Tuesday, August 11, 2009

New TB rules affect family's adoption

It seems the Scruggs family's problem in bringing home their newly-adopted TB-affected daughter is getting some traction in the media. From the Washington Post:

"Papa, don't go!" she screamed in Cantonese after Scruggs kissed her and tried to hand her over to the foster family that would care for her until he could return.

Finally, the foster mother took the girl and Scruggs slipped out the door, the first step on a trip he wasn't ready to make, a day after his wife, Candace Litchford, had made the same wrenching journey back home to Alexandria.

So, instead of starting life with her new family in the United States, Harper remains in China, the visa she needs to enter the country blocked because of federal regulations aimed at limiting the number of immigrants entering the country with tuberculosis. If her parents had known she was sick, they would have waited for her to finish treatment before they visited, they said.

"You know, she loved us, she bonded with us and she attached to us, and we had to leave," Litchford said. "How's she supposed to trust us? We did everything to explain why, but how do you explain government to a child? You can't."

In 2007, the Centers for Disease Control issued new tuberculosis testing and treatment rules for immigrants older than 2. The policy applies to all immigrants, including foreign children adopted by U.S. citizens, and has outraged several adoption organizations.Advocates said the rules will be particularly problematic for adoptions from Ethiopia, where the guidelines went into effect April 1, and in China, where they took effect July 1.

Both the Wall Street Journal and the Boston Globe have run recent articles on the way the new TB rules affect adoptions, with the Scruggs family getting a mention in the Boston Globe. There's also an interview with the mom in the Examiner.com.

I don't know enough on the medical end to know whether the general rule for immigrants & TB testing should apply to children, but it sure seems that with 2 years of notice, adoption agencies should do a better job of finding out children's health status before families travel.

Zoe tested positive for TB after we got home, though her chest X-ray was clear and so it was only dormant and not active. Still, we had to go through 9 months of treatment, oh joy! Even if the rule had been in force then, it wouldn't have affected her since she was under 2. But I can still only imagine the damage it would have done to to her to be given a "forever family" and have them walk away. I can't help but think there's a better way; it'll have to come from the agencies, though, since there are some good reasons for the health rules for immigration.

Update: Here's the link to the New York Times article.


RamblingMother said...

Apparently this is a new rule put into place by the CDC that only affects immigrants. If this family lived in China as expats and were returning home and if this child was there bio daughter, she would be allowed to come into the states now without restriction. This particular child has been cleared/non-contagious by a panel of Chinese docs as well as an American doc from Johns Hopkins. If the adoption wasn't placed under immigration then there would be no issue. This is a poor law that is going to psychologically damage this child due to the now 4th abandonment (as far as she is concerned) in 4 years. It is very sad.

Jeff and Madeline said...

Regardless of the law, it is the family that is causing her fourth abandonment, not the law! They left her there. International adoption has delay, risk, unforeseen obstacles. The law may need to be changed, but do not blame the CDC for this family leaving their child. Yes, it is very sad that she has been abandoned again!

Steve said...

That is the most self-righteous comment I have read on this blog; and that is no mean feat.

Jeff and Madeline said...

Perhaps, but maybe if just once I saw someone speak for the child and not the families heartbreak it might make it easier to stomach the constant barrage of requests to call the CDC, Sec. of State, Congressman, etc so the family could get back to their son and jobs. So, when does she get a voice? Yes, fight to change the law if that needs to be done, but no child should have to endure abandonment, especially when repeated over and over again.

malinda said...

Rambling mom -- hmm, hadn't occurred to me that taking adoption outside of immigration would be a way to solve the problem. I'm not fond of the FACE legislation that wants to do that, and on balance I still hope it won't pass, but this is a strong argument to do it.

Wendy -- you're right, I haven't heard anyone ask why the family didn't simply stay for the additional 6 weeks it will take to get a TB result immigration will accept. I don't know enough about their personal circumstances to know whether it was possible. I'd like to think I would have stayed, but it's never possible to know what you'd do in any given circumstances.

Steve -- could you expand on your comment? I'm assuming you are labeling Wendy's comment as self-righteous. Could you explain why? These kind of quasi-ad-hominum (you avoided ad hominum by calling Wendy's COMMENT self-righteous, rather than labeling WENDY self-righteous, but you got as close to the line as you could!) comments are hard to decipher into a positive contribution to the discussion. I'm left to make assumptions about what you meant, and you know what a problem that is!

Anonymous said...

Malinda, what is the source of the 6-week rule for TB and immigration or is that common knowledge? I've seen this story everywhere but that was the first I heard of that. As you know, you're often pretty tapped out financially by the time you complete your adoption in China, so perhaps that came into play. I could not have afforded another 6 weeks there.

Lisa said...

I am with Wendy. My first thought was "why leave"? Just stay until she is cleared. I know some may say "we don't have the resources" - but if you can pay that much for an adoption, can't you stay with your child until she is cleared to come home? What bio parent would leave their child behind in China? Just another abandonment.

Anonymous said...

Oh, duh, I guess you just mean have a TB test and wait. Yeah, one would just have to make that work. Borrow money, do something. They're a couple; one parent could return to the son. I couldn't watch the vid.

