State records show that Michigan’s licensing agency closed its investigation into Nagarwala before the federal case ended, never investigated Attar at all, told the press both investigations were active when its own files show they were closed, and renewed Nagarwala’s license in seven minutes. I obtained the records through more than one hundred Freedom of Information Act requests.

The federal case began when the FBI arrested Nagarwala in April 2017 and charged her with performing genital cutting on young girls at a Michigan clinic owned by Attar. Agents identified nine victims between the ages of seven and thirteen. Prosecutors estimated that as many as 100 girls may have been cut over twelve years. Attar acknowledged to agents that Nagarwala treated girls ages six to nine at his clinic after hours.

The case never reached a jury. Judge Bernard Friedman ruled the federal FGM statute unconstitutional in November 2018 and dismissed the FGM charges. The ruling addressed the law, not the physicians’ conduct. No party in the case disputed that procedures were performed on the girls. Congress repaired the statute with the STOP FGM Act of 2020, but the fix could not apply retroactively. The only disciplinary avenue left was to take the doctors’ medical licenses. However, Michigan had already closed its licensing investigations before the federal court ruling.

Michigan’s Board of Medicine wanted an investigation. Within days of the arrests, five board reviewers unanimously authorized an investigation into Nagarwala. Board reviewers authorized an investigation into Attar three days later. Dr. Peter Graham went further, writing on Attar’s file: “I approve investigation. Please also refer to Director Gaedeke for summary suspension, which I approve.” Dr. James Sondheimer wrote: “Agree with proceeding with investigation. Res ipsa loquitur.” The facts speak for themselves.

The Michigan Department of Licensing and Regulatory Affairs (LARA), the agency that executes the board’s decisions, never carried out the suspension. It never assigned an investigator to Attar. State records certify that “a traditional investigation was not conducted” on Attar. The doctor who owned the clinic, and who told federal agents that girls were treated there after hours, was never investigated by the state.

The Nagarwala investigation consisted of one attempted witness interview. LARA investigator Jennifer Pappas contacted Dr. Dena Nazer, a child abuse pediatrician, to arrange an interview. Two days later, federal prosecutor Sara Woodward called Pappas and blocked the interview. Pappas submitted her investigation report the same day. No further investigative activity occurred. The state never interviewed another witness.

What ended the cases was a recommendation from the Attorney General’s office. Assistant Attorney General Bridget K. Smith authored closure memos for both physicians on the same day in July 2018. The substantive content of both memos is redacted in full. LARA closed the Nagarwala investigation that September with the disposition “No Action Taken.” The federal charges were still pending. Trial was scheduled for January 2019. LARA closed the Nagarwala file two months before the FGM charges were dismissed. The Attorney General recommended closing Attar’s file four months before.

When asked, the agency told the press that closed investigations were still active. In December 2018, Medscape reported that both licenses were “active but under investigation” and that LARA “could not comment further on active investigations.” LARA’s own records show both investigations had been closed. Internal LARA emails show senior officials, including Bureau of Professional Licensing Director Cheryl Wykoff Pezon, Division Director Jon Campbell, Cynthia Rowe, and Forrest Pasanski, coordinating the agency’s response to the Medscape inquiry.

A physician who tried to raise the alarm got the same treatment. In June 2019, a board-certified anesthesiologist filed a complaint against Nagarwala, writing that she had “apparently performed over 100 surgeries without anesthesia, over the past 10 years” and that the practice “amounts to torture, for which we forbid on death row inmates.” LARA dismissed the complaint, telling the physician the concerns were “being addressed” in file COMxx-146169. That file was a criminal monitoring file with no investigative authority, opened to passively track a federal case whose FGM charges had been dismissed over a year earlier. LARA said nothing about the civil investigation file, 43-XX-146153, which it had already closed with “No Action Taken.”

Nothing in Michigan’s licensing system has checked either license since. When Nagarwala renewed her license in April 2026, she submitted her application at 12:53 PM and received her confirmation email at 1:00 PM. The renewal record contains only what she submitted and automated system emails. No complaint history check. No compliance screening. No human review. The renewal form asks about convictions, not charges or investigations, so she was not required to disclose the federal case. Her license runs through June 19, 2029.

Michigan never held a single administrative hearing on either license. The Michigan Office of Administrative Hearings and Rules, the body that adjudicates physician discipline, has zero proceedings on file for either physician.

The legislature handed the agency new authority to act. When legislators considered Senate Bill 410, which required permanent license revocation upon conviction for FGM, LARA’s official position was “No position.” The bill passed the House 105-2 and the Senate 38-0. Governor Rick Snyder signed it as part of a package of twelve anti-FGM bills. LARA used neither the authority it told the legislature it already had nor the new authority the legislature provided.

Both physicians returned to practice. In August 2022, Attar reopened his clinic under a nearly identical name at a new address in Farmington Hills. The practice kept the same phone number. The authorized official on the federal provider registry is Farida Attar, who was charged in the federal case.

Nagarwala and Attar also registered a new practice together: Livernois Primary and Urgent Care at 18254 Livernois in Detroit. Nagarwala is the founder. Attar is staff. The clinic advertises school physicals, sports physicals, camp physicals, and childhood immunizations. It accepts Medicaid, Medicare, and other taxpayer-funded insurance. Neither physician’s biography on the clinic’s website mentions the federal prosecution.

Patients encounter these physicians without knowing their history. In May 2025, a patient treated by Nagarwala at Garden City Hospital filed a complaint against her. Nothing on Nagarwala’s public license record indicates her history. The patient had no way of knowing who their doctor was.

The documents that would explain the state’s decisions remain sealed. The Attorney General’s closure memos are withheld in full under attorney-client privilege. On May 18, 2026, LARA and the Attorney General’s office each denied FOIA appeals seeking the memos, on the same day, using similar language. Both denials placed the word “appeal” in scare quotes. Neither addressed the argument that the statute requires agencies to separate privileged legal analysis from releasable factual content.

No Governor has addressed LARA’s handling of the cases. No legislator has called for an oversight hearing. The House Oversight Committee has subpoena power over LARA. It has not used it. Both licenses remain active. Both closure memos remain sealed. No one in state government has answered for either.

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• Read the full timeline of this investigation here.

• Support this investigation here.

Disclosure: I filed a defamation lawsuit against Bruchim in 2023; it was dismissed in 2024. The reporting below is based on public records, published scholarship, and direct correspondence.

Dr. Dena S. Davis, the lead author of the American Academy of Pediatrics’ retracted 2010 policy recommending physicians offer a “ritual nick” on girls’ genitals, wrote peer-reviewed scholarship on Brit Shalom in collaboration with members of Bruchim, a Jewish nonprofit that advocates for non-circumcising families. Her name does not appear anywhere on the organization’s public platforms, including their website, podcast, or press releases.

The paper, “B’rit shalom: a Jewish ritual alternative to newborn male circumcision,” was published in the International Journal of Impotence Research, a Nature-family journal, in 2023. The byline lists Max DuBoff, Bruchim’s Director of Education and a board member of Bruchim, and Dena S. Davis, the lead author of the AAP ritual nick policy. The paper cites Davis’s ritual nick scholarship in its references.

The acknowledgments thank Eliyahu Ungar-Sargon, Lisa Braver Moss, and Rebecca Wald, Bruchim’s founders, and Max Buckler, Bruchim’s “Bioethics Researcher.” Braver Moss and Wald are cited as sources in the paper, which quotes “conversation between authors and Lisa Braver Moss and Rebecca Wald, August 2, 2021.” The reference list also cites Bruchim’s website, Rebecca Wald’s blog Beyond the Bris, Lisa Braver Moss, and Rebecca Wald’s book Celebrating Brit Shalom, and Ungar-Sargon’s documentary Cut. DuBoff’s competing interests disclosure in the paper states he is a board member of Bruchim. Davis declares no competing interests.

On July 4, 2026, I submitted a request to the International Journal of Impotence Research asking the editors to review whether the competing interests disclosures on this paper meet the journal’s published standards.

Bruchim’s website does not disclose their relationship to Davis. A search of her name on their website, team page, podcast, press releases, and Beyond the Bris Substack written by Bruchim’s executive director Rebecca Wald, produced zero results, despite her paper being the primary scholarship done on Brit Shalom, the circumcision-alternative promoted by Bruchim.

When Bruchim leadership appeared at the 2023 Ritualwell panel “Brit Beyond Milah,” the event description called DuBoff “the lead author” and did not mention Davis. The paper’s author contribution statement states that Davis wrote the first draft of the paper: “DSD [Dena S. Davis] wrote the initial version of the article. MD [Max DuBoff] rewrote and reorganized the article.”

Davis also confirmed in emails with me that she wrote the initial version of the paper. She described the differences between her first draft and Max DuBoff’s rewrite as stylistic — “not my style” — rather than ideological and said it “left out a lot of the human interest stuff.” Davis said the final paper “does not misrepresent me but it’s very different than I would have written it.”

When I asked Davis if her 2023 brit shalom paper represented a change or "a continuation of the same perspective" that produced the 2010 ritual nick paper, she replied, "No, I don't think the Brit Shalom paper was a change."

She also said that she “did not think AAP should have retracted the policy statement” in which she advocated that doctors should be allowed to perform a ritual nick of little girls genitals for families who want female genital cutting. “Still don’t.”

In their previous writing, Davis and Wald describe the same regulatory approach to male genital cutting:

• Davis, 2001: “Nonphysician ritual practitioners of MGA should be certified. The state regulates the hygienic practices of the people who cut our hair and our fingernails, so why not a baby’s genitals?”

• Wald, 2026: “What regulation can do is ensure that when brit milah is performed, it is performed safely: with proper training, sterile conditions, and clear protocols for when medical care is needed.”

Wald has previously argued against a full criminal ban on male genital cutting in multiple articles. Wald did not respond to a request for comment when asked if she also opposes a ban on female circumcision.

The paper appeared in a special collection titled “Genital Cutting and Surgery in Children: Part Two,” guest-edited by bioethicist Brian D. Earp. Earp holds affiliations at Yale, Oxford, and the National University of Singapore. He has co-authored with Bruchim’s Max Buckler, appeared on the Bruchim Podcast, and leads the Brussels Collaboration on Bodily Integrity, which includes Bruchim leadership team member David Balashinsky. Davis told me the collaboration with DuBoff was arranged by the journal after her solo paper was rejected. She said she “didn’t know the Brit Shalom people” before writing the paper.

This paper is not the only connection between Bruchim and Davis. In 2023, Buckler co-authored a paper with Brian Earp and Lori Bruce in Current Sexual Health Reports: “From Intimate Exams to Ritual Nicking: Interpreting Nonconsensual Medicalized Genital Procedures as Sexual Boundary Violations.” The acknowledgments thank Davis for “discussions and/or comments.” Buckler’s competing interests disclosure in that paper states he is “affiliated with Bruchim.”

Bruchim did not issue a press release for the paper Davis drafted. It did issue a press release through EINPresswire for Buckler’s “As controversies mount, circumcision policies need a rethink” in the Journal of Medical Ethics in November 2025.

The Buckler paper that received Bruchim’s press release reported the results of two months of recorded interviews with Dr. Douglas Diekema and Dr. Andrew Freedman, both members of the AAP’s 2012 Task Force on Circumcision, that produced a policy statement declaring that the health benefits of male circumcision outweigh the risks. Diekema chaired the AAP Committee on Bioethics, the same committee that published the 2010 policy on female genital cutting where Davis served as lead author.

In those interviews, Diekema told Buckler he doesn’t believe the data supports saying benefits outweigh the risks. Freedman called the AAP policy a “permission slip” and said the AAP should “get out of the business” of circumcision. He said circumcision is “not really a medical practice” and that “there is nothing wrong with the penis.”

Freedman has stated publicly that he circumcised his own son at the family’s kitchen table. Wald reported this detail across multiple Beyond the Bris articles without criticism. In her article “These Jewish Doctors Tried to Stop America’s Circumcision Train“ she presents him as anti-circumcision, placing him alongside intactivists like Paul Fleiss and Dean Edell, and attributes routine circumcision to Christians. In “On Eric Clopper and Misdirected Anger“ (2018), Ungar-Sargon published a defense of Freedman, calling him “a man with whom I disagree, who is clearly able to distinguish between his medical opinion on the one hand and his religious beliefs on the other.”

