

So what do you do?

You get ambitious pediatricians to give them that extra push.

In a YouTube video published by First Choice Pediatrics, one can see Esther Song brazenly saying the AAP actually does recommend male infant circumcision, and boasting that they use a sucrose solution to help with pain management among other things.

"American Academy of Pediatrics do recommend circumcision for the babies... there's some controversies and the problem is that insurance are not covering it, they're still considering it as cosmetic procedure, but we do believe that it is better for their hygiene, and there's other studies showing that it does decrease rates of sexually transmitted infections... and its' actually quicker healing, and we do use this sucrose solution to calm them down and it is very effective and doctors do use local anesthesia to help with the pain also, so I do recommend getting the circumcision and we do offer the surgery here..." ~Esther Song, Pediatrician, First Choice Pediatrics

So many things wrong here, beginning with the fact that actually, no, the AAP does not recommend male infant circumcision. They stopped short in their 2012 statement stating that the "benefits are not sufficient."

Second, babies don't have sex, so why a possible reduction in sexually transmitted diseases is relevant to tell parents is questionable.

Third, she is talking about pain management that has been shown by studies to actually be quite ineffective.

Here is what one study on "sucrose solution," or sugar water has to say on the matter:

"Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief."
Slater, Rebeccah; Laura Cornelissen, Lorenzo Fabrizi, Debbie Patten, Jan Yoxen, Alan Worley, Stewart Boyd, Judith Meek, Prof Maria Fitzgerald (2010-10-09). "Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial". Lancet, The 376 (9748): 1225-1232. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext. Retrieved 2011-04-08.

Additionally, here are two studies on local pain management:

  "...more than half of the study group had what we considered excessive pain/discomfort over the course of the entire procedure.". 
Taeusch, H William; Alma M Martinez, J Colin Partridge, Susan Sniderman, Jennifer Armstrong-Wells, Elena Fuentes-Afflick (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. http://www.nature.com/jp/journal/v22/n3/full/7210653a.html. Retrieved 2011-04-08.

"The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine.".
Williamson, Paul S.; Nolan Donovan Evans (August 1986). "Neonatal Cortisol Response to Circumcision with Anesthesia". Clinical Pediatrics 25 (8): 412-416. http://cpj.sagepub.com/content/25/8/412.abstract. Retrieved 2011-04-08.

I think it is clever how she makes the controversy about "insurance companies not covering it," and doesn't get into how human rights groups consider it to be mutilation and a human rights violation outside a valid medical necessity.

Will she inform parents about how circumcision has been abandoned by pretty much every other English-speaking country?

I guess you can't talk about that if you're trying to sell circumcision to parents, can't you...

One of the persons in the videos said that babies "sleep through the procedure." I'm guessing she thinks, or she hopes, YouTube videos aren't available for parents to watch, and that parents wouldn't bother to see them, because no, babies don't sleep through the procedure. And they certainly aren't asleep during the post-operation diaper changes when the babies scream their lungs out. There are YouTube videos for that too.

How stupid do the folks at First Choice think parents are?

Hurray for fully informing parents!

"It is difficult to get a man to understand something when his salary depends on his not understanding it."
~Upton Sinclair

So the only thing really going for First Choice is their "belief" that male infant circumcision is more "hygienic." Why they don't believe in soap and water like the rest of the English-speaking world is puzzling.

I wonder what the American Academy of Pediatric thinks about medical groups deliberately misquoting them for profit...

For their own benefit, we do hope the folks at First Choice are willing to rectify the deliberate misinformation they're feed parents.

Statements by Other Organizations
Just for fun, here is a list of statements on circumcision released by medical organizations around the world. 

"The British Medical Association has a longstanding recommendation that circumcision should be performed only for medical reasons... Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns".
~AMA Report 10 of the Council on Scientific Affairs

"...benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised."
~American Academy of Pediatrics (AAP) 

"...the association between having a sexually transmitted disease (STD) - excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive... most of the studies [of the effect of circumcision on HIV] ...have been conducted in developing countries, particularly those in Africa. Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S. population".
~AAFP "Position Paper on Neonatal Circumcision" 

"Current understanding of the benefits, risks and potential harm of this procedure no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention."
~College of Physicians and Surgeons of British Columbia 

"[We] do not support recommending circumcision as a routine procedure for newborns."
"Circumcision of newborns should not be routinely performed."
~The Canadian Paediatric Society 

"The BMA considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."
~The British Medical Association

The Royal Australasian College of Physicians stated in 2010 that the foreskin "exists to protect the glans" and that it is a "primary sensory part of the penis, containing some of the most sensitive areas of the penis."
According to the Australasian Academy of Paediatric Surgeons:
"The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available."

"We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce."

"Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove."
In the Netherlands, the Royal Dutch Medical Association (KNMG) issued a statement in 2010 stating that "The official viewpoint of KNMG and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity." Circumcision can cause complications, including infection and bleeding, and are asking doctors to insistently inform parents that the procedure lacks medical benefits and has a danger of complications. In addition to there not being any convincing evidence that circumcision is necessary or useful for hygiene or prevention, circumcision is not justifiable and is reasonable to put off until an age where any risk is relevant, and the boy can decide himself about possible intervention, or opt for available alternatives. They went on to say "There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation."

Related Posts:
AAP: Around the Bush and Closer to Nowhere

OUT OF LINE: AAP Circumcision Policy Statement Formally Rejected

Friday, July 7, 2017

FACEBOOK: Circumcision Regret Mom Shares Son's Story


I ran across the rant of a circumcision regret mom on my Facebook news feed and thought it would be worth a post on my blog.

Advocates of circumcision are always trying to minimize the risks and complications of male infant circumcision. "The risks are minimal," they say, without really getting into any detail.

But what are those risks?

The risks of male infant circumcision include infection, partial or full ablation, hemorrhage and even death.

It is difficult to come up with concrete numbers for many reasons, namely that doctors and hospitals are not required to report the number of adverse outcomes in circumcision, the complications are often attributed to something else, and parents are complicit with doctors in keeping complications under wraps. At 1.3 million circumcisions a year, male infant circumcision is a money-maker, and thus doctors and hospitals have financial incentive to minimize adverse male infant circumcision outcomes.

But there's a risk that is not often talked about, even though, according to research, it is fairly common, particularly in circumcised males; meatal stenosis, a narrowing of the urethra which makes it difficult to urinate.

I'm not going to say much on this post; I will merely copy/paste the rant, and cite research on the topic immediately following that.

All I will say is that ANY risk is unconscionable, given that male infant circumcision is elective, non-medical surgery on a healthy, non-consenting individual.

The mother's rant was as follows:

Meatal Stenosis. What?
Does your son have it? Do you know what it is?
I didn't, 6 years ago. I'd never heard of it until I started learning about infant circumcision harm, far too late, I might add, to protect my son.
Meatal Stenosis, 100% caused by circumcision.
It's a good thing that I do now. It could have saved my eldest son's life.

Studies Have shown approx. up to 26% of circumcised males develop it- at least 81% in some communities(Israel), experts believe.
I learned about it because of the volunteer work that I do, although he didn't present with typical symptoms. The pediatric urologist told my husband that he was lucky I caught it. I wasn't sure, it was only my instinct and knowledge that saved him. He has it severely, btw. (Edited to add, the pediatric Urologist of nearly 20 years, does about 10+ of these a week, and has NEVER done one on an intact child).
Would you have caught it in your son? Do you know what the symptoms are?

Tomorrow my son has to have a surgery.
A surgery he should never have to have, CAUSED because of the vicious amputation he should NEVER have had to suffer within a day or two of his life. Circumcision.

I will ALWAYS speak out to protect those that can be spared the agony he had to, and has to, endure because a Father wanted the same for his son. He was a victim too. The same old story.....

I will ALWAYS speak out to help STOP this scourge in America.
I will ALWAYS speak out to protect Babies that can't speak or scream 'NO!'.
'Unfriend' me if you are tired of seeing my posts. I, however, am tired of seeing babies suffer, endure years of agony and even death. I'm so tired of it. Tired of seeing MY baby suffer. It makes me nauseous. I have regretted not fighting harder for the last 6 years, and to make it up to him, I will fight till my last breath.
Informed consent? They didn't mention one of the many complications, including Meatal stenosis, to us when we had to sign. That is NOT informed consent. That's deceit.
Were you told?

Fu*k you circumcison. See you in the grave clamps.

That said, here are links to the research, as well as relevant quotes:

"The condition is called meatal stenosis and the risk of developing it is 16-26 times higher in circumcised than intact boys under the age of ten.

Meatal stenosis can occur several years after circumcision, and may lead to infection if left untreated. The only solution is a minor operation under general anaesthesia."
"Meatal stenosis is markedly more common in circumcised than genitally intact males, affecting 5–20 per cent of circumcised boys."
"Meatal stenosis as a complication is often missed by the clinician because children do not usually have late follow-up after circumcision. The symptoms of pain are often mistaken for symptoms of a lower urinary tract infection and symptoms of distal urethral impairment of urinary flow are usually ignored for many months until parents witness the child's voiding habit."
"Meatal stenosis is a relatively common acquired condition with a symptomatic presentation that occurs in 9-10% of males who are circumcised; the frequency may be ashigh as 20% after circumcision if the condition is defined as a meatal diameter of less than 5 French."
"Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications."

Related Posts:
GUEST AUTHOR: Meatal Stenosis

JOHNS HOPKINS: Meatal Stenosis Article Scrubbed from Website