Inside story of the brit death case

The JC’s resident legal expert represented the mohel at the recent inquest into baby Amitai who died after being circumcised. He reveals how his questioning of eye-witnesses proved that, contrary to an expert pathologist’s claim, the ritual surgery was not responsible for the child’s demise

By Jonathan Goldberg, September 24, 2009

I thought I would abandon my usual format in order to give readers “the inside track” about the coroner’s inquest into the tragic death of baby Amitai Moshe which concluded a fortnight or so ago. I have defended many causes, some good and some not so good, but none, I think, as important to the Jewish people as this one, nor with such sinister potential to have done us harm.

Baby Amitai, then eight days old, was circumcised at Golders Green Synagogue in February 2007 after morning prayers. The mohel was an experienced member of the Initiation Society. He had performed over 1,000 circumcisions, not only to Jewish baby boys, but also Muslims and Africans. The society is a charity which ever since 1745 has been performing its role of training and licensing mohelim. Its medical standards are strict, demanding rigorous examinations and continuing training and education.

After the surgery and blessings, and while the festive breakfast for the guests was in full swing, Amitai’s mother noticed bleeding from his nose and mouth after breast-feeding him. Such bleeding is a recognised sign of acute cardiac failure. The mohel immediately rang Hatzola, the Orthodox volunteer ambulance service. Two guests present, Dr Cohen and Mr Freiberger, who happen themselves to be experienced medical men, attempted cardiac resuscitation. Within literally two minutes the Hatzola ambulance had arrived, and within six minutes thereafter it had deposited Amitai at the Royal Free Hospital. It was accepted evidence that the London Ambulance could not have arrived at the synagogue until several minutes after Amitai was already in hospital. Sadly he died on a life-support machine about a week later.

The office of Her Majesty’s Coroner is one of the most ancient in our legal system. It dates from the Norman Conquest and is mentioned in the Magna Carta. The Coroner’s main role nowadays is to hold an inquest to determine the cause of death in cases where the death was sudden or unnatural, occurred abroad or in a police or prison cell, or was suspicious.

A distinguished child pathologist, Professor Risdon, was instructed by the coroner to conduct a post-mortem examination and report on the cause of death. Consternation resulted when he gave his opinion that “the fact that the collapse occurred immediately following circumcision strongly indicates a link between the two”. He certified a cause of death as “cardiac arrest following circumcision”. And questions were now being raised whether the London Ambulance crew would have reacted more competently than Hatzola.

I was asked by communal elders as a mitzvah to defend the interests of the mohel and the Initiation Society, ably assisted by my junior Gary Grant. My own former pupil, Timothy Kendal, accepted my request to defend Hatzola. The courtroom contained many campaigners against circumcision. The internet was buzzing with talk of the case.

The three-day hearing was conducted with scrupulous thoroughness and fairness by the North London Coroner, Andrew Walker. It was enlivened by the presence in court at times of the baby who has since been born to Amitai’s parents. He, too, was circumcised in the traditional manner, incidentally.

The coroner finally concluded that death was due to natural causes, and that no criticism whatever attached to the mohel or to Hatzola. Both were praised by him. The circumcision had been deftly performed he found, and Hatzola had responded entirely appropriately.

Professor Peter Fleming of Bristol University, the world-renowned expert in sudden infant death syndrome, otherwise known as Sids or cot death, concluded that the pathologist had got it wrong. He was supported by two eminent consultant paediatricians from London, Dr Jaswon and Dr Markiewicz. The pathologist had suggested that the collapse could be due to vaso-vagal inhibition due to the surgery. This means the same mechanism which can cause someone to faint or even die in response to sudden pain or shock. But if it happens, it happens immediately. Here, however, I established in cross-examination of the eye-witnesses that the baby had been in good form until at least 35 minutes after the end of the surgery. That time gap was fatal to the diagnosis of vaso-vagal inhibition. Instead, the paediatricians unanimously attributed Amitai’s sudden collapse to Sids, which, by freak coincidence, had occurred when it did.

They reported that Sids does not only happen when babies are asleep in their cots, contrary to popular belief. Some 20 per cent of cases occur elsewhere, often in the mother’s arms. Professor Fleming cited two cases from his own personal experience which had occurred in Church at baptisms. He agreed with me that this terrible syndrome is no respecter of religions.

Circumcision has been practised by the Jews for over 3,500 years and is widely regarded as both healthy and safe. In its history the Initiation Society had never encountered such a case. Yet in the end this inquest received no coverage in the national press.

A journalist once told me that two aphorisms of his profession are “Jews are news” and “If it bleeds, it leads”. If the case had gone the other way, I do not doubt that we could have woken to banner headlines proclaiming “Circumcision kills baby” or “Vigilante ambulance fails child”, with awful consequences.

Last updated: 10:25am, September 24 2009