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On June 25, I sent requests for comment to the following Bruchim figures: Lisa Braver Moss (President), Rebecca Wald (Executive Director), Eliyahu Ungar-Sargon (Founding Executive Board), Max DuBoff (Director of Education), and Max Buckler (Bioethics Researcher). After giving them a week to respond, I sent a follow-up email July 2, letting them know they would need to respond within a day if they wanted any comment included. I also called a publicly listed number for Bruchim and left a message.

None responded. Screenshots of the requests for comment are below:

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No member of the organization answered the question “Do you consider yourself an intactivist?”

Previous public statements indicate that the answer in most cases is no:

• Lisa Braver Moss has said that “Bruchim is not an intactivist organization, because convincing Jewish people not to circumcise isn’t our main objective.”

• Max Buckler says he does not identify as an intactivist.

• Rebecca Wald has said she prefers to label herself a ‘circumcision critic’ or ‘circumcision questioner.’”

• Eliyahu Ungar-Sargon said in an interview with James Loewen, “I don’t call myself an intactivist” but that he shares the intactivist position.

While publicly declining the intactivist label, publicly listed members of Bruchim hold overlapping roles across genital-autonomy organizations.

• David Balashinsky is listed on Bruchim’s leadership team as Outreach & Advocacy, as a Board Member and Co-founder of GALDEF, and on Doctors Opposing Circumcision’s Board of Directors and Advisors. He has spoken at the Worldwide Day of Genital Autonomy in 2020, 2022, and 2023.

• Lisa Braver Moss is Bruchim’s President and Co-Founder and appears on Your Whole Baby’s Advisory Board. She has presented at genital-autonomy symposiums and conferences in 1991 and 2014.

• Bruchim’s team page lists Elana Johnson as Bruchim’s Social Media Manager and says: “Additionally, Elana serves as one of the Directors of Equity for Your Whole Baby.” Your Whole Baby’s Equity Commitment page directly points readers to Bruchim and to a statement authored by Bruchim leaders.

• Bruchim’s Physician Advisor, Leif Thompson, is listed under Doctors Opposing Circumcision’s Board of Directors and Advisors, spoke at WWDOGA 2024, and also appeared at the 2026 Intact Global Conference.

• Mark D. Reiss, who died in late 2025, served as DOC’s Executive Vice President for over 25 years and on Intact America’s Board of Health Professionals. His Celebrants of Brit Shalom directory, the network cited in the DuBoff/Davis paper, is now incorporated into Bruchim’s Inclusion Directory.

• Eliyahu Ungar-Sargon presented at Intact America’s 2022 conference and 2026 Intact Global Conference in Los Angeles.

• Multiple intactivist individuals and organizations signed a “Statement Opposing Antisemitism Within The Genital Autonomy Movement” authored by Bruchim leadership, including David Balashinsky, Rebecca Wald, Lisa Braver Moss, and Eliyahu Ungar-Sargon.

Eliyahu Ungar-Sargon has described the genital autonomy movement as “a breeding ground for antisemitism, Islamophobia, misogyny, and misinformation” and characterized its members as “white, aggrieved men” who “have always been the bull’s eye for fascists.” Ungar-Sargon did not respond to a request for comment. No other Bruchim member responded to a request for comment.

No Bruchim member answered the question: “Does Bruchim have a policy regarding communication, coordination, or funding relationships with organizations that advocate for circumcision or oppose the genital autonomy movement?”

In a previous interview with James Loewen, Eliyahu Ungar-Sargon explicitly cites the ritual nick and double standard between male and female genital cutting as an argument against circumcision.

Davis has said that “the ritual nick is a good way to equalize male and female, but it would be even better, in my opinion, not to do it at all.” No member of Bruchim responded to a request for comment on whether they agree with Davis’s statements or have a position on the ritual nick policy.

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If you are someone who has been waiting for what you can do to make a difference on this issue, now is the time to act.

Below are some resources, updates, and suggestions.

Share This Medium Article

One piece of feedback I received is that checking my research might be difficult for a journalist unwilling to file their own freedom of information act requests and that casual readers might not be willing to go through the full timeline I published.

To solve this, I wrote a short version of the story on Medium:
https://medium.com/@hegemonmedia/fgm-doctors-hold-medical-licenses-and-practice-together-at-detroit-clinic-dbc3a854f825

The medium version uses only publicly available information and is written in a short to-the-point style with glossy photos. This is designed for casual readers and journalists who don’t want to have to independently verify FOIA requests.

All they have to do to see what I’ve written is true to is click links.

Where You Can Share

Here are some suggestions for where you can share the article:

• Reddit: r/Detroit, r/MetroDetroit, r/Michigan, r/Lansing, r/Dearborn, r/AnnArbor, r/grandrapids, r/flintmichigan, r/bioethics, r/Ethics, r/TwoXChromosomes, r/Feminism, r/fourthwavewomen, r/AskFeminists, r/Intactivism, r/Intactivists, r/TrueCrimeDiscussion, r/medicine

• Facebook Groups: Detroit Community, 24/7 Only in Detroit News Group, Detroit Community Event Calendar, The Detroit Scanner’s Community Outreach, Newspaper Friends, Politics in Lansing, Michigan Democratic Progressives, Michigan Resistance, Ann Arbor Politics, Ann Arbor Townies — Politics, Sterling Heights City Politics, Dearborn Heights Civic Discussion, Women of Metro Detroit, All Things Michigan, Patient Safety Action Network Community, Ethics in Medicine, Healthcare Ethics Consultant, Speak Out on FGM

• Local News / Investigative Tips: BridgeDetroit, Outlier Media, WDIV / Local 4 Contact, WXYZ 7 Action News Contact, CBS News Detroit Tips, Detroit Metro Times Tips, Planet Detroit Contact, Michigan Public Contact, Bridge Michigan Contact, Michigan Advance Contact, The Michigan Independent Contact, Axios Detroit, Axios Tips

  Anti-FGM Organizations: U.S. End FGM/C Network, Sahiyo, Equality Now, Global Woman P.E.A.C.E. Foundation, AHA Foundation, Sanctuary for Families, Safe Hands for Girls

  Patient Safety / Medical Accountability: Patient Safety Action Network, Patients for Patient Safety US

  Regulatory / Public Accountability: Michigan LARA Licensing Complaint, LARA Health Professional Complaints, Michigan Board of Medicine Agendas and Minutes, Joint Commission Patient Safety Concern

  Other Platforms / Forums: X / Twitter, Bluesky, Threads, Substack Notes, Mastodon, Medium FGM Tag, DetroitYES Forum, City-Data Detroit Forum, Patch Detroit, Nextdoor

Challenges Sharing

I’ve struggled to share this article. Some examples:

• I posted the article on reddit. A pop-up suggested I crosspost. I did. It removed the post for spamming. Many reddits also don’t allow crossposts or certain content, despite their users being interested in this news.

• I posted on Facebook. It suggested I boost it. I did. It refused the ad for potential “election interference.” (I’d love to know what election could change this issue.)

• I posted a video on TikTok. It blocked it for community guidelines violations. Reversed on appeal, but delayed the video a day.

I’m sure these are automated systems, not targeted suppression, but the impact is the same. It’s frustrating. If you’re experienced with these platforms, please share your solutions in the comments and use them to show us how it’s done.

More Suggestions

At the end of my timeline article, that collects all information from my investigation, there is a “Next” section on what could happen next that includes some possibilities for activists. That section has even more ideas.

Michigan Residents

Your elected representatives can change this. The Governor of Michigan is Gretchen Whitmer. The oversight committee is chaired by Rep. Jay DeBoyer. Both of these officials could act. Respectfully let them know you want them to investigate.

Sample email you could send:

I am writing to ask you to investigate the Michigan Department of Licensing and Regulatory Affairs’ handling of the medical licenses of Dr. Jumana Nagarwala and Dr. Fakhruddin Attar, two doctors charged in United States v. Nagarwala, the first federal FGM prosecution in U.S. history.

The doctors did not dispute that they had engaged in female genital mutilation. Federal charges were dismissed on constitutional grounds in 2018. However, no conviction was required for Michigan to take licensing action, because the Public Health Code allows discipline based on conduct, not just criminal outcome.

LARA closed its licensing investigation with no disciplinary action before the federal court ruling. Neither physician was suspended, reprimanded, or restricted in any way. Both hold active, unrestricted Michigan medical licenses today. Both are currently practicing together at the same Detroit clinic, advertising school physicals and receiving state funds through medicaid.

The memos explaining why the state closed its investigation have been withheld from public disclosure. No one outside LARA and the Attorney General’s office has explained to the public why they closed their investigation while these doctors were being federally prosecuted. LARA has lied to the press about its actions, by claiming in a statement to Medscape that they were investigating, when they were not.

A detailed account of these facts, sourced to public records and documents obtained through FOIA, is available here: https://www.hegemonmedia.com/p/how-doctors-prosecuted-for-fgm-kept

Find out why this happened and ensure it does not continue.

Support Legal Action

I am exploring legal challenges to make public the memos explaining why the state closed its licensing investigation. Those will cost money. If you want to support that, contribute here:

GoFundMe: Expose Medical Board for Licensing an FGM Doctor

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Dr. Jumana Nagarwala and Dr. Fakhruddin Attar were charged in 2017 in the first federal prosecution of female genital mutilation in United States history. Both hold active, unrestricted medical licenses issued by the State of Michigan. They now practice together at a Detroit clinic that advertises school physicals and accepts Medicaid.

Michigan’s licensing agency closed its investigation into Nagarwala on September 25, 2018, two months before the federal charges were dismissed. The Attorney General recommended closing Attar's case on July 27, 2018, four months before. State records certify that no traditional investigation was ever conducted into Attar. Both cases were closed with no disciplinary action.

Every fact in the timeline below is sourced to state licensing files, Attorney General records, internal agency communications, federal court documents, public record, or on-the-record statements. I obtained the non-public records through more than a hundred Freedom of Information Act requests.

Summary

• Michigan's Board of Medicine unanimously authorized an investigation into Nagarwala and recommended emergency suspension for Attar.

• The state never executed the suspension and never assigned an investigator to Attar’s case.

• The only witness interview attempted in Nagarwala’s investigation was blocked by the federal prosecutor.

• The Attorney General recommended closing both cases while the federal trial was still scheduled.

• LARA told the press both investigations were “active” months after its own records show they were closed.

• When a physician filed a new complaint in 2019, LARA dismissed it by citing a monitoring file with no investigative authority, saying nothing about the civil investigation it had already closed.

• Every medical organization asked about the case — including the AMA, the AAP, and the Federation of State Medical Boards — declined to say that physicians who cut the genitals of children should lose their medical licenses.

• The lead author of the AAP’s retracted 2010 ritual nick policy says it should never have been retracted.

• The memos explaining why the state closed both investigations remain sealed.

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Timeline

September 30, 1996 — Congress criminalizes FGM.

President Clinton signs the Illegal Immigration Reform and Immigrant Responsibility Act, which includes 18 U.S.C. § 116, making it a federal crime to circumcise, excise, or infibulate the genitalia of any female under 18. The maximum penalty is five years in prison. The law provides no exception for custom or ritual.

2001 — A law professor argues the federal FGM statute is constitutionally vulnerable.

Dena S. Davis publishes “Male and Female Genital Alteration: A Collision Course with the Law?” in Health Matrix at Case Western Reserve. Davis argues that the federal FGM statute is vulnerable because it bans all genital alteration on girls — “no matter how minimal the surgery or how safe and sanitary the procedure” — while leaving male circumcision untouched. Her recommendation: “Federal and state laws should be rewritten to allow the sort of minor genital nick.” The article calls the disparity “unacceptable on First Amendment grounds.”

April 26, 2010 — The American Academy of Pediatrics (AAP) proposes legalizing a “ritual nick” of girls genitals.

The AAP’s Committee on Bioethics publishes “Policy Statement—Ritual Genital Cutting of Female Minors“ in the journal Pediatrics. The lead author of the statement was Dena S. Davis, who cites the constitutional argument she published nine years earlier.

The statement suggests that since “some forms of FGC are less extensive than the newborn male circumcision” federal and state laws should be changed to “enable pediatricians to reach out to families by offering a ritual nick.” The AAP compares the nick to an ear piercing.

The statement is retracted in just twenty-six days due to public outcry. However, the retraction is not the result of its author changing her mind. Dena S. Davis, the author of the statement told me that she “does not think AAP should have retracted the policy statement--still don’t.”

