Source · Prevention of Future Deaths

Oliver Asante-Yeboah

Ref: 2015-0201 Date: 27 May 2015 Coroner: R Brittain Area: London Inner (North) Responses identified: 2 / 1 View PDF

Concerns were raised about the lack of formal regulation for non-medical providers of circumcision, a procedure considered surgical with increased infection risk in non-medical settings.

Date 27 May 2015

56-day deadline 22 Jul 2015 est.

Responses identified 2 of 1

Child Death (from 2015)

Coroner's concerns

AI summary

Concerns were raised about the lack of formal regulation for non-medical providers of circumcision, a procedure considered surgical with increased infection risk in non-medical settings.

View full coroner's concerns

During the course of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. The MATTERS OF CONCERN are as follows.  –

(1) The Rabbi who performed Oliver’s circumcision gave evidence that his practice was not regulated by any official body or organisation. The pathologist who performed the post mortem was clear that she considered the circumcision to be a surgical procedure. The consultant paediatrician, who was involved in attempts to resuscitate Oliver, stated that research has demonstrated an increased risk of infection after circumcision in a nonmedical setting.

It was clear from the evidence adduced at the inquest that the circumcision had contributed to Oliver’s death, although it was not possible to conclude that the fact it was performed in a nonmedical setting increased the risk of infection in this particular case.

I am concerned that future deaths could occur in similar circumstances, owing to the lack of formal regulation of nonmedical providers of circumcision.

Responses

2 respondents

CQC Regulator / Inspectorate

16 Jul 2015 PDF

Noted

The CQC states it has no regulatory remit over non-therapeutic circumcisions performed for religious purposes by non-healthcare professionals, as the regulations would require amendment by the Secretary of State. (AI summary)

View full response

Dear HM Assistant Coroner Britain

Inquest into the death of Oliver Asante-Yeboah

We write in response to the Regulation 28 report addressed to and received by the Care Quality Commission on 29th May 2015. The report concerns the very sad death of Oliver Asante-Yeboah following a non-therapeutic circumcision performed by Mr

who we understand, from your report, was certified to perform the procedure by the ‘Initiation Society of Great Britain’ (an organisation which supervises the training of Rabbis to perform circumcisions).

We understand that during the course of the inquest you heard evidence that the risk of urinary tract infections is increased after circumcision and that this risk is heightened where the procedure is undertaken in a ‘nonmedical’ setting. In this case on 2 November 2014 Oliver’s parents took him to their local Emergency Department because he was feeding less well and his sleep pattern had altered. Analysis of his urine demonstrated the presence of an infection. Despite the institution of intravenous antibiotics and attempts to resuscitate him, he rapidly deteriorated and died later on 2 November 2014.

In your Regulation 28 report you have expressed concern that non-therapeutic circumcisions (surgical procedures) performed in a non-medical setting are not independently regulated by any official body or organisation. You have asked the Care Quality Commission to respond the these concerns in writing.

CQC Response to Regulation 28 report – inquest into the death of Oliver Asante - Yeboah

The Care Quality Commission is a statutory body and thus its functions, powers and regulatory remit are determined by statute and Regulations. Schedule 1 to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and from 1 April 2015 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 define the “regulated activities” the Commission is empowered to regulate.

Circumcision for the purpose of religious observance falls within the definition of “surgical procedures” in paragraph 7 to Schedule 1 (2010 Regulations) and paragraph 6 to Schedule 1 (2014 Regulations). However as paragraphs 7 and 6 each make clear the Commission’s regulatory remit is limited to circumcisions for the purpose of religious observance when carried on by a healthcare professional. Healthcare professional is defined in Regulation 2(1) of the 2010 and 2014 Regulations as being “a person registered as a member of any profession to which section 60(2) of the Health Act 1999 applies”.

The Commission therefore has no regulatory remit over non-therapeutic circumcisions performed for the purpose of religious observance where the individual carrying out the surgical procedure is not a healthcare professional. In this case we understand Mr

was not a healthcare professional.

In order to extend the Commission’s regulatory remit to cover non-healthcare professionals the 2014 Regulations would require amendment. This is not within the Commission’s power and can only be undertaken by the Secretary of State.

