100+ circumcision deaths each year in United States

Each year in the United States more than 100 newborn baby boys die as a result of circumcision and circumcision complications. This is the alarming conclusion of a study, published in the Journal of Boyhood Studies which examined hospital discharge and mortality statistics in order to answer two questions: (1) How many baby boys dies as a result of circumcision in the neonatal period (within 28 days of birth)? (2) Why are so few of these deaths officially recorded as due to circumcision?

The study, by researcher Dan Bollinger, concluded that approximately 117 neonatal deaths due directly or indirectly to circumcision occur annually in the United States, or one out of every 77 male neonatal deaths. This compares with 44 neonatal deaths from suffocation, 8 in automobile accidents and 115 from Sudden Infant Death Syndrome, all of which losses have aroused deep concern among child health authorities and stimulated special programs to reduce mortality. (Remember those red noses?) Why, the study asks, has the even greater number of deaths from circumcision not aroused the same response?

Part of the answer lies in the fact that most circumcision-related deaths are not officially as recorded as due to circumcision at all, but to the immediate cause, most commonly stroke, bleeding, infection or reactions to anaesthesia. Medical statistics are thus at fault in that they do not give the true cause of death at all. Previous studies have given wildly varying estimates the death toll from circumcision. In 1949 paediatrician Douglas Gairdner found that sixteen British boys died each year, while more recent estimates range from a low of two boys per year to a high of as many as 230. Some textbooks and most circumcision promoters claim that there have never been any deaths from circumcision in a modern clinical context (whatever may happen in the insanitary conditions of the Third World). For his study Bollinger collected data from hospital records and government sources to attempt to provide a more accurate estimate of the magnitude of the problem.

But another part of the answer lies in the unique place that circumcision occupies in American medical culture, as an entrenched cosmetic ritual that many parents feel they have to submit their baby boys to, and as a lucrative sideline that doctors are reluctant to abandon. American obstetricians can’t seem to rid themselves of the notion that circumcision of boys is somehow an integral part of childbirth. The study points out that “These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said ‘Yes,’ or lacked the courage to say ‘No.’” It further points out that because circumcision is a completely unnecessary operation, all these deaths are easily avoidable, and thus characterises the annual loss as neither a beneficial surgery nor a beneficent rite of passage, but as “an unrecognized sacrifice of innocents.”

Because circumcision is unnecessary surgery (there being no pathology to treat in a normal male baby), the old calculus of surgical risk vs benefit is not nearly enough. “Risk assessment for an unnecessary surgery must be held to a higher standard than that for a life-saving surgery. We accept that a heart transplant carries with it a substantial risk of death, but without it there is a certainty of death. On the other hand, the risk from circumcision, which has no therapeutic value, needs to be zero for the infant’s sake, all the moreso because he is never consulted about whether he wishes to take his chances.”

Bollinger argues that the scale of the problem remains unrecognised because of the inadequacies of the death-certificate system and unwillingness on the part of the doctors who performed the surgery or the hospitals where it took place to admit responsibility, or even to acknowledge that circumcision is a surgical operation which, like all surgery, carries real risks. Too often they have tried to blame incorrect care on the part of parents, or even the peculiarities of the boy himself. As well as analysing the figures, the study runs through some of the few prominent instances where circumcision was recognised as the true cause of death, including the Ryleigh McWillis case in Canada, and several United States deaths that somehow made it into the news.

Some of these make chilling reading, as these excerpts from the article show:

The first known reported circumcision-related deaths were in New York City, where circumcision was introduced. The first was Julius Katzenstein in 1856 and the second was one-week-old Myer Jacob Levy in 1858. Both boys were circumcised by a Dr. Abrahams, and the same coroner reviewed both deaths. The coroner found that Abrahams had performed the surgeries properly, and that the boys died from blood loss as a result of parental neglect. Neither boy had received a follow-up examination.

Allen Ervin, born 1985, was in a coma for more than six years before he died. He had been on life support after his brain was damaged from oxygen deprivation during his circumcision. Demetrius Manker was born in 1993 and died soon thereafter from blood loss. The coroner’s examination found a large, gaping wound on the underside of the boy’s penis extending almost to the scrotum. The coroner listed cause of death as blood loss due to penile circumcision; however, there is no mention of further action being taken. A West Virginia child, whose name was withheld, was born in 1996 without incident and circumcised prior to hospital release. A few days later, the parents rushed him to the emergency room because he was having seizures and his penis had turned green in color. He died the next day from septicemia.