The policy statement had revealed the medical establishment’s willingness to accommodate genital cutting on girls within a clinical framework. The retraction showed it could not do so publicly.

April 2017 — The first federal FGM case begins.

The FBI arrests Dr. Jumana Nagarwala, an emergency room physician, and charges her with performing female genital mutilation on young girls at a clinic in Livonia, Michigan. The clinic is owned by Dr. Fakhruddin Attar. His wife, Farida Attar, is charged with assisting during the procedures. Federal prosecutors call it the first federal FGM case in U.S. history, twenty-one years after Congress passed the law.

The FBI identifies nine victims between the ages of seven and thirteen from Michigan, Minnesota, and Illinois. One girl tells agents she had been told they were going to the doctor because “our tummies hurt.” When agents interview Attar, he acknowledges that Nagarwala treated girls ages six to nine at his clinic, that she came only after hours on Fridays and Saturdays, performed the procedures for free with no paperwork, and did so five or six times per year. Prosecutors estimate as many as 100 girls may have been cut at the clinic over a twelve-year period.

April 18, 2017 — Michigan’s Board of Medicine authorizes an investigation into Nagarwala.

Five board reviewers unanimously authorize an investigation into Nagarwala’s medical license (complaint file 43-XX-146153). The same day, a Michigan Department of Licensing and Regulatory Affairs (LARA) analyst opens a separate criminal monitoring file (#146169) to passively track the federal prosecution. Two files now exist on the same physician — one for the state’s own civil licensing investigation, one to monitor the federal case.

April 21, 2017 — The Board authorizes an investigation into Attar and recommends emergency suspension.

Board reviewer Dr. Peter Graham writes on Attar’s file (43-XX-146259): “I approve investigation. Please also refer to Director Gaedeke for summary suspension, which I approve.” Board reviewer Dr. James Sondheimer, a professor of medicine at Wayne State University, writes: “Agree with proceeding with investigation. Res ipsa loquitur” — a legal term meaning “the facts speak for themselves.”

The Michigan Department of Licensing and Regulatory Affairs (LARA) never executes the summary suspension. It never assigns an investigator to Attar’s case.

June 2017 — LARA takes “no position” on a bill to revoke FGM doctors’ licenses.

Senate Bill 410 would require permanent revocation of a health professional’s license upon conviction for female genital mutilation. LARA’s enrolled bill analysis records the agency’s official stance: “ADMINISTRATION POSITION: No position.”

The same document identifies the Nagarwala and Attar case by name. Internal emails show the decision was deliberate. On June 13, 2017, Marnie Wills, Deputy Director of LARA's Office of Policy and Legislative Affairs, wrote to colleagues: “I let her know we will have no position.”

July 11, 2017 — Governor Snyder signs Michigan’s anti-FGM laws.

Governor Rick Snyder signs a package of twelve bills criminalizing FGM under Michigan state law. The package increases the maximum penalty to fifteen years in prison — triple the federal penalty. It requires automatic license revocation upon conviction. It makes parental consent no defense. It makes custom or ritual no defense. Michigan becomes the twenty-sixth state to ban FGM.

The bill passes the Michigan House 105-2 and the Senate 38-0. LARA uses neither the authority it told the legislature it already had, nor the new authority the legislature provided.

September 29, 2017 — The federal prosecutor blocks the state’s only witness interview.

LARA investigator Jennifer Pappas contacts Dr. Dena Nazer, a board-certified child abuse pediatrician at Kids TALK Medical Center whose job is evaluating children suspected of being maltreated. The interview has been requested by the Assistant Attorney General’s office itself. Nazer responds that she will forward the request to her attorneys.

Two days later, U.S. Assistant Attorney Sara Woodward, the lead federal prosecutor on the FGM case, calls Pappas directly. Woodward tells the state investigator that Nazer “will not be providing a statement to our Bureau due to the pending Federal Court Case and due to WITNESS NAZER’s limited knowledge about the licensee’s activities.”

Pappas submits her investigation report the same day. It documents no further investigative activity. The state never interviews another witness in the case. Ten months later, the Attorney General recommends closing the investigation.

July 27, 2018 — The Attorney General recommends closing the Attar investigation.

Assistant Attorney General Bridget K. Smith authors a “Request to Close File” memo for Attar’s case (43-XX-146259), addressed to Cheryl Wykoff Pezon, then Director of LARA’s Bureau of Professional Licensing. The substantive content is redacted in full. LARA receives the memo on August 7, 2018.

No investigation into Attar is ever conducted. LARA later confirms under FOIA: “A traditional investigation was not conducted under 43-XX-146259.” Michigan’s Board of Medicine authorized an investigation and recommended emergency suspension. No investigator was assigned. No suspension was executed. No hearing was held. The Attorney General closed a file the state never opened.

Smith authors a parallel closure memo for the Nagarwala investigation the same day. The federal case is still active. Trial is scheduled for January 2019. The state does not wait for it to conclude.

September 25, 2018 — LARA closes the Nagarwala investigation.

Two months after Smith recommended closure, LARA closes civil investigation file 43-XX-146153. The complaint history printout records the disposition: “No Action Taken.” The federal case will not be resolved for another two months.

Eight days earlier, LARA Division Director Jon Campbell emailed staff: “Please add this to the criminal file – 146169. It appears the investigative file is being closed until witnesses can testify on behalf of the department, thus, this is the only remaining file under the criminal charges.”

November 20, 2018 — A federal judge strikes down the FGM law.

U.S. District Judge Bernard A. Friedman rules that 18 U.S.C. § 116 — the federal FGM statute Congress passed in 1996 — is unconstitutional. In a 28-page opinion, Friedman writes that Congress “overstepped its bounds” and that FGM is “’local criminal activity’ which, in keeping with longstanding tradition and our federal system of government, is for the states to regulate, not Congress.”

The ruling dismisses the FGM charges against both physicians. It addresses the law, not the physicians’ conduct. No party in the case disputes that procedures were performed on the girls.

Friedman’s opinion includes this passage: “The government’s suggestion that ‘those seeking the procedure [can] travel to refuge states where the practice is not prohibited’ is simply false. No state offers refuge to those who harm children.”

Michigan closed its own investigations before this ruling. The Nagarwala investigation ended two months earlier. The Attar closure was recommended four months earlier. The collapse of the federal case did not cause the state’s inaction.

December 10, 2018 — LARA lies to the press by claiming both investigations are still active.

Medscape publishes an article reporting that both physicians’ licenses are “active but under investigation” and that LARA “could not comment further on active investigations.”

LARA’s own records show both investigations had been closed. The Nagarwala investigation closed months earlier with no action taken. No investigation into Attar was ever conducted. Internal LARA emails from December 5 show multiple senior officials — including BPL Director Pezon, Division Director Campbell, Cynthia Rowe, and Forrest Pasanski — coordinating the agency’s response to the Medscape inquiry.

2019 — The Department of Justice declines to appeal. It asks Congress to fix the law instead.

The DOJ does not appeal Judge Friedman’s ruling that the federal FGM statute is unconstitutional. In April 2019, the Department sends a letter to Congress asking lawmakers to amend 18 U.S.C. § 116 to add Commerce Clause language that would survive constitutional challenge. The government that brought the first FGM prosecution in American history declines to defend the law that made it possible.

Remaining charges in the case, conspiracy and obstruction, continue in Friedman’s courtroom.

June 22, 2019 — A physician files a complaint calling the cutting “torture.”

A board-certified anesthesiologist files licensing complaint COM19-001459 against Nagarwala. The complainant identifies themselves as a former Michigan physician with an active California medical license. They write that Nagarwala “has apparently performed over 100 surgeries without anesthesia, over the past 10 years” and say the practice “amounts to torture, for which we forbid on death row inmates.” They implore the Board of Medicine to “take action against this physician.”

The complainant knows the federal case has been dismissed. They are asking the state to use its independent authority to discipline the license.

February 5, 2020 — LARA dismisses the complaint by citing the wrong file.

LARA tells the physician their concerns are “being addressed” in file number COMxx-146169 — the criminal monitoring file, which has no investigative authority. The agency says nothing about civil investigation file 43-XX-146153, which was closed with “No Action Taken” seventeen months earlier.

The criminal monitoring file existed to passively track the federal case. The federal case was dismissed over a year before. LARA cited a file that could not investigate and said nothing about the file that already hadn’t.

After February 2020 — No state agency takes any further action on either physician’s license.

Michigan never holds a single administrative hearing. The Michigan Office of Administrative Hearings and Rules, the body that adjudicates physician disciplinary cases, has zero proceedings related to either physician on file. No investigator is ever assigned to Attar’s case.

January 5, 2021 — Congress passes the STOP FGM Act.

The Strengthening the Opposition to Female Genital Mutilation Act of 2020 (H.R. 6100) becomes law. It amends 18 U.S.C. § 116 to add Commerce Clause nexus language, increases the maximum penalty to ten years, and expands the scope of punishable acts. Section 5 includes a “sense of the Congress” that Judge Friedman’s ruling was wrong.

The law is a direct response to Friedman’s November 2018 decision and the DOJ’s April 2019 letter. It cannot be applied retroactively. Congress has fixed the statute, but the fix comes too late to prosecute the physicians whose case broke it.

August 2022 — Attar reopens his clinic under a nearly identical name at a new location.

The corporate entity that operated Burhani Medical Clinic at the Livonia address, the clinic where federal prosecutors said Nagarwala performed FGM on minor girls, dissolved in May 2021. The remaining federal charges were dismissed in September 2021.

Eleven months later, on August 29, 2022, the NPI record is updated to a new address: 32910 W 13 Mile Road in Farmington Hills. The practice keeps the same phone number. The authorized official on the federal provider registry is Farida Attar, who was charged alongside her husband as a co-defendant in the federal case.

The new clinic advertises sports physicals and care for patients of “every age group.” It accepts Medicare, Medicaid, and major commercial insurers. Private physician offices are exempt from facility licensing in Michigan. There was no facility license to revoke, no facility-level inspection triggered by the federal charges, and no regulatory mechanism to prevent the same practice from reopening under a nearly identical name. The only oversight ran through the individual physicians’ medical licenses, which the state never restricted.

September 28, 2021 — Judge Friedman dismisses the remaining charges for vindictive prosecution.

After having the FGM counts dismissed, and then successfully moving to dismiss charges under 18 U.S.C. § 2423 (transport of a minor for criminal sexual activity — a statute Friedman ruled had no reasonable application to FGM), the defendants face a fourth superseding indictment. The government files new conspiracy and witness tampering charges based on the same underlying conduct.

Friedman rules the prosecution vindictive. He writes that “the government obtained the fourth superseding indictment, which asserts new and additional charges, in retaliation for defendants’ past success in having other charges dismissed.” He notes that all remaining charges rely on FGM being a federal offense — which his own earlier ruling declared void ab initio, as if it had never been passed. He dismisses the fourth superseding indictment.

The case is over. No defendant is convicted. The federal system spent four and a half years prosecuting the case and has nothing to show for it. The state system spent eighteen months not investigating and has nothing to show for it either. The question of whether these physicians should hold medical licenses has never been adjudicated by anyone.

March 2022 — Both physicians are practicing together again, at a new clinic advertising services for children.

Nagarwala and Attar register a new practice, Livernois Primary and Urgent Care, at 18254 Livernois in Detroit’s University District neighborhood. The National Provider Identifier is registered on March 24, 2022. Nagarwala is the founder. Attar is staff. Neither physician’s biography on the clinic’s website mentions the federal prosecution.

The last time they worked out of the same clinic was Burhani Medical Center in Farmington Hills — where, according to the federal indictment, Nagarwala performed FGM procedures on minor girls while Attar opened his clinic after hours to let her do it.

The clinic’s services page advertises school physicals, sports physicals, camp physicals, and childhood immunizations — services marketed to children and their parents. Its Google listing identifies it as “women-owned,” “Asian-owned,” and “LGBTQ+ friendly.”

The clinic accepts thirteen insurance providers, at least seven of which are taxpayer-funded: Medicaid of Michigan, Medicare of Michigan, UnitedHealthcare Community Plan, Molina Healthcare, Meridian Health Plan, Aetna Better Health of Michigan, and McLaren Medicaid.

May 17, 2025 — A patient files a complaint against Nagarwala.

