10 NEWS
10 NEWS
12 JULY 2024 ausdoc . com . au
Circumcision GP a ‘ safety risk ’
Heather Saxena A GP who allegedly amputated a newborn ’ s penis during a ritual circumcision remains banned from performing the procedure after a tribunal refused to stay conditions on his registration .
Three months ago , the Medical Board of Australia used its emergency powers to stop Dr Hershel Goldman from carrying out further circumcisions following complaints that two infants had experienced serious complications .
The board said the Melbourne GP had amputated — or partly amputated — a seven-day-old infant ’ s penis during a bris ( ritual circumcision ) in a family home .
“[ Initially ] when there was more bleeding than normal , he appeared concerned that something had gone wrong but pressed on with the ritual prayers for several minutes and delayed providing care to the infant ,” the board claimed .
“ Further , once confirming the amputation , concerns have been raised that Dr Goldman had no procedures in place to manage the complication , with management of the emergency being undertaken by guests at the party who were also medical practitioners .”
Dr Goldman appealed the board ’ s ban before the Victorian Civil and Administrative Tribunal , arguing that he was now a safer doctor because he was more aware of amputation as a possible complication .
“ After the procedure , Dr Goldman was not immediately concerned that something had gone wrong , as bleeding is common immediately after a circumcision , and while there was more bleeding than average , it was not significantly higher and was controlled easily with the bandage ,” his lawyers had told the board .
The board also claimed Dr Goldman had placed a bandage on another newborn infant after performing a ritual circumcision in the family ’ s home and then left , instructing the family not to remove the boy ’ s nappy for four hours .
When the nappy was removed , the board said , there was significant bleeding .
When the parents contacted Dr Goldman — who had earlier warned that he would be travelling interstate and not available on call — he told them to take the child to a hospital 40 minutes away .
“ The management of the emergency was then undertaken by family members who were also medical practitioners , and the infant [ was ] taken to a hospital closer by , where he required stitches and a blood transfusion ,” the board claimed .
There were also concerns over Dr Goldman ’ s hygiene practices after he washed his hands at the kitchen sink and used a nearby tea towel before performing the circumcision , the board said .
In his submission to the tribunal , Dr Goldman stressed he had performed more than 20,000 circumcisions over 40 years without any complications and was , to his knowledge , the only Jewish GP in Melbourne performing circumcisions and the only religious circumciser willing to travel interstate . He argued he needed to keep performing the procedure to maintain the religious goals of circumcision
Without circumcision , the ‘ soul suffers pain ’.
in the Jewish faith , which he described as being when the “ soul of the Jewish boy fully enters the body ”.
Without circumcision , the “ soul suffers pain ”, he also said , adding that many Jewish parents had turned to non-religious options for circumcision , “ which do not achieve the religious goals of circumcision ”.
He said his services were also essential to the Muslim community .
However , the tribunal found that patient safety was “ paramount ”, with a risk analysis conducted by an expert committee for the board deciding there was a serious risk if Dr Goldman was allowed to continue performing circumcisions .
It also said restricting Dr Goldman to circumcisions in clinical settings would not reduce the risk either .
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Clinical factors to consider when prescribing an oral antiviral for COVID-19
Age & Comorbidities
Medications
Other
Dr Hershel Goldman .
Age is the single biggest risk factor for COVID-19 death and hospitalisation . 1 According to the ABS data ( March 2020 – January 2024 ), out of the 17,276 total deaths due to COVID-19 during that period : 1
~ 9 / 10 of those deaths were in people aged ≥ 70 years . 1
Comorbidities also increase risk of COVID-19 death and hospitalisation . 1
82 % of the COVID-19 related deaths from the ABS data were in patients with a pre-existing chronic condition . 1
Of these , the top 5 pre-existing chronic conditions were chronic cardiac conditions ( 39 %), dementia ( 30 %), chronic respiratory conditions ( 18 %), neoplasms including cancer ( 17 %) and diabetes ( 15 %). 1
Older patients often live with a range of chronic conditions , which may need pharmaceutical treatment . 2 , 3
50 %
ABS = Australian Bureau of Statistics
of Australians aged ≥65 years live with 2 or more comorbidities , according to 2022 ABS data . 2
People who take certain medications may be at increased risk of potential drug-drug interactions . 3 , 4 Clinicians should review relevant Product Information and consult the Liverpool Drug Interaction checker . 5
This may include patient ’ s renal and hepatic function , pregnancy status and previous hospitalisation due to COVID-19 . 6-9
Don ’ t wait for symptoms to progress . Start oral antiviral treatment within 5 days of symptom onset . 6 , 7
PBS information : Authority required ( STREAMLINED ): LAGEVRIO must be for use when nirmatrelvir (&) ritonavir is contraindicated . 9 The contraindications to nirmatrelvir (&) ritonavir can be found using the Liverpool COVID-19 Drug interaction checker or the TGAapproved Product Information for nirmatrelvir (&) ritonavir . 5 , 6 , 9 Visit www . pbs . gov . au for more information .