Because the penis is highly vascularized, blood-loss is a risk even for boys circumcised past the neonatal period. In 2008, a 6-week-old Native American, Eric Keefe, died from massive blood loss. Hospital officials claimed that his circumcision was not to blame, but instead faulted the parents because they had administered over-the-counter pain medication that, they also claimed, thinned his blood.

Death sometimes occurs following repair of a circumcision complication. Dustin Evans Jr., was circumcised soon after being born in 1998. The surgeon took so much shaft skin that the scar healed as a tight “collar” around his penis, preventing him from urinating. When he was later given an anesthetic in order to repair the damage, he immediately died of cardiopulmonary arrest. His father lamented, “You think, ‘What could go wrong with a circumcision?’ The next thing I know, he’s dead.”

To stop killing boys, stop circumcising them

The solution to the problem, Bollinger suggests, does not lie in improving surgical techniques or giving operator better training. “The problem is this: circumcision is a killer of baby boys. No one, except for some human-rights activists, is trying to save them. It is unlikely that improving circumcision techniques would eliminate these deaths. No matter how skilled the physician is, some deaths will always occur.” The only effective way to eliminate this death toll and save these boys is to admit that circumcision is unnecessary and potentially harmful surgery and stop performing it on neonates and minors. This would give all boys the chance to decide for themselves whether they wish to be circumcised, and (if they do) would allow them to choose it for themselves as adults, when the surgical risks are so much less severe.

Source: Dan Bollinger, Lost boys: An estimate of U.S. circumcision-related infant deaths, THYMOS: Journal of Boyhood Studies, Vol. 4, No. 1, Spring 2010, 78-90.

More circumcision death and injury in United States

$429,000 awarded for circumcision disfigurement

In August a Californian jury awarded $429,484 to an infant whose penis was disfigured for life by surgery. On Nov. 12, 2006, Evan Tank was circumcised by pediatrician Ralph Berberich, who accidentally cut the tip of Evan’s penis. Plaintiff’s counsel claimed that Berberich failed to remove adhesions tethering the foreskin to the glans, causing the glans to be pulled into the clamp along with the foreskin. Hence the glans was cut off along with the foreskin. Berberich countered that penis trauma is a recognized complication of the procedure and that Evan’s parents had accepted the risk The doctor argued that, rather than an error on his part, Evan probably had an unusual penile anatomy that caused his penis to be pulled into the clamp.

Source: Recorder (San Francisco) August 12, 2009

Interesting that the operator tried to blame the infant’s anatomy rather than admitting negligence in his own technique. The fact is that all penises are different; if surgeons are going to muck around with them, they ought to examine each one carefully before they charge in. It's also interesting that the operator tried to defend himself by admitting that (additional) damage to the penis was so common as to be "a recognised complication of the procedure". A bit like Russian roulette.

Parents sue over baby’s death after circumcision

The parents of a 6-week-old boy who bled to death after a circumcision at Rosebud’s Indian Health Service Hospital last year are suing the government for wrongful death. According to documents filed Wednesday in federal court, Eric Keefe underwent a circumcision on June 13, 2008. His mother gave him Motrin and Tylenol for pain and he suffered massive blood loss at home that night, dying at the hospital the next morning. His parents, Forrest and Mary Keefe of Wood, say Dr. Douglas Lehmann failed to inform them of the type of pain medication they should have used. The Keefes are seeking $2 million for personal injury and wrongful death. Sturgis lawyer Mick Strain, who represents the plaintiffs, said he and the parents wouldn’t talk about the case until it is tried or settled. The file lists no attorney for the government.

Source: Argus Leader [South Dakota], September 18, 2009

$2.3 million awarded for botched circumcision

A Fulton County jury (Georgia, U.S.A.) has awarded $1.8 million in damages to a boy whose penis was severed in a botched circumcision. The state court jury gave another $500,000 to the boy’s mother in the decision rendered Friday. The case involves a child, identified only as D.P. Jr., who was born at South Fulton Medical Center in 2004. In a suit filed two years later, his mother contended that the doctor who circumcised him removed too much tissue and that his pediatrician failed to respond when a nurse complained of excessive bleeding. The tip of the penis was placed in a biohazard bag and might have been reattached if a urologist had attended to the boy within eight hours, one of the mother’s lawyers, David J. Llewellyn of Atlanta [and ARC] said.