A patient who is treated by Nagarwala in the emergency room at Garden City Hospital in Westland, Michigan files a licensing complaint alleging she improperly administered a drug injection following a car accident. The patient had no way of knowing who their doctor was. Nothing on Nagarwala’s public license record indicates her history.

Garden City Hospital, asked to comment, calls Nagarwala “an independent physician” who “is not employed by Garden City Hospital.” The hospital characterizes the federal prosecution as a case that was “dismissed by the courts.” It declines to say whether it was aware of Nagarwala’s prosecution when she was credentialed.

Nagarwala, contacted directly, responds: “This is the first I have heard about this.” She does not respond to a follow-up invitation for a full interview.

April 14, 2026 — LARA renews Nagarwala’s license in seven minutes.

Nagarwala submits her renewal application at 12:53 PM. By 1:00 PM, the system emails her a confirmation. The FOIA production contains only what Nagarwala submitted and the automated system emails. No complaint history check. No compliance screening. No human review. No reference to the federal case or the cutting allegations anywhere in the renewal record.

The renewal form’s good moral character questions ask only about convictions, not charges, indictments, arrests, or investigations. Since the federal case was dismissed on constitutional grounds, Nagarwala was not required to disclose her history with the federal FGM prosecution or the cutting allegations.

Her license is renewed through June 19, 2029.

May 18, 2026 — Both agencies deny appeals to release the closure memos on the same day, using the same language.

LARA and the Attorney General’s office each deny FOIA appeals seeking the unredacted closure memos. LARA’s denial, signed by Appeals Officer Adam Sandoval, does not address the argument that the statute requires separating privileged legal analysis from releasable factual content. The AG’s denial, signed by Division Chief Eric Jamison, does not address it either. Neither addresses privilege waiver. Neither addresses the AG’s mixed investigative role.

Both responses contain the same construction. Sandoval refers to the filing as one “which has been characterized as an ‘appeal.’” Jamison refers to the filing as one “which you identify as an ‘appeal.’” Both place the word appeal in scare quotes. Both issued the same day.

The closure memos remain sealed.

June 1, 2026 — The Federation of State Medical Boards declines to condemn licensing physicians who perform genital cutting on children.

The Federation of State Medical Boards (FSMB), the national organization representing every state medical board in the country, is asked whether physicians who performed genital cutting on children should retain active medical licenses.

It responds that it “does not license or discipline individual physicians and is not involved in any decisions about investigations or cases” and “cannot comment on the circumstances involving any particular physician.”

Several of the questions concern FSMB’s own policy positions, not specific physicians. A follow-up removes all case-specific questions and asks only about policy. The FSMB does not respond.

June 6, 2026 — The American Medical Association condemns FGM but defers to the organization that won’t.

The AMA is sent seven questions about the licensing of the Michigan physicians. R.J. Mills of AMA Media & Editorial responds the next day. He answers none of the seven questions.

He calls FGM “child abuse by any physician in the United States” but says the AMA “does not have an authorized role in the regulatory process run by the State of Michigan.”

He refers the inquiry to the Federation of State Medical Boards as “the national voice of the state-run regulatory system for medicine.” Five days earlier, the FSMB declined to condemn genital cutting on children and refused to comment on the case.

June 7, 2026 — No medical organization will say FGM doctors should lose their licenses.

Eleven medical organizations are contacted and asked whether physicians who perform genital cutting on children should retain medical licenses, including the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Emergency Physicians.

The three that do — the FSMB, the AMA, and the Oakland County Medical Society — do not answer the question. None of the eleven says that female genital cutting on children should cost a physician their medical license.

June 19, 2026 — The lead author of the retracted AAP policy says it should never have been retracted.

Dena S. Davis, the lead author of the AAP’s 2010 ritual nick policy, states in an email that she opposes the retraction. “No, I did not think AAP should have retracted the policy statement,” Davis writes. “Still don’t.”

She adds that "the ritual nick is a good way to equalize male and female, but it would be even better, in my opinion, not to do it at all." Asked to clarify what she means by "equalize," she does not answer.

June 23, 2026 — The AAP does not answer questions about its physicians’ licensing.

Asked five questions about the retraction, Davis’s position, and the licensing of the Michigan physicians, the AAP answers none of them.

It sends its 2020 clinical report on FGM/C. The report does not mention Nagarwala, does not mention Attar, does not mention their continued licensing, and does not mention the absence of disciplinary action.

Asked directly whether the AAP believes physicians who performed FGM/C on children should lose their medical license, the AAP does not reply.

Douglas Diekema, who chaired the committee that published the 2010 policy and is listed as Committee on Bioethics liaison on the 2020 report, does not respond.

Never — A single instance of mandatory reporting.

Every state in the country requires physicians to report suspected child abuse. Physicians are mandatory reporters in Michigan under MCL 722.623, in Minnesota under Minn. Stat. § 626.556, in Illinois under 325 ILCS 5/4 — in all fifty states. The standard is not certainty. It is reasonable cause to suspect. Failure to report is a crime. In Michigan, it is a misdemeanor punishable by up to 93 days in jail.

Federal prosecutors estimated that as many as 100 girls were cut at Attar’s clinic over twelve years. The FBI identified nine victims between the ages of seven and thirteen from three states. One girl told agents she “got a shot” that “hurt really badly and she screamed.” After the procedure, she could barely walk and felt pain all the way down to her ankle. Her parents told her the procedure was “a secret” and that she was not supposed to talk about it. Those girls had other doctors in at least three states. If any of their physicians suspected or saw evidence of what had been done to them and did not report it, that physician committed a crime.

The Government Accountability Office reviewed federal efforts on FGM in 2016. It identified only a handful of U.S. investigations or prosecutions. It noted that healthcare providers may be mandatory reporters. It did not identify a single case that began with a physician’s report. Arkansas, one of the few states that formally tracks FGM reports by healthcare practitioners to its child abuse hotline, reported zero such reports for state fiscal year 2024.

Now — FGM doctors are a part of American medicine.

Michigan has never held a hearing on either physician’s license. The memos that would explain why remain withheld in full under attorney-client privilege. Both physicians practice together at a clinic that advertises school physicals for children and accepts Medicaid. One of those licenses was renewed in seven minutes.

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Next — What could happen.

Before this investigation, the public had no access to the record. Through this investigation that has begun to change. No institution documented above has been required to answer for what these records show.

• The Michigan legislature could hold oversight hearings. The House Oversight Committee has subpoena power over LARA. The officials who closed these investigations, told the press the cases were active months after their own records show they were closed, and dismissed a physician’s complaint by citing a file with no investigative authority can be compelled to testify under oath. No hearing has been held. The committee is chaired by Rep. Jay DeBoyer.

• The Governor could act. LARA is an executive agency. It reports to the Governor. Every closure, every non-investigation, every lie to the press documented above happened within an agency the Governor directs. No Governor has addressed it. The Governor of Michigan is Gretchen Whitmer.

• Federal agencies could review Medicaid provider enrollment. The clinic lists at least seven taxpayer-funded insurance programs. The Centers for Medicare and Medicaid Services has the authority to review whether physicians with documented FGM allegations should remain enrolled as Medicaid and Medicare providers. That review does not require a state disciplinary action that has never come, and it does not require LARA’s cooperation. The Secretary of Health and Human Services is Robert F. Kennedy Jr.

• Courts could unseal the closure memos. The memos explaining why the Attorney General recommended closing both investigations — the only documents that would reveal the state’s reasoning — are withheld in full under attorney-client privilege. Lawyers I have spoken to have told me a legal challenge to those privilege claims would require a $10,000 retainer. The FOIA litigation and investigative reporting behind this article are funded here.

• Victims could bring civil claims. The FBI identified nine victims between the ages of seven and thirteen from three states. Federal prosecutors estimated as many as a hundred girls were cut at the clinic over twelve years. No civil lawsuit has been filed. The statute of limitations for minors in Michigan does not begin to run until they turn eighteen.

• Other states could investigate. The victims came from Michigan, Minnesota, and Illinois. Each state has its own medical board and its own mandatory reporting laws. Whether physicians in those states who treated the girls saw evidence and failed to report it is a question no one has asked.

• Hospitals and insurers could act on their own. Every hospital that grants privileges and every insurer that contracts with these physicians has the independent authority to review that decision. They do not need LARA’s permission.

• Michigan media could cover the licensing story they missed. Local outlets covered the federal arrests in 2017 and the constitutional ruling in 2018. The licensing failure — documented in state records obtained through FOIA — has not been covered. The Detroit Free Press, Bridge Michigan, the Detroit News, WDIV, and CBS Detroit all accept news tips.

• National media could publish what’s already assembled. I assembled this timeline as a single independent journalist. The national press has not touched the case since the federal prosecution collapsed. I’ve already done the bulk of the work for them. The documentation is linked, sourced, and public. Fox News, ProPublica, NBC News, and the Washington Post accept tips.

• International media could cover it through a different lens. International outlets do not share the same cultural and political issues that America has around genital cutting. They have no reason to avoid stories that document American institutional failure. In India, where the Dawoodi Bohra community at the center of this case is headquartered, journalists have covered this story for years. The BBC, Channel 4, and Sky News; the Times of India, The Wire, NDTV, The Caravan, and Al Jazeera all accept tips.

• The story could spread through social media. Every media outlet listed above requires an editor to say yes. Social media does not. Media covers stories that are already trending. One way that could happen is if you share this article.

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• Nothing happens. Every institution and organization documented above failed to act. It is possible that either this investigation doesn’t reach those who can act or they do not act when they read it.

• The unexpected happens. Something not on this list that no one predicted could happen. It depends who reads this and takes action.

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Conclusion

Every failure documented above traces back to the issue that American law forbids genital cutting on girls and permits it on boys. As long as that disparity exists, no institution will be able to confront what happened in Michigan without confronting what happens in every hospital across the country. Holding physicians accountable for female genital cutting will require creating the systems necessary to end male genital cutting. Rather than confront that, they have chosen to permit female genital cutting through non-enforcement.

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Dena S. Davis, the lead author of the American Academy of Pediatrics’ (AAP) retracted 2010 ‘ritual nick’ policy on female genital cutting, told me in an email on June 19, 2026 that she does not believe the AAP should have retracted it.

“No, I did not think AAP should have retracted the policy statement,” Davis wrote. “Still don’t.”

The 2010 policy recommended that physicians be permitted to perform a “ritual nick” on girls’ genitals. The AAP retracted the recommendation within weeks after public outcry. What has not been reported until now is that the lead author who wrote the policy never changed her mind. Davis stands behind the recommendation sixteen years later.

In 2001, Davis published “Male and Female Genital Alteration: A Collision Course with the Law?” in Health Matrix at Case Western Reserve. She argued that the federal law criminalizing all genital alteration on female minors was constitutionally vulnerable because it banned procedures on girls “no matter how minimal the surgery or how safe and sanitary the procedure,” while leaving male circumcision untouched. Once female genital alteration was understood to include a hygienic “ritual nick,” Davis wrote, the two practices “lack a legally defensible distinction.”

The article called out the double standard directly: “What this boils down to is, if you are an American Jew, you can have your baby boy genitally altered with impunity, even if it is done outside a hospital by an unlicensed ritual practitioner, and without the analgesia deemed ‘essential’ by the AAP. But if you are recent immigrant from Somalia, even if you would take the enlightened route and subject your daughter to a ritual nick at the Seattle clinic, you (and the doctor) would be subject to criminal prosecution. This is unacceptable on First Amendment grounds.”

Her recommendation: “Federal and state laws should be rewritten to allow the sort of minor genital nick.”

Nine years later, the AAP’s Committee on Bioethics adopted that position. The committee, chaired by Douglas Diekema of Seattle Children’s Hospital, published a policy statement concluding that “the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting.” The statement lists Davis as “Consultant” with an asterisk denoting her as lead author and cites her 2001 law review article.

The statement suggested that the AAP “opposes all forms of FGC that pose risks of physical or psychological harm” but that “pricking or incising the clitoral skin… is no more of an alteration than ear piercing.” The conditional phrasing — “that pose risks” — created space for forms of genital cutting the committee judged not to pose such risks.

Anti-FGM organizations condemned the recommendation. Equality Now Executive Director Taina Bien-Aimé told The Lancet the statement “defies decades of extremely hard work” to eradicate female genital mutilation. On May 22, 2010, twenty-six days after publication, the AAP’s Board of Directors voted to retire the policy. In a new statement published in July, the AAP wrote: “The AAP does not endorse the practice of offering a ‘clitoral nick.’ This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members.”