Anonymous said...

Lisa, the bio parent would be allowed to take the sick child home. The adopted child is considered an immigrant and is subject to immigration rules.

malinda said...

Osolo -- they had to have a new TB test in China at a lab approved by CDC, and results would take 42 days.

I don't know the family's circumstances, there may have been more than money at issue, and I know several groups were prepared to take up a collection to keep them in China and they declined.

RamblingMother said...

They couldn't afford to stay. The adoption agency didn't know the child wouldn't be able to travel even after being declared not contagious. they would have lost their jobs and home staying for another 6 weeks and what if it didn't clear up for a negative test. They have talked about the child. There is a very sad video of leaving the child with an american foster family not going back to the orphanage where the officials wanted her to go. You know the place where she caught it in the first place. The child is very much grieving. I assure you the parents are nearly as heartbroken as the child and they realize the pain it is causing her. Had the agency and orphanage done the test as requested prior to travel the family would have waited. they didn't and that left an already strapped family in a serious situation. Yes, the immigration is causing the problem not the family. Go read their blog. The family is very clear that they would have adopted her anyway but waited until she could enter the US too. Nope the CDC is to blame. this was totally an unforeseen situation on the family and agency who didn't think the child wouldn't be allowed to travel with her new parents.

Lisa said...

Osolo - missed that, I thought the adoption was final, but she was subject to US immigration rules. So my thought was to stay WITH the child. Perhaps I read it too fast.

How very very sad. My heart aches for all of them - the parents and the child.

malinda said...

FYI, they should not have faced losing their jobs. The Family Medical Leave Act guarantees up to 12 weeks of unpaid leave to care for a newly adopted child. Since the child was adopted under Chinese law, she is their adopted child, and something that international comity requires the U.S. to recognize, regardless of her immigration status. Thus, they could have requested, and their employers would have had to grant, up to 12 weeks of leave, with guaranteed return to work.

It does not have to be consecutive -- she could take 3 weeks now, he could take 3 weeks later, then keep alternating that 4times. Or one could take 12 weeks now, and the other 12 weeks after that, for a total of 24 weeks.

Something to keep in mind.

malinda said...

I should add, there needs to be over 50 employees in the firm -- I did a web search of Mr. Scruggs' firm and it looks like they are just at 50 (assuming accuracy of what I found!)

RamblingMother said...

And if he was a key employee the FMLA doesn't apply. So if no one else could do the job within a 50 mile radius the employer doesn't have to offer it. In a down economy when companies are trying to cut what better way to get rid of someone? Also, it is not paid leave so 12 weeks with no money and all expenses is a bit much for anyone. I without that additional stay time couldn't afford to take 12 weeks after adopting and that included the 2 1/2 weeks of travel. No the CDC policy should be changed to allow travel for adopted kids period. Usually these kids aren't contagious or if they are it is very minorly so. The joint committee offered a statement on the CDC policy and basically this policy didn't apply to China until July 1, 2009. Which would explain why the adoption agency didn't know how it would affect the Scruggs.

malinda said...

I don't want to pick on the Scruggs' family, I don't know the full range of constraints they faced in their decision-making to return home and leave their daughter in China. Yes, the CDC rule plays a huge part in it, but it's not the CDC who made them leave. This isn't just about the Scruggs family -- it isn't just about the CDC rule, either. It's about how people view adoption.

But think for a minute -- what if CDC passed a rule that prevented ANY TB-affected person to fly into the U.S. on a commercial plane. (It wouldn't be unknown for them to do that -- remember that attorney guy a few years ago who flew to Europe and back, despite doctor's advice not to do so? He flew into Canada, and CDC and Customs said he shouldn't be allowed to cross the border without contacting CDC first, and the Border agent who let him in without doing so was suspended! See this link about the passengers who sued him: http://www.cnn.com/2007/HEALTH/conditions/07/12/tb.suit/index.html)

If a family had left their bio daughter abroad because she had TB and wasn't being allowed to fly with them, do you think the mainstream media would be as hands-off with that family's decision as they are with the Scruggses? I don't think so. Do you imagine that any other bio parent would say, "They would have lost their jobs -- don't judge!" I don't think so.

The reaction seems to me to be based on that unconscious "adoption is different, adoption is lesser" theme.

RamblingMother said...

Malinda, I agree with you to a point. I don't think it is the Scruggs' opinion of the adopted child though that should be questioned. I think it is society's view as a whole. I don't think a family would feel the same pressure from a job for a bio child as much as an adopted or step child, even. I think society still sees blood as thicker than love or relationship or as the foundation of relationship when it comes to parents and children. Oh and lest you think there aren't companies out there, I worked for one, and it wasn't a small mom and pop business either.

You are right though the CDC didn't tell them to come to the US without the child. The CDC just said the child couldn't come. I would think they would need to come home and re-group, plan a new strategy.

But I think your example of what if it were a bio kid is unfair as it will never be a bio kid who will have to face this situation if the parents are US citizens so it is a straw man argument knocked down.

But again