The jury found that both the pediatrician, Dr. Cheryl Kendall, and the physician who performed the circumcision, Dr. Haiba Sonyika, were negligent. South Fulton Medical Center was absolved of liability. The pediatrician’s lawyer, Roger Harris, said he disagreed that the jury’s decision indicated that Dr. Kendall was negligent because she didn’t go to the hospital. He hinted at an appeal. “We believe there was error committed during the course of the trial,” he said. Dr. Sonyika’s lawyer could not be reached for comment.

Llewellyn said the money awarded by the jury is to cover the cost of medical treatments and psychiatric counseling for the boy and his family. The jury did not award punitive damages. The Atlanta Journal-Constitution is not naming the mother to avoid identifying the child. “This case does point out one of the dangers of circumcision that every parent must seriously consider when having the procedure done,” Llewellyn said. He contended that parents are not told of the risks of the procedure.

Source: Atlanta Journal-Constitution, Monday, March 30, 2009

Claim for circumcision damage in Chicago

A Northwestern Memorial Hospital obstetrician is being sued for allegedly botching a circumcision of a 1-day-old baby and cutting off a portion of the infant's penis, according to WBBM-AM 780. The suit, filed Tuesday in Cook County Circuit Court by David Burden on behalf of his son Daniel Burden, claims that on Oct. 5, 2007, one day after Daniel was born, Dr. Marc Feldstein performed a circumcision on the boy. However, rather than removing only the foreskin, the doctor cut and removed a portion of the baby's penis, the suit said. After the procedure, baby Daniel was transferred to Children's Memorial Hospital to have emergency corrective surgery. Burden accuses Dr. Feldstein, Northwestern Women's Health Associates and Northwestern Memorial Hospital of medical negligence. The suit asks for more than $50,000.

Chicago Breaking News Centre, 15 April 2009

Utah (USA) study: Circumcision complications up to 5 times higher than expected

INTRODUCTION AND OBJECTIVES: Circumcision remains a very common procedure in the United States. Published complication rates are lower than clinical practice suggests. We aimed to use a population-based claims database to define the regional 2 year complication rate in boys who underwent circumcision. We hypothesized that this rate would be between 1 and 5%.

METHODS: The Utah All-Payer Claims Database (UAPCD) contains data from health insurance carriers, Medicaid, and third party administrators in Utah. The data consist of medical and pharmacy claims as well as insurance and health care provider data, and all residents in the State of Utah are included unless they opt out. The UAPCD was queried for all male patients aged 0-730 days undergoing circumcision (CPT 54150, 54160 and 54161) during the year 2013. Subjects were censored if they had less than 2 years of post-procedure data. Demographic, medical and procedure-specific data was abstracted. ICD-9 and -10 codes were used to identify infectious, bleeding, urethral, skin and wound healing-related complications. Encounters for circumcision revision (CPT 54161, 54163), or lysis of penile adhesions (CPT 54162) were noted.

RESULTS: In 2013 there were 26,069 male births and 6298 circumcisions were captured. The mean age at circumcision was 9.8 days for those who had circumcision with a clamp (CPT 54150), 16.3 days for those who had a surgical circumcision other than clamp (CPT 54160) and 309.3 days for boys who had a formal circumcision after the neonatal period (CPT 54161). 725 (11.5%) complications were identified. The two most common complications were phimosis in 433 (6.9%) and other wound related complications such as acquired torsion, buried penis and edema in 168 (2.7%). Infectious/inflammatory (1.2%), urethral (0.5%), and bleeding (0.3%) complications were rare. 101 (1.6%) patients underwent surgical revision or lysis of penile adhesions. Complications did not differ significantly between patients who h the original circumcision in a hospital vs. an outpatient setting (p=0.33) or in an urban vs. rural location (p=0.22). When adjusted for healthcare setting and location, the difference in complications between patients less than 90 compared to those 90 to 730 days old was not significant.

CONCLUSIONS: The incidence of post-circumcision complications at 2 years is much higher than expected at 11.5%, but does not appear to be influenced by age at circumcision, healthcare setting or a rural vs. urban location. A minority of subjects needed reoperation during the ensuing 2 years.

Glen Lau, Jaewhan Kim, Anthony Schaeffer. Identification of circumcision complications using a regional claims database. Spuonline reports, February 2018.