In April 2017, the FBI charged Dr. Jumana Nagarwala in the first federal prosecution under the United States’ female genital mutilation statute. Dr. Fakhruddin Attar, who owned the Livonia, Michigan clinic where the procedures were performed, was also charged.

At Nagarwala’s detention hearing, defense counsel Shannon Smith described the procedures in terms that tracked the AAP committee’s own language. Smith told the court the procedure involved removing a small amount of mucus from the clitoral area — “the amount of a sesame seed” — placed on gauze and given to the family. “It was completely a religious practice,” Smith said.

The defense described the procedures in terms that tracked the AAP committee’s own language. At a detention hearing, defense counsel told the court the procedure involved removing a small amount of mucus from the clitoral area — “the amount of a sesame seed” — placed on gauze and given to the family. “It was completely a religious practice,” the attorney said.

In the criminal complaint, a seven-year-old said Nagarwala took off her pants and underwear and put her on the table. She “got a shot” that “hurt really badly and she screamed.” She drew a picture of the room with an “X” to mark blood on the examining table. Her parents told her “the procedure is a secret and that she is not supposed to talk about it.” Afterward, she could barely walk and felt pain all the way down to her ankle. Nagarwala told her she was fine.

In November 2018, Judge Bernard Friedman of the Eastern District of Michigan dismissed the charges. He struck down the federal FGM statute as exceeding Congress’s authority under the Commerce Clause. The court did not reach the equal protection question of whether banning genital cutting on girls while permitting it on boys constituted sex-based discrimination. The court avoided resolving the constitutional collision Davis described in 2001.

As previously reported, both Nagarwala and Attar hold active, unrestricted Michigan medical licenses with no record of discipline. The state opened investigations into both physicians and closed them without action.

In an exchange over multiple emails between June 18 and June 19, Davis told me she believes “the ritual nick is a good way to equalize male and female, but it would be even better, in my opinion, not to do it at all.”

I asked her to clarify what she meant by “equalize.” She did not answer.

I contacted the AAP on June 21 with five questions: on what basis the statement was retracted, whether the committee was consulted, whether any committee member has said the recommendation was an error, the AAP’s position on the Nagarwala prosecution and its licensing outcome, and whether the AAP has a response to its own lead author’s statement that it would be better if genital cutting were not performed.

Alex Hulvalchick, a media relations specialist in the AAP’s Advocacy and External Affairs division, responded. She did not answer any of those questions. Instead, she sent the AAP’s 2020 clinical report on “Diagnosis, Management, and Treatment of Female Genital Mutilation or Cutting in Girls.”

The 2020 report takes a stronger stance against female genital cutting. It classifies “nicking” as type IV FGM/C and says health care providers “should not perform any type of FGM/C” on girls. This report rejects the harm-reduction argument behind the ritual nick proposal, stating that “By agreeing to perform the procedure, however, health care providers are granting it medical legitimacy, which not only undercuts the moral prohibition on the procedure but also contributes to its spread and ongoing societal acceptance.”

The report directly acknowledges the Nagarwala prosecution but treats it as a constitutional ruling. It does not mention Attar, does not mention their continued licensing, and does not mention the absence of any disciplinary action. It was reaffirmed in January 2026.

I replied to the AAP: “The report does not address my five questions about the 2010 policy statement, its retraction, or Dr. Davis’s position. It also does not address my May 27 inquiry about the licensing of the Michigan physicians. I still need responses to both.” I asked directly, based on the report the AAP itself sent me: “Does the AAP believe physicians who performed FGM/C on children should lose their medical license?”

They did not reply.

Diekema is listed as Committee on Bioethics liaison on the 2020 report. He chaired the committee that recommended the ritual nick in 2010. I contacted Diekema separately with five questions, including whether he agreed with Davis that the retraction was wrong.

He did not respond.

The federal FGM statute that was struck down in the Nagarwala case has been replaced by the STOP FGM Act of 2020. Hadachek v. Oregon, filed in state circuit court in March 2025, argues that Oregon's FGM statute violates equal protection by protecting only girls from non-therapeutic genital cutting.

Davis wrote the argument in 2001. The AAP adopted it in 2010 and retracted it twenty-six days later. The author who wrote it still says the AAP should never have retracted it. No medical organization, insurer, or licensing board has said that physicians prosecuted for FGM should lose their licenses.

“No, I did not think AAP should have retracted the policy statement--still don’t. Good luck with publishing.”

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A federal prosecutor told Michigan's licensing investigator that a medical witness in the state's investigation would not be providing a statement. The state never interviewed another witness in the case.

The witness was Dr. Dena Nazer, a board-certified child abuse pediatrician at Kids TALK Medical Center. Nazer is a professor of pediatrics at Wayne State University School of Medicine and currently serves as chair of the Michigan Human Trafficking Health Advisory Board, appointed by the governor. Her job is evaluating children suspected of being maltreated.

Michigan’s licensing agency wanted to talk to her. The federal government said no.

On September 27, 2017, Michigan Department of Licensing and Regulatory Affairs (LARA) investigator Jennifer Pappas left a message for Nazer at Kids TALK. The interview had been requested by the Michigan Attorney General’s office itself. Pappas’s investigation report states that “an Additional Investigation was requested from the Assistant Attorney General’s Office requesting this Investigator interview WITNESS NAZER.”

The next day, Nazer called back and left a message. That afternoon, Pappas reached Nazer by phone and requested an interview. She also emailed a formal witness letter. Nazer responded that she would forward the request to her attorneys.

On September 29, 2017, at 1:35 PM, U.S. Assistant Attorney Sara Woodward, the lead federal prosecutor on the FGM case, called Pappas. Woodward told Pappas that Nazer “will not be providing a statement to our Bureau due to the pending Federal Court Case and due to WITNESS NAZER’s limited knowledge about the licensee’s activities.”

The federal prosecutor called the state investigator and told her the witness was off limits.

When contacted for this article, Nazer said she was “always willing to cooperate with the state licensing investigation.” She did not address whether the federal prosecutor directed her not to provide a statement. She said “the investigation was still ongoing, and I did not have direct knowledge about Nagarwala’s actions” — language matching Woodward’s stated rationale but attributed to herself.

Nazer also said she “had contact with the office” in 2019 “for updates,” after the investigation had closed. She did not specify which office. She said she remains willing to share her perspective with the state licensing investigation.

Pappas submitted her investigation report to her supervisor on September 29, 2017. The report lists two attachments: the witness letter she sent to Nazer and the email Nazer sent back. It does not document any further investigative activity.

The Michigan Board of Medicine had authorized the investigation on April 18, 2017, after Nagarwala’s arrest. The state closed the investigation on September 25, 2018, with no action taken, nearly two months before the federal court ruling. The memo explaining why is fully redacted.

Nagarwala’s medical license (No. 4301071795) remains active and unrestricted. Michigan renewed it through 2029 while this reporting was underway. She and Dr. Fakhruddin Attar have since opened a new clinic together in Detroit, where they advertise school physicals for children.

This sequence is documented in LARA’s own Investigation Report for complaint file 43-XX-146153, authored by Pappas. The report was obtained through a Freedom of Information Act request to the Michigan Attorney General’s office.

LARA did not release this report. In January 2026, I filed a FOIA request to LARA for “all records relating to Dr. Jumana Nagarwala, including investigative files.” LARA produced the complaint file with redactions but did not include the Pappas investigation report. The report was authored by LARA’s own investigator, about LARA’s own complaint file, and submitted to LARA’s own supervisor. It was obtained only because the Attorney General’s office had a copy in its files and released it. LARA has previously lied to the press about its investigations.

Sara Woodward, who is no longer at the U.S. Attorney’s Office and now works as a Trial Attorney in the Health Care Fraud Unit at the Department of Justice in Washington, responded but did not answer questions about her actions. She redirected the inquiry to the current U.S. Attorney’s Office. When informed the questions concerned her personal actions, she did not respond further.

LARA, the Michigan Attorney General’s office, and the U.S. Attorney’s Office for the Eastern District of Michigan did not respond to requests for comment.

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Taxpayer-funded insurance programs pay two physicians federally prosecuted for performing genital cutting on children. No insurer or government agency will say whether it has ever reviewed them.

Dr. Jumana Nagarwala and Dr. Fakhruddin Attar were charged in the first federal prosecution of female genital mutilation in United States history. Both hold active, unrestricted Michigan medical licenses after the state closed its investigations without discipline. As previously reported, they now practice together at Livernois Primary and Urgent Care in Detroit, a clinic Nagarwala founded. The clinic’s website lists 13 accepted insurers. Seven are taxpayer-funded programs.

On June 15, I sent comment requests to Blue Cross Blue Shield of Michigan, Aetna Better Health of Michigan, Priority Health, UnitedHealthcare, Molina Healthcare of Michigan, HAP, Meridian Health Plan and Ambetter (both operated by Centene), McLaren Health Plan, Humana, the Michigan Department of Health and Human Services, and the Centers for Medicare and Medicaid Services. Each received a set of questions about physicians federally prosecuted for genital cutting on children with a request to respond by June 18.

Three responded. None named either physician. None answered the questions.

Blue Cross Blue Shield of Michigan (BCBSM) issued a statement attributable to the company:

“Blue Cross Blue Shield of Michigan is committed to providing our members with access to high quality healthcare providers. Part of our role is to protect our members from the human and financial costs of waste, fraud, and abuse. Should we determine that a crime has been potentially committed by a provider in our network, we have a dedicated investigations team that works with law enforcement to bring that provider to justice.”

BCBSM did not confirm or deny whether Nagarwala or Attar are in its network. It did not say whether it had reviewed either physician.

Aetna Better Health of Michigan, a Medicaid managed care plan, responded through Phillip Blando:

“Aetna Better Health of Michigan complies with all federal and state rules and regulations. Health care providers serving Medicaid beneficiaries in Michigan are screened through the State’s provider enrollment system. In addition, providers that are suspended or removed from the system, or subject to state or federal payment suspensions are not reimbursed by the state’s Medicaid program.”

Aetna did not name either physician. It deferred responsibility to the state’s provider enrollment system.

The Michigan Department of Health and Human Services, which administers Medicaid in Michigan, responded through spokesperson Lynn Sutfin:

“MDHHS is committed to ensuring that Michigan families have access to affordable health care and that every Medicaid provider is properly licensed and meets all state and federal requirements.”

MDHHS did not name either physician. It did not answer any of the five specific questions it received, including whether it was aware that Nagarwala and Attar are Medicaid-eligible providers, whether it had reviewed the federal prosecution, or whether it had any concerns about these physicians treating Medicaid beneficiaries, including children.

The following did not respond:

• Priority Health.

• United Healthcare.

• Molina Healthcare of Michigan.

• HAP (Health Alliance Plan).

• Meridian Health Plan and Ambetter, both operated by Centene

• McLaren Health Plan.

• Humana.

• The Centers for Medicare and Medicaid Services.

All of the above insurers are listed on the website for Livernois clinic owned by Nagarwala here.

Aetna says Medicaid providers are screened through the state’s enrollment system. MDHHS says it ensures providers are properly licensed. The licensing agency, Michigan’s Department of Licensing and Regulatory Affairs, closed its investigations into both physicians without discipline. LARA’s Board of Medicine unanimously recommended summary suspension in April 2017. Neither license was ever suspended. Both investigations were closed before the federal case ended.

The insurer relies on the state enrollment system. The state enrollment system relies on the licensing system. The licensing system closed the case.

No institution in this chain said it had reviewed whether these physicians should be in its network.

Female genital cutting on children is a federal crime under the STOP FGM Act of 2020 and is illegal in most states, including Michigan.

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Two state agencies denied appeals to release the memo that closed Michigan’s only licensing investigation of a doctor federally indicted for performing female genital mutilation on children. They issued their denials on the same day. They used the same language.

The document at issue is a July 27, 2018 memorandum authored by Assistant Attorney General Bridget K. Smith, titled “Request to Close File.” It recommended that the Bureau of Professional Licensing end its investigation of Dr. Jumana Nagarwala without disciplinary action. A redacted version exists in the state’s files. Every word of substance has been blacked out.

