Surgeon: Physicians in Genital Cutting Case Should Lose Licenses

Marcia Frellick

December 10, 2018

A gynecologist and surgeon in Atlanta, Georgia, T. Wayne Bloodworth, MD, who this year founded the nation's only clinic dedicated solely to the repair of female genital mutilation (FGM), told Medscape Medical News that the two Michigan physicians charged in the nation's first FGM case should lose their licenses.

Jumana Nagarwala, MD, an emergency room physician, of Northville, and Fakhruddin Attar, MD, of Farmington Hills, Michigan, were both charged in 2017 with various federal counts related to cutting the genitalia of female minors. The physicians are both believed to be members of the small Dawoodi Bohra Indian Muslim sect, whose religious beliefs have been linked with FGM.

In a big defeat for federal prosecutors, US District Judge Bernard Friedman ruled in Detroit late last month — as detailed by the Detroit Free Press — that, "as despicable as this practice may be," Congress was not authorized in 1996 to pass a law that made FGM a crime.

Judge Friedman ruled that the federal law was unconstitutional and that states should regulate the practice.

According to various media reports, including one by the Chicago Tribune and one by NPR,  Friedman noted that criminal law in the United States is generally defined and enforced by states — not by the federal government. There are exceptions, he said, but only where the federal government has specific authority to pass laws.

The judge argued that Congress can regulate interstate commerce, for example, but FGM would not come under this banner. And although healthcare can be regulated by the federal government, FGM is "a form of physical assault," not a healthcare service, according to the judge.

The Chicago Tribune noted: "Nagarwala has maintained she committed no crime and is being prosecuted under a law that slid through Congress without proper vetting."

Judge Friedman ultimately agreed. Some of the charges against Nagarwala and Attar were therefore dismissed, though the physicians face other charges, including obstruction of justice, related to the procedures and will face trial in April of next year, according to the Detroit Free Press report.

27 US States Have Now Legislated on FGM

FGM is internationally recognized as a violation of human rights and is outlawed in more than 30 countries, including the United States. Twenty-seven states, including Michigan, have passed specific legislation against it.

But Michigan only passed the law last year in the wake of the physicians' cases and the physicians cannot be charged retroactively, the Detroit Free Press reports.

"I'm angry that the federal judge dismissed this horrific case that affected upwards of a hundred girls who were brutally victimized and attacked against their will," Michigan state Sen. Rick Jones said in a statement.

"This is why it was so important for Michigan to act. We set a precedent that FGM will not be tolerated here, and we did so by passing a state law that comes with a 15-year felony punishment. I hope other states will follow suit."

According to the Detroit Free Press, prosecutors say that Nagarwala may have performed FGM on 100 girls over 12 years, although they have cited nine victims in this case.

Defense lawyers say the procedure performed on the girls was a mild form of female circumcision and not FGM, according to the same newspaper.

As detailed in court documents, Attar is accused of conspiracy to commit FGM and aiding and abetting in FGM at his Burhani Medical Clinic in Livonia, Michigan.

Attorneys for the two physicians did not reply to requests by Medscape Medical News for comment.

However, in a video interview with an ABC news affiliate, Shannon Smith, an attorney for Nagarwala, said Judge Friedman's November 21 ruling is "absolutely a huge victory. When you actually studied the law [Congress] enacted, there was no constitutional basis for them to enact the law. It's really an issue that should be left to the states."

Meanwhile, Gina Balaya, a spokeswoman for the US Attorney's Office, told CNN, "We are reviewing the judge's opinion and will make a determination whether or not to appeal."

Physicians' Licenses Under Investigation

As of December 7, both physicians' licenses were active but under investigation, according to a spokesperson for Michigan's Department of Licensing and Regulatory Affairs (LARA), who told Medscape Medical News that LARA could not comment further on active investigations.

A petition by the global advocacy group Care2 asking for revocation of the physicians' licenses had more than 63,000 supporters as of December 10.

Surgeon Bloodworth agrees their licenses should be revoked.

He told Medscape Medical News, "What that sect does is the most minimal amount of damage that can be done. They call it 'nicking' or pricking the clitoris." But even that can cause lifetime damage, he said, adding, "You don't know how deep it goes."

There are four types of FGM, he explained: "The first excises the tip of the clitoris; class 2 takes off the clitoris and part of the labia; class 3 is called infibulation where the labia is sutured, or sewn together; and type 4 is anything else."

The procedures in this case would probably fall under type 1, he said.

"The damage from that in the cases I see are that these people have no sexual sensation, and they very classically have [post-traumatic stress syndrome] and/or depression associated with it. They've lost their self-image."

Most FGM Performed by Laypeople, but Also by Some Physicians

Bloodworth, a cosmetic surgeon and gynecologist, is founder, owner, and medical director of the Surgery Center for FGM near Atlanta, Georgia.

The nonprofit clinic opened earlier this year and so far more than 100 repair surgeries have been completed, he said, adding that he has covered the costs himself and does not charge the patients.

"The most classic remark we get is 'I feel whole again.' They all consider themselves disfigured, and to a degree they are," he added.

He said about the actions described in the charges, "They're disfiguring a minor without that child's consent. It's permanent damage."

However, he said, a US physician performing such a procedure is rare.

"The vast majority are done by a layperson and certainly under the radar. I don't think many physicians at all are doing this. I was horrified [by the cases of Nagarwala and Attar]," he said. "I just don't believe American medicine is guilty of that."

"That being said," he added, "there are certain parts of Africa where it has become medicalized and some of the physicians there are doing it for profit and charging fees for the mutilating."

According to court documents, some members of the Dawoodi Bohra sect who have spoken out against FGM say the practice is done to suppress sexual pleasure and avert promiscuity.

More than 200 million girls and women worldwide who are alive today have undergone FGM, according to the World Health Organization.

"There's never a day that goes by that I don't hear a story that just tears my heart out," Bloodworth said.

No relevant financial relationships were reported.

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