2 boys almost bled to death in botched circumcisions by Manitoba doctor

WARNING: This story contains graphic descriptions

Two boys almost bled to death from botched circumcisions performed by a now-suspended Winnipeg doctor.

Dr. Ejaz Ahmad pleaded guilty to professional misconduct on Oct. 15 for performing circumcisions on as many as 18 pediatric patients in 2016 and 2017, when he lacked the training and know-how to do the procedures.

Several of his young patients ended up in the emergency room with complications.

"It is disturbing any time a physician practises and performs procedures that they are not competent to do," said Dr. Anna Ziomek, CEO and registrar of the College of Physicians and Surgeons of Manitoba, in an interview Thursday.

Among the complications, two boys were rushed to hospital with potentially life-threatening bleeds, one after a portion of his penis was amputated and the other with arterial bleeding.

Other boys experienced complications like swelling, pain, embedded gauze from improper wound care, possible infections and disfigurement.

At least one boy's penis was left so deformed he required a revision surgery.

Ahmad admitted to using an inappropriate technique and lacking knowledge, skill and judgment. He acknowledged he provided anesthetic at a "non-specific dose," used only alcohol swabs to sterilize the surgical site and did not suture after circumcision.

The removal of each patient's foreskin was done for cultural reasons and not insured by Manitoba Health, the college found.

The circumcisions were performed at Ahmad's private clinic.

On Thursday, CBC contacted Al-Shifa Medical Clinic on Portage Avenue where Ahmad worked. A staff member referred the call to Ahmad's lawyer who did not return our call. CBC has also requested to speak with Ahmad directly but has yet to hear back.

Parents not to blame, says college

The decision states the parents approached Ahmad, a doctor trained in Pakistan who has been a family doctor in Manitoba since 2004. Most of the families were recent immigrants and had been referred to Ahmad by "members of their community," the decision states.

"The parents went to someone they believed was competent," said Ziomek. "We should not blame the parents for any of this outcome."

The college declined to provide the ages of the patients to protect their privacy.

Along with malpractice, the college found Ahmad displayed several "multi-dimensional" professional shortcomings.

He neglected to warn parents about the risks of their surgeries, failed to create records and when families went to other doctors for help, he told them not to disclose who had carried out the surgeries.

In one instance, Ahmad told a doctor and nurses in an emergency room the procedure had been performed by a "traditional man" and not, in fact, himself.

In the Muslim community, it is common for boys to be circumcised.

"This just comes from Islam's emphasis on cleanliness and hygiene," said Idris Elbakri, a former president of the Manitoba Islamic Association

Normally the circumcision is carried out in the first few weeks after birth, he said, and for many people it's not necessary for the circumcision to be carried out by a Muslim doctor or imam, although it can be.

5-month suspension

Dr. Martin Koyle, a professor of urology at the University of Toronto and head of urology at Toronto's Hospital for Sick Children, said it's rare to see truly botched circumcisions like those described in the college decision.

"There's a difference between circumcisions done improperly and bad results," he said.

But the Toronto children's hospital sees anywhere from zero to five boys per week with some type of complication arising from a circumcision, he said, including issues with healing or otherwise unexpected results.

In severe cases, he's seen some children die as a result of complications. Those instances are usually linked to arterial bleeding, he said.

He said he's concerned there aren't more rules around performing circumcisions.

Ahmad began serving a five-month suspension in October.

Along with being temporarily barred from practising medicine, he is also barred from doing any more circumcisions until he gets training and approval from a pediatric urologist.

When Ahmad began doing circumcisions in Winnipeg in 2016, he hadn't done one for 19 years.

"From our perspective, as a regulatory college, if you haven't done something for 19 years, we would have questions about why you think you're still competent to do it," said Ziomek.

She added Ahmad's case is the first instance of malpractice related to circumcision College of Physicians and Surgeons of Manitoba has dealt with in at least two decades. 

Ahmad was ordered to pay more than $24,400 to cover the costs of the investigation and inquiry.

He will be able to resume his practice on March 15, 2019.