As previously reported, the investigation closed on September 25, 2018, two months before the federal prosecution was dismissed. No licensing discipline resulted. Dr. Nagarwala holds an active, unrestricted Michigan medical license. LARA renewed it through June 2029 this past April, in seven minutes, with no screening of her complaint history. Dr. Fakhruddin Attar, the clinic owner charged alongside her, also holds an active, unrestricted license through March 2027. His clinic has reopened at a new location in Farmington Hills. Both physicians now also practice together at Livernois Primary and Urgent Care in Detroit.

The closure memo is the only document that explains why.

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On May 1, 2026, I appealed to LARA, the licensing agency that received the memo and closed the investigation. The appeal argued that Michigan’s FOIA statute requires agencies to separate privileged legal analysis from factual content and release the non-privileged portions. It cited the AG’s own privilege log, which revealed two versions of the memo sent to two different bureau directors, neither previously disclosed by LARA.

On May 2, I filed a parallel appeal to the Attorney General, the agency whose lawyer wrote it. That appeal made four arguments: that the statute requires segregation of exempt and non-exempt material, that the AG’s role in this case was investigative rather than purely advisory, that factual content is not automatically privileged because an attorney wrote it, and that privilege may have been waived through disclosures to federal prosecutors.

Both agencies denied the appeals on May 18, 2026.

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LARA’s denial, signed by Appeals Officer Adam Sandoval, did not address the segregation argument. It did not address the two-version discrepancy. It did not address LARA’s independent authority to waive privilege as the client. It offered one paragraph of analysis: the memo “fall[s] squarely within this privilege, and redactions made were appropriate.”

The AG’s denial, signed by Division Chief Eric Jamison of the State Operations Division, did not address the segregation argument. It did not address the waiver question. It did not address the AG’s mixed investigative role. It accused the requester of having “neglected to mention” that privilege covers an attorney’s factual materials.

My appeal had stated: “Even if portions of the memorandum contain privileged legal analysis, the AG has not justified withholding the document in its entirety.” This statement directly addresses the point their denial claims I “neglected to mention.”

Both denials share a distinctive feature. Sandoval’s response refers to the filing as one “which has been characterized as an ‘appeal.’” Jamison’s response refers to the filing as one “which you identify as an ‘appeal.’” Both place the word appeal in quotation marks. Both use distancing language to suggest the filings were not, in their view, actually appeals.

This is the same rhetorical construction, scare quotes around the same word, applied through the same syntactic structure, appearing in official legal determinations from two different agencies, signed by two different officials, on the same day.

The AG’s Licensing and Regulation Division is the common thread. AAG Smith authored the closure memo. Her division would have been consulted before LARA could rule on whether to release a communication from its own attorney. The parallel language in the denials is consistent with both responses having been shaped by the same legal position, if not the same drafter.

However, the scare quotes and editorializing in the response raised a question: Was what I sent them an appeal or merely “characterized” as an appeal? Because, if it was not an appeal, I still had a legal right to file one.

On May 24, I asked both agencies whether their May 18 responses constituted final determinations under MCL 15.240. I asked why the responses used language distinguishing the filings from appeals, and whether I was entitled to file one.

LARA’s FOIA Office responded on May 26 and confirmed the filing was an appeal and their response a final determination and I could not file another appeal. They did not explain why Sandoval’s written denial characterized that same filing as something other than an appeal when LARA says it treated it as one.

The Attorney General did not respond. I sent a follow-up on June 6. The AG did not respond to that either. Since the AG would not confirm whether they considered my first appeal an actual appeal or its May 18 response was a final determination, I filed a second appeal on June 8.

My second appeal restated the four original arguments, documented that the AG’s May 18 response had not addressed any of them, and proved that the “neglected to mention” claim was wrong by quoting the passage from the first appeal that directly argued the point. It asked the AG to address each argument individually, to identify any arguments it was declining to address, and to explicitly state whether its response constituted a final determination.

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On June 12, the AG responded. The response is seven pages. It is signed by FOIA Coordinator Christy Wendling-Richards, not by Division Chief Jamison, who signed the May 18 denial.

The first five pages reproduce the text of the June 8 appeal. Page six reproduces the May 18 Jamison denial, word for word. Page seven adds a referral to the Michigan State Bar’s lawyer referral service, where a $25 fee will connect the requester with an attorney for a 25-minute consultation.

The AG did not address the segregation argument. It did not address the mixed investigative role argument. It did not address the privilege waiver argument. It did not address the request for particularized justification. It did not identify which arguments it was declining to address. It did not state whether the response was a final determination.

The letter does contain one structural change. The May 18 denial referred to “your May 2, 2026 email, which you identify as an ‘appeal.’” The June 12 response refers to “your May 2, 2026 appeal.” The scare quotes are gone. The AG now calls it an appeal, while reproducing a denial that treated it as something less than one.

The June 12 letter also contains a particular arrangement. Pages two through five include the passage from the second appeal proving that the first appeal argued the very point the AG claimed it “neglected to mention.” Page six reproduces the “neglected to mention” claim. The AG placed the refutation and the claim it refutes in the same document, in sequence, and issued both as its official position.

The closure memo remains sealed. The public has no way to know why the state continues to license physicians federally prosecuted for FGM and their response to attempts to disclose their reasoning indicate they will not address arguments for disclosure unless a court compels them to.

A Court of Claims lawsuit could unseal the memo. If you’d like to support legal action, contribute here: Expose Medical Board for Licensing an FGM Doctor

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The two physicians at the center of America’s first federal FGM prosecution have opened an urgent care clinic together in Detroit where they are advertising school physicals for children.

Dr. Jumana Nagarwala and Dr. Fakhruddin Attar are listed as providers at Livernois Primary and Urgent Care, a clinic at 18254 Livernois in Detroit’s University District neighborhood. Nagarwala is listed as the clinic’s founder. Attar is listed as staff. Both hold active, unrestricted Michigan medical licenses with no public record of discipline.

The last time Nagarwala and Attar worked out of the same clinic was Burhani Medical Center in Farmington Hills — the location where, according to the federal indictment in United States v. Nagarwala (2:17-cr-20274, E.D. Mich.), Nagarwala performed FGM procedures on minor girls while Attar opened his clinic after hours to let her do it.

Now they’ve rebuilt together, 20 miles southeast, in a clinic Nagarwala founded herself.

The practice registered its National Provider Identifier (NPI 1659021509) on March 24, 2022. The current website launched in spring 2025, with staff photos uploaded in April and May of that year. As of June 15, 2026, the clinic’s Google listing shows 131 reviews and a 4.8-star rating. The business identifies itself on Google as “women-owned,” “Asian-owned,” and “LGBTQ+ friendly.”

The clinic’s services page lists general illness and injury care, occupational health screenings, labs, x-rays, flu shots, and physical exams. The physical exams page specifically advertises “school physicals,” “sports physicals,” “camp and program physicals,” and “childhood and adult immunizations,” services marketed to children and their parents.

The clinic accepts 13 insurance providers, at least seven of which are taxpayer-funded: Medicaid of Michigan, Medicare of Michigan, UnitedHealthcare Community Plan, Molina Healthcare, Meridian Health Plan, Aetna Better Health of Michigan, and McLaren Medicaid. (I have reached out to all for comment and will update once they respond.)

Nagarwala’s bio on the clinic’s website describes her as “a board-certified emergency medicine physician with over 20 years of clinical and academic experience” and a graduate of Johns Hopkins School of Medicine. It mentions senior roles at Henry Ford Hospital. It does not mention the federal prosecution.

Attar’s bio describes him as “a board-certified Internal Medicine physician who has been practicing for over 25 years,” with residency training at Albert Einstein College of Medicine. It does not mention the federal prosecution.

A third provider, listed only as “Mr. Ayyub,” is described as a certified physician assistant with a master’s from Western Michigan University and 13 years of experience on the Acute and Critical Care Team at Corewell Health in Royal Oak. A Tebra listing identifies him as Ayyub Ahmad (NPI 1861708711). Physician assistants in Michigan practice under physician supervision, in this case, under Nagarwala or Attar.

In 2017, federal prosecutors alleged that Nagarwala performed FGM on at least nine minor victims at Burhani Medical Center, Attar’s clinic, between 2015 and 2017. The indictment alleged that Attar opened his clinic after hours to allow the procedures, and that both physicians instructed others not to speak about what had taken place. Families traveled from as far as Minnesota to bring their daughters to the clinic.

The federal case was dismissed in 2018 after the trial judge ruled the federal FGM statute unconstitutional. Michigan’s Department of Licensing and Regulatory Affairs opened complaint investigations into both physicians and closed them without disciplinary action, before the federal case concluded. Both physicians retained their licenses throughout. Nagarwala renewed hers through June 19, 2029, despite complaints.

Now they are seeing patients together again, at a clinic that advertises school physicals for children, accepts Medicaid, and identifies itself as “women-owned” and “LGBTQ+ friendly” on Google.

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Michigan renewed the medical license of Dr. Jumana Nagarwala, the physician charged in America’s first federal FGM prosecution, through 2029 in seven minutes, with no human review, no screening of her complaint history, and no reference to the federal case or the cutting allegations anywhere in the renewal record.

Records obtained through the Freedom of Information Act show that Nagarwala submitted her renewal application on April 14, 2026 at 12:53 PM. By 1:00 PM, the system had emailed her a confirmation.

The production contained only what Nagarwala submitted and the automated system emails. Nothing in the record indicates anyone at the Michigan Department of Licensing and Regulatory Affairs (LARA) looked at Nagarwala’s file before extending her license by three years.

Her license number (4301071795) now shows an expiration date of June 19, 2029 in the state’s public licensing database. When this publication first reported on Nagarwala’s license status in January 2026, the same database showed an expiration of June 19, 2026. Her previous medical license is archived here and the new medical license is archived here.

LARA has at least four complaint files on this physician:

• The original civil investigation (43-XX-146153), which the agency closed in September 2018 with the disposition “No Action Taken” two months before the federal charges were even dismissed.

• The criminal monitoring file (146169), opened to track the federal prosecution.

• A 2019 complaint from a physician who called Nagarwala’s practice of genital cutting on children without anesthesia “torture,” which LARA dismissed by citing the monitoring file rather than the closed investigation.

• A 2025 patient complaint filed against Nagarwala by a patient she treated at GCH Westland Emergency Room.

LARA renewed Nagarwala’s license anyway.

The renewal application asks two good moral character questions. Both ask only about convictions not previously reported to the department. Since the federal case against Nagarwala was dismissed on constitutional grounds, Nagarwala was not required to disclose her history with FGM or the previous federal case against her.

The form does not ask about criminal charges, indictments, arrests, or investigations, open or closed, by this department. The sanctions question asks only whether another state or country has imposed sanctions. Michigan’s own history with the licensee is structurally invisible on its own renewal form.

A patient complaint filed in 2025 alleged Nagarwala improperly administered a drug injection at GCH Westland Emergency Room. Her controlled substance license was also renewed.

The renewal took place during a period when LARA’s own communications director had personally responded to this publication’s questions about whether the agency made false statements to Medscape about the status of the investigations, breaking a months-long pattern of silence across multiple published articles. The agency’s Director of Legal Affairs had been CC’d on correspondence from a Board of Medicine reviewer who treated the inquiry as a legal exposure question. FOIA requests targeting internal communications about the case were active and pending response.

None of that stopped the renewal.

Nagarwala was charged in April 2017 with performing genital cutting on young girls at a Livonia clinic, in what federal prosecutors called the first FGM case in U.S. history. The FBI identified nine victims between the ages of seven and thirteen from Michigan, Minnesota, and Illinois. Prosecutors estimated as many as 100 girls may have been cut over a twelve-year period. The federal case ended in November 2018 after U.S. District Judge Bernard Friedman ruled the federal FGM statute unconstitutional. No party in the case disputed that the procedures occurred.

Michigan’s Board of Medicine authorized an investigation days after the federal arrest. Internal emails show LARA staff requested a summary suspension and administrative complaint. Neither was executed. Michigan never held hearings on her license. The state closed its investigation with “No Action Taken,” and the closure memo, authored by Assistant Attorney General Bridget K. Smith and addressed to then-Bureau of Professional Licensing Director Cheryl Wykoff Pezon, remains withheld in full under attorney-client privilege.

Dr. Fakhruddin Attar, who owned the Livonia clinic where prosecutors alleged the procedures took place, also holds an active, unrestricted medical license (No. 4301067384). His clinic is still open and his license does not expire until March 2027. As previously reported, LARA never assigned an investigator to his case and certified that “a traditional investigation was not conducted.”

