In an interesting twist of events, the Joe DiMaggio Children’s Hospital tried to deny that the child at the center of the Nebus vs Hironimus dispute, “is or has been” a patient. Shortly afterwards, a copy of a pre-surgical assessment printed on Joe DiMaggio Children’s Hospital at Memorial letterhead, was posted.
See the screenshot of the pre-surgical assessment, dated 6/4/2015 (first visit) at the bottom of this post.
On it, we can see the typical excuses for circumcision: “father reports frequent urine trapping and ballooning of foreskin. Also has noted mild erythema of distil[sic] foreskin”
Ballooning is normal at that age, it’s one of the ways nature has to stretch the balanopreputial lamina to desquamate it. There can be several causes to redness (erythema), from too much soap or improper rinsing, to a mild irritation, to rubbing, to balanitis; all of those causes are usually easily treatable and don’t require circumcision.
The review mentions:
- “penile pain” – do you cut parts of your body when you have pain, or do you find the cause of the pain?
- “ballooning of foreskin” – again, not a cause for concern at this age, and
- “foreskin not retractable”. Per Oster, less than 30% of boys can retract the foreskin at Chase’s age, so again, it’s not a cause for concern.
Down the paper, it reiterates:
- “Foreskin reduces approximately 30 percent” – foreskin shouldn’t be retractable yet and nobody should be retracting it – indication that doctor was fondling his penis to see whether it would retract or not.
- “Mild foreskin inflammation” – this is, again, the redness mentioned above; so, if you had inflammation in one ear, would you cut your ear? or treat it? how is this medicine?
- “Urine noted under foreskin” – the foreskin traps moisture, it’s normal and more in children, every male in the world who has a foreskin maintains a certain moisture between the foreskin and the glans, it’s how mucosas work; to try to make this into a pathological situation is like saying that moisture inside the mouth is indication of improper hygiene, it simply makes no sense!
The paper does not mention the tendency to form hypertrophic scars, which has been noted on a previous surgery, and which could have negative results in a circumcision.
Then, the Assessment and plan continues:
“Discussed pros and cons, RCA in detail with father and aunt as relatives to elective circumcision. They have asked that we proceed.”
Here we can see that the doctor refers to the circumcision as “elective”. He is not recommending it, he is “discussing pros and cons”. In other words, the procedure is not medically necessary. The child has no condition requiring the procedure. Dr. Birken is clearly washing his hands over the procedure: he didn’t recommend it, the father elected it.
It’s clear from the form that the circumcision is not necessary, and the doctor wants it to be evident so he can dodge any blame later. That’s why he is calling it elective and reiterating that the father gave the go ahead.
The problem is also, if the father elected it (because it is not medically necessary), then Medicaid should not cover the procedure at all. But of course we know that this is where medical fraud is committed daily in this country. Should Medicaid cover this procedure, do not doubt there will be clear investigations.