I hope the above clarifies the Commission’s position but should you require any further information please do not hesitate to contact me.

Department of Health Central Government

22 Oct 2015 PDF

Action Planned

The Department of Health acknowledges concerns about non-medical settings for male circumcision and notes that a change in legislation would require consultation. They will copy the letter to clinical leads of CCGs in England to highlight the case and reiterate the advice that circumcision should be carried out by a regulated healthcare professional. (AI summary)

View full response

From Ben Gummer MP Parliamentary Under Secretary of State for Care Quality Department Richmond House of Health 79 Whitehall London SWIA 2NS POCS 952833 2 8 OCT 2015 Tel: 020 7210 4850 Mr R Brittain HM Senior Coroner Inner North London POPLAR CORONER'S Poplar Coroners Court COURT 127 Poplar High Street London E14 OAE 22 October 2015 Sdla Thank you for your letter about the death of Oliver Asante-Yeboah. I was saddened to of this case. [ would be grateful if you could please pass my condolences to baby Oliver's family: Your report detailed the circumstances surrounding Oliver' s death and specifically raised the question of legislation regulating non-medical settings As you are aware, male circumcision, where it is carried out by a healthcare professional, is regulated by the Care Quality Commission (CQC), included under the regulated activity of *surgical procedures' The NHS normally only performs male circumcision where medically indicated. A change in legislation as suggested would require considerable consultation with all interested parties (including the CQC) Clinical Commissioning Groups (CCGs) are responsible for commissioning services to meet the health needs of local communities. In some areas, particularly where feel children are at risk of unsafe procedures, CCGs can work with local providers and communities to ensure that a safe and affordable service is available. I will be copying this letter to the clinical lead of each CCG in England to highlight this case and reiterate this This is a complex issue for CCGs; for the CQC and for the Department: Our advice for parents is to ensure that circumcision, where necessary, is only carried out by a regulated healthcare professional. DECEIE hear they - point:

I hope that this informationlis useful. Thank you for bringing the circumstances of Oliver's death to my attention. O^ Szka2l BEN GUMMER

Report sections

Investigation and inquest

Oliver AsanteYeboah died on 2 November 2014, aged three weeks. The medical cause of death was E. coli sepsis, resulting from mild renal abnormalities and a urinary tract infection. His death was contributed to by a nontherapeutic circumcision which had been performed a few days days prior. An inquest into his death was opened on 7 January 2015 and heard on 15 May 2015, at which I recorded a narrative conclusion (see attached).

Circumstances of the death

Oliver was born on 9 October 2014. His parents identified a Rabbi who agreed to perform a nontherapeutic circumcision. The Rabbi gave evidence at the inquest that he had been certified to perform the procedure by the ‘Initiation Society of Great Britain’ (the organisation which supervises the training of Rabbis to perform circumcisions) and that he has performed two to three circumcisions per week over the past 15 years, without any complications to his knowledge. He set out that his sterilisation procedures include the use of an autoclave (to prepare the necessary surgical instruments) and the application of ‘Dettol’ to the surgical site. The Rabbi noted his consenting procedure comprised discussion of the risk of infection through use of that term only, without further clarification of what infections could develop following the procedure.

I heard evidence that the risk of urinary tract infections is increased after circumcision and that this risk is heightened where the procedure is undertaken in a ‘nonmedical’ setting.

On 2 November Oliver’s parents took him to their local Emergency Department because he was feeding less well and his sleep pattern had altered. Analysis of his urine demonstrated the presence of an infection. Despite the institution of intravenous antibiotics and attempts to resuscitate him, he rapidly deteriorated and died later on 2 November 2015.

Copies sent to

I am also under a duty to send the Chief Coroner a copy of your responseAssistant Coroner R Brittain

Similar PFD reports

Shared signals

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Report details

Reference: 2015-0201
Date of report: 27 May 2015
Coroner: R Brittain
Coroner area: London Inner (North)

Responses identified

Responses identified 2 of 1

All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 22 Jul 2015 (estimated).

Sent to

Care Quality Commission

Source links

Judiciary.uk page → Report PDF →

Data: judiciary.uk under OGL.