No medical organization contacted for this investigation was willing to say that a physician who performed genital cutting on children should lose their medical license.

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State licensing records obtained through a Freedom of Information Act request show the complaint was filed on May 17, 2025, through Michigan’s MiPLUS system. The patient reported that Nagarwala administered a 30-milligram ketorolac injection following a car accident involving a concussion. The incident occurred on April 28, 2025. The complaint lists Nagarwala’s business address as GCH Westland Emergency Room, 6245 Inkster Road, Garden City, MI 48135.

Garden City Hospital, asked to comment, provided a statement through a spokesperson describing Nagarwala as “an independent physician” who “is not employed by Garden City Hospital.” The hospital did not address whether she holds active privileges at the facility.

The statement characterized the federal prosecution as a case that was “dismissed by the courts.” The federal FGM charges were dismissed after the presiding judge ruled the statute unconstitutional, finding that Congress lacked authority under the Commerce Clause to criminalize the practice. The ruling addressed the law, not Nagarwala’s conduct.

The hospital said it maintains “rigorous screening and credentialing processes” including verification of “licensure, background, certifications, training, professional qualifications, and other relevant information,” but declined to say whether it was aware of Nagarwala’s federal prosecution when she was credentialed. Notably absent in their statement was a direct answer to my question “Does Garden City Hospital's credentialing process include an internet search of a physician's name?” or what its position is on credentialing physicians who have been prosecuted for performing genital cutting on children.

“As a matter of policy, Garden City Hospital does not comment on individual credentialing matters or personnel-related issues,” the statement said.

Nagarwala, contacted for comment, initially responded to ask about the identity of the patient who filed the complaint. “This is the first I have heard about this,” she wrote. She has not yet responded to follow-up questions or to an invitation to share her perspective in a recorded longform interview.

The complaint itself appears insignificant. Though Ketorolac risks worsening an undetected intracranial bleed, it is still a common pain medication administered in emergency rooms. What is significant is that a patient walked into a suburban Detroit emergency room, was treated by a doctor who had been charged with performing genital cutting on children, and had no way of knowing.

This is not the first complaint on Dr. Nagarwala’s license. In June 2019, a board-certified anesthesiologist filed a complaint calling Dr. Nagarwala’s cutting of young girls “torture.” LARA dismissed the complaint by claiming they had already conducted an investigation they had not. Now there is a second complaint, filed by a patient who apparently did not know her history at all.

Emergency rooms are not like other medical settings. You do not choose your doctor. You are brought in by ambulance or you walk in from the waiting room, and you see whoever is on shift. Patients rely on the system — the licensing board, the hospital credentialing process, the state — to protect them.

Nothing on Nagarwala’s public license record would make a patient aware of her history, despite there being two complaints on her file. No action has been taken on the complaints against her. No medical organization will say that doctors who perform FGM should not be licensed.

The patient who filed this complaint had no way of knowing who their doctor was. Neither would you.

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Michigan’s Department of Licensing and Regulatory Affairs (LARA) took “no position” on a bill to permanently revoke the medical licenses of doctors convicted of female genital mutilation, while its own medical board was investigating two physicians charged with that conduct.

LARA’s enrolled bill analysis of Senate Bill 410, obtained through a Freedom of Information Act request, records the agency’s official stance: “ADMINISTRATION POSITION: No position.” The bill amended the Public Health Code to require permanent revocation of a health professional’s license upon conviction for FGM. It passed the Michigan House 105-2 and the Senate 38-0. Governor Snyder signed it into law.

Two months before the analysis was completed, LARA’s Board of Medicine authorized investigations into both physicians. On April 18, 2017, board reviewers approved an investigation into Dr. Jumana Nagarwala, one of the physicians federally indicted for performing FGM on minor girls. On April 21, Kim Gaedeke, then the Director of LARA’s Bureau of Professional Licensing, directed staff to open a file on Dr. Fakhruddin Attar, who owned the clinic where prosecutors alleged the procedures took place, and associate it with the already-opened Nagarwala matter. In Attar’s file, board reviewer Dr. Peter Graham recommended summary suspension.

LARA’s own analysis identified the case by name. Its PROBLEM/BACKGROUND section states: “Two Detroit-area doctors, and a third person, have recently been charged under the Federal FGM statute, related to the performing of FGM on two girls from Minnesota at a medical clinic in Livonia.”

The agency was not weighing an abstract policy question. It was taking no position on a bill about conduct it was actively investigating in two named physicians whose case it cited by name in the same document.

The “no position” was not a default. Internal LARA emails show it was a deliberate decision communicated to other state agencies. On June 13, 2017, nine days before the analysis was finalized, Marnie Wills, LARA’s Deputy Director for Policy and Legislative Affairs, emailed colleagues: “I let her know we will have no position but appreciate the head’s up that they will support I have no concerns with them supporting.”

Wills had communicated this to Debi Cain of the Michigan Domestic and Sexual Violence Prevention and Treatment Board. That board supported SB 410. So did the Michigan Catholic Conference. The bill analysis lists no arguments against it. The “Con” section is blank.

A separate Bureau Bill Response in the same FOIA production, an earlier, undated document prepared while SB 410 was still being drafted, explains the posture. BPL wrote: “Historically, it is not within the Bureau’s place to agree or disagree with any suggested sanctions, just so long as they are written properly and clearly in the statute for BPL to enforce.”

Wills had also written to Senator Colbeck’s legislative director during the drafting process: “Generally, the concept isn’t anything we would have a problem with, but we don’t take positions until we see final versions of the bill.”

In that same Bureau Bill Response, BPL noted that existing law already provided a path to revocation. A felony conviction, BPL wrote, “would be a violation of MCL 333.16221(b)(v),” and “permanent revocation would already be an option for a Board’s Disciplinary Subcommittee under MCL 333.16226(1).” BPL was telling the legislature it already had the authority to permanently revoke a doctor’s license for an FGM felony while both FGM investigations were still open on its own docket.

As previously reported, both investigations were later closed with no disciplinary action, the Nagarwala investigation on September 25, 2018 and the Attar closure recommended four months before federal charges were even dismissed. BPL used neither the authority it told the legislature it already had, nor the new authority SB 410 provided.

Neither physician was convicted — the federal case was dismissed on constitutional grounds — so neither conviction-triggered revocation route was triggered. But LARA also did not discipline either physician through any other means. Dr. Nagarwala and Dr. Attar both hold active, unrestricted Michigan medical licenses.

LARA did not respond to a request for comment.

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I sent medical organizations across the country the same question: Should a physician who has performed genital cutting on children retain an active, unrestricted medical license?

Not one said no.

For context: Dr. Jumana Nagarwala and Dr. Fakhruddin Attar, federally indicted in 2017 for performing genital cutting on minor girls, hold active, unrestricted Michigan medical licenses. Michigan’s licensing agency closed its investigations into both physicians with no disciplinary action.

On May 27, I sent each organization a set of questions regarding the licensing of FGM doctors.

Three organizations responded:

• The Federation of State Medical Boards declined to condemn genital cutting on children and refused to comment on the case.

• The American Medical Association condemned FGM in the abstract but declined to say whether these physicians should lose their licenses. They also deferred to an organization that refused to condemn genital cutting on children or licensing FGM doctors.

• The Oakland County Medical Society acknowledged receipt but did not answer the questions.

None said that female genital cutting on children should cost a physician their medical license.

The following organizations did not respond:

• American College of Physicians

• American Academy of Pediatrics

• American College of Obstetricians and Gynecologists

• American College of Emergency Physicians

• Michigan State Medical Society

• Wayne County Medical Society

• Michigan College of Emergency Physicians

• Michigan Chapter, American Academy of Pediatrics

Female genital cutting on children is a federal crime under the STOP FGM Act of 2020 and is illegal in most states, including Michigan.

If any of the organizations contacted for this article respond or send comment, I will update it with their statements.

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When I asked the American Medical Association (AMA) whether physicians who performed genital cutting on children should retain active medical licenses, they referred me to the Federation of State Medical Boards.

As I reported on June 1, FSMB declined to condemn genital cutting on children.

On May 27, I sent the AMA seven questions about the licensing outcome for Dr. Jumana Nagarwala and Dr. Fakhruddin Attar, federally indicted in 2017 for performing genital cutting on minor girls. Both hold active, unrestricted Michigan medical licenses. Michigan’s licensing agency closed its investigations into both physicians with no disciplinary action.

R.J. Mills of AMA Media & Editorial responded the next day. He answered none of the seven questions. He said the AMA “does not have an authorized role in the regulatory process run by the State of Michigan” and referred me to FSMB as “the national voice of the state-run regulatory system for medicine.”

Mills opened his response with: “While I am not an AMA spokesperson, I can provide the following background information to help inform your reporting.” He was writing from the AMA’s own Media & Editorial department.

His response included one substantive statement: “The AMA condemns the practice of female genital mutilation and opposes this form of child abuse by any physician in the United States.”

The organization the AMA endorsed as the authority on physician licensing will not say whether genital cutting on children should cost a doctor their license.

On June 1, I followed up with the AMA. I removed all questions about Michigan’s regulatory process and asked only about AMA policy: Does the AMA agree with FSMB’s decision not to condemn genital cutting on children? Should a physician who has performed genital cutting on children retain a license? Does the AMA Code of Medical Ethics address this? Do physicians have an ethical obligation to report colleagues?

I asked whether the AMA has an on-the-record position on these questions.

As of June 6, the AMA has not responded.

Female genital cutting on children is a federal crime under the STOP FGM Act of 2020 and is illegal in most states, including Michigan.

Screenshots of our emails can be found below:

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When the Federation of State Medical Boards was asked whether a physician who performs female genital cutting on children should retain a medical license, they declined to answer.

FSMB is the national non-profit organization that represents every state medical board in the United States. It describes itself as working to ensure that state licensing boards “protect the public.”

In response to questions I sent asking whether physicians who perform female genital cutting on children should retain active medical licenses, Joe Knickrehm, FSMB’s Chief Public Affairs Officer, responded:

“The Federation of State Medical Boards does not license or discipline individual physicians and is not involved in any decisions about investigations or cases. We therefore cannot comment on the circumstances involving any particular physician or on actions taken by one of our member boards.”

Of the questions I had sent, several concerned FSMB policy, not specific physicians or cases. I sent a follow-up, asking only about FSMB’s own policy positions, and removing all questions pertaining to specific cases. FSMB did not respond.

For context: Dr. Jumana Nagarwala and Dr. Fakhruddin Attar, doctors that were federally indicted in 2017 for performing genital cutting on minor girls, hold active, unrestricted Michigan medical licenses today. Michigan's licensing agency, LARA, closed its investigations into both physicians with no disciplinary action.

Female genital cutting on children is a federal crime under the STOP FGM Act of 2020 and is illegal in most states, including Michigan.

Screenshots of our emails can be found below:

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Michigan’s medical board lied to the press about investigating FGM doctors.

On December 10, 2018, Medscape reported that “as of December 7,” the licenses of Dr. Jumana Nagarwala and Dr. Fakhruddin Attar, two physicians charged in 2017 with federal counts related to female genital cutting, were “active but under investigation,” and that the Department of Licensing and Regulatory Affairs (LARA) “could not comment further on active investigations.”

Based on the agency’s own records, which I obtained through Freedom of Information Act (FOIA) requests, that was a lie.

FOIA records I obtained show the Michigan Attorney General’s office recommended closing the Attar investigation (file 43-XX-146259) on July 27, 2018. LARA confirmed under FOIA that “a traditional investigation was not conducted” on Attar at all.

LARA closed the Nagarwala investigation (file 43-XX-146153) on September 25, 2018, with a disposition of “No Action Taken.” LARA never held a single hearing on either physician’s license.

When the spokesperson told Medscape that LARA “could not comment further on active investigations,” there were no active investigations to comment on.

When they claimed both physicians’ licenses were “under investigation,” Dr. Nagarwala's investigation had been closed months earlier with no action taken, and no investigation into Dr. Attar was ever conducted at all.

The Medscape article ran three weeks after U.S. District Judge Bernard Friedman ruled the 1996 federal FGM statute unconstitutional, dismissing key charges against both physicians. LARA had closed its investigations before that ruling.

The closure memos for Nagarwala and Attar have been withheld in full by both LARA and the Attorney General's office under attorney-client privilege. Both agencies denied appeals to release them.

Both physicians retain active, unrestricted Michigan medical licenses. Attar’s clinic has reopened at a new location and is accepting new patients, including children.

The Medscape story containing LARA’s false claims, “Surgeon: Physicians in Genital Cutting Case Should Lose Licenses,” written by Marcia Frellick and published December 10, 2018, is archived here.

On May 19, Emily Fitzgerald of LARA's Office of Communications replied to my request for comment, acknowledging receipt and stating that she was "working to get you a response” but “it is unlikely we will be able to issue a response within 24 hours of receiving this request, but I will try to get one to you as soon as possible.”

In order to allow LARA time to respond, I delayed my original publication date of this story a full week. On May 25, I sent a follow-up email, asking when I might expect a comment, because I could not delay indefinitely. As of publication, I still have not received comment. I will update this article to include LARA's statement if and when one is received.

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Michigan’s Department of Licensing and Regulatory Affairs (LARA) dismissed a a 2019 licensing complaint against Dr. Jumana Nagarwala that called her genital cutting torture by falsely claiming they had already conducted an investigation.

The complaint, COM19-001459, was filed on June 22, 2019 by a board-certified anesthesiologist who identified themselves as “a former physician licensed by the state of Michigan” with “an active medical license in California.” They said Nagarwala’s practice of female genital mutilation on young girls without anesthesia “amounts to torture, for which we forbid on death row inmates.”

They wrote that Nagarwala “has apparently performed over 100 surgeries without anesthesia, over the past 10 years” and implored the Board of Medicine to “take action against this physician.”

The complainant knew the federal case was dead. They attached the DOJ’s 530D letter to Congress, dated April 10, 2019, in which the Department of Justice admitted it had “reluctantly determined” it “lacks a reasonable defense of the provision, as currently worded, and will not pursue an appeal.” State licensing was the only disciplinary path left.

The board took seven months and fourteen days to respond. On February 5, 2020, LARA finally replied. Here is the full substantive content of the letter:

“We have reviewed your correspondence in the above-referenced matter. While we understand your expressed concerns, please be advised our office is unable to proceed with your complaint because the issues identified have previously been reviewed and is being address [sic] in file number COMxx-146169.”

FOIA records identify the author as Department Analyst Debra Wright-Chambers.

File COMxx-146169 was a criminal monitoring file, not an investigation, meaning that all the file did was monitor the federal criminal prosecution. Department Analyst Terri Schrauben opened it on April 18, 2017. Her email that day: “Criminal File #146169 has been opened to monitor the U.S. District Court, Eastern District of Michigan.” There was never an investigator assigned.

LARA’s own officials knew what it was. On September 17, 2018, Investigations & Inspections Division Director Jon Campbell emailed a colleague about file 146169: “It appears the investigative file is being closed until witnesses can testify on behalf of the department, thus, this is the only remaining file under the criminal charges.”

The file with actual investigative authority was 43-XX-146153. The Board of Medicine unanimously authorized that investigation in April 2017. Regulation Agent Jennifer Pappas was assigned to it. Assistant Attorney General Bridget K. Smith recommended closing it on July 27, 2018. LARA closed it September 25, 2018. Disposition: “No Action Taken.”

This means that LARA’s justification that “the issues identified have previously been reviewed and is being address” was false. The issue was not reviewed in the file they cited, was not addressed, and was not being actively addressed.

Wright-Chambers left state service in 2025. Under Michigan’s retention policy, the Department of Technology, Management & Budget deletes a departing employee’s emails after 60 days. Whatever internal communications explain how or why she cited a criminal monitoring file instead of the closed investigation are gone.

When I requested the records from file 146169 through FOIA, LARA denied the request. The reason given was that the two files had been “consolidated.” LARA now says 146169 and 146153 were the same file all along.

But in 2020, when a physician asked LARA to investigate the doctor charged in America’s first federal FGM case, LARA treated them as different files. It cited the one with no investigative authority and said nothing about the one that had been closed with no action taken.

LARA, the Attorney General’s office, AAG Bridget K. Smith, and LARA Division Director Jon Campbell did not respond to requests for comment.

As I’ve previously reported, Dr. Nagarwala still holds an active, unrestricted Michigan medical license (No. 4301071795) with no record of discipline. Michigan never held hearings on her license.

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The state of Michigan never assigned an investigator into the medical license of a doctor who ran an FGM clinic.

Asked through the Freedom of Information Act to identify the investigator assigned to Dr. Attar’s file, the Department of Licensing and Regulatory Affairs responded: “A traditional investigation was not conducted under 43-XX-146259.” In other words, the requested information does not exist because no investigator was ever assigned.

Michigan’s Board of Medicine authorized the investigation on April 21, 2017. Board reviewer Dr. Peter Graham wrote: “I approve investigation. Please also refer to Director Gaedeke for summary suspension, which I approve.” Board reviewer Dr. James Sondheimer, a professor of medicine at Wayne State University, wrote: “Agree with proceeding with investigation. Res ipsa loquitur.” The Latin means the facts speak for themselves.

Despite the Board of Medicine authorizing an investigation and calling for suspension, the Department of Licensing and Regulatory Affairs, the state agency responsible for carrying out the Board’s directives, never assigned an investigator to the case.

As I have previously reported, Dr. Attar still holds an active, unrestricted Michigan medical license (No. 4301067384) with no record of discipline. Federal prosecutors alleged that Attar allowed Dr. Jumana Nagarwala to perform FGM on young girls at his Livonia clinic after hours for over a decade, with his wife Farida assisting during the procedures. Prosecutors estimated that as many as 100 girls were cut at the clinic over twelve years. His clinic has since reopened at a new location in Farmington Hills and is accepting new patients.

LARA did assign an investigator to the companion file on Dr. Nagarwala (43-XX-146153). State records identify Jennifer Pappas as the regulation agent on that case. Pappas attempted to interview a key medical witness but was blocked by the federal prosecutor. That investigation was also closed with no action taken.

Dr. Attar’s file was opened, authorized for investigation and summary suspension by the Board of Medicine, and closed. Between opening and closing, nothing happened. The file is a record of inaction.

The only document that would explain why is the closure memo authored by Assistant Attorney General Bridget K. Smith, dated July 27, 2018. It is redacted in full.

The Michigan Department of Licensing and Regulatory Affairs and the Michigan Attorney General’s office did not respond to requests for comment.

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On July 27, 2018, Michigan’s Assistant Attorney General Bridget K. Smith recommended closing the state’s licensing investigation into Dr. Fakhruddin Attar, the owner of the clinic at the center of America’s first federal FGM prosecution. The federal FGM charges were not dismissed until November 20, 2018, four months later.

Smith sent her recommendation in a memo titled “Request to Close File” addressed to Cheryl Wykoff Pezon, then Director of the Bureau of Professional Licensing at LARA. LARA received the memo on August 7, 2018, as recorded by a received stamp on the document.

Like the closure memo for Dr. Nagarwala, the physician accused of performing the procedures at Attar's clinic, the substantive content of the Attar memo is redacted in full. The state has never explained why it closed either investigation.

As I have previously reported, Dr. Attar still holds an active, unrestricted Michigan medical license (No. 4301067384) with no record of discipline. Federal prosecutors alleged that Attar allowed Dr. Jumana Nagarwala to perform FGM on young girls at his Livonia clinic after hours for over a decade, with his wife Farida assisting during the procedures. Prosecutors estimated that as many as 100 girls may have been cut at the clinic over a twelve-year period. His clinic has since reopened at a new location in Farmington Hills and is accepting new patients, including children.

Michigan’s Board of Medicine unanimously authorized the investigation into Dr. Attar on April 21, 2017. Board reviewer Dr. Peter Graham wrote: “I approve investigation. Please also refer to Director Gaedeke for summary suspension, which I approve.” Board reviewer Dr. James Sondheimer, a professor of medicine at Wayne State University, wrote: “Agree with proceeding with investigation. Res ipsa loquitur,” a legal term meaning “the facts speak for themselves.”

Despite the Board's authorization, no disciplinary action was taken. The only document that would explain this decision, the closure memo from AAG Smith, is redacted in full.

Documents obtained from the Attorney General’s office show that Smith authored both the Attar and Nagarwala closure memos on the same date, July 27, 2018, and sent them to the same recipient. A response from LARA’s Cynthia Rowe to Smith, dated August 14, 2018, is also withheld under attorney-client privilege.

Both closure memos were sent while the federal case was still active. Trial had been scheduled for January 2019. The state did not wait for the federal case to conclude. As we reported previously, Michigan closed the Nagarwala investigation on September 25, 2018, two months before the federal dismissal. The AG recommended closing the Attar investigation even earlier, on July 27, four months before the federal case ended.

Due to Bridget K. Smith’s recommendation and the Michigan Department of Licensing and Regulatory Affairs’ acceptance of it, the doctor who owned a clinic prosecuted for FGM still holds his medical license and would have retained it even if convicted.

Those involved have hidden their reason for protecting FGM doctors’ medical licenses from the public.

The Michigan Department of Licensing and Regulatory Affairs and the Michigan Attorney General’s office did not respond to requests for comment.

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Michigan closed its licensing investigation into Dr. Jumana Nagarwala, the physician at the center of America’s first federal FGM prosecution, on September 25, 2018, two months before the federal court dismissed charges against her on November 20, 2018.

This means that an FGM doctor retaining her medical license had nothing to do with losing the federal case. The investigation into the medical license ended while the federal case was still set to go to trial.

State licensing records obtained through the Freedom of Information Act show that the only licensing investigation Michigan ever opened into Dr. Nagarwala was closed with the disposition “No Action Taken.” The closure date of September 25, 2018 is recorded in a LICENSE 2000 COMPLAINT HISTORY printout from Michigan’s Department of Licensing and Regulatory Affairs (complaint file 43-XX-146153).

The closure was initiated by Assistant Attorney General Bridget K. Smith of the AG’s Licensing and Regulation Division. On July 27, 2018, Smith sent a memo titled “Request to Close File” to Cheryl Wykoff Pezon, then Director of the Bureau of Professional Licensing at LARA. The memo’s content is redacted in full.

Neither Michigan’s Department of Licensing and Regulatory Affairs nor the Michigan Attorney General’s office has disclosed why they recommended closing the investigation. Both agencies have withheld the memo under attorney-client privilege.

As I previously reported, Michigan never held administrative hearings on Dr. Nagarwala’s license. Dr. Nagarwala still holds an active, unrestricted Michigan medical license (No. 4301071795) with no record of discipline. She was federally charged in April 2017 with performing female genital mutilation on young girls in what prosecutors called the first federal FGM case in U.S. history. The federal charges were dismissed in November 2018 after a judge ruled the 1996 federal FGM ban was unconstitutional. No party in the case disputed that procedures were performed on the girls.

Michigan’s Board of Medicine unanimously authorized the investigation on April 18, 2017, days after the federal indictment. Multiple reviewers signed Board Review Sheets directing the Bureau of Professional Licensing to investigate under MCL 333.16231(2). One reviewer wrote that the charges “warrant suspension and investigation.”

Despite the Board’s authorization, the investigation produced no disciplinary action. The only document that would explain why, the closure memo authored by AAG Bridget K. Smith, is redacted in full.

If Michigan had closed its investigation after the federal case collapsed, the state could argue it was deferring to federal proceedings and lost its basis for action when the charges were dismissed. But Michigan closed first. The state abandoned its own investigation while the federal case was still active.

At the time the medical licensing case was closed, the government had just obtained a Third Superseding Indictment thirteen days earlier, defendants had not yet been arraigned on it, and trial remained on the court's calendar.

Documents obtained from the Michigan Attorney General’s office confirm that both the AG and LARA hold copies of the closure memo, and both refuse to release it. The AG’s privilege log identifies it as Document 72: “Request to Close File,” July 27, 2018, from AAG Bridget Smith to Cheryl Pezon. A draft version is listed as Document 78, also withheld. LARA has separately confirmed that “no other closure letter exists” beyond this memo.

Michigan closed an investigation into female genital cutting on children while those responsible were still being prosecuted and will not explain why.

The Michigan Department of Licensing and Regulatory Affairs and the Michigan Attorney General’s office did not respond to requests for comment.

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This is an ongoing investigation. If you’d like to support this work, you can contribute here: Expose Medical Board for Licensing an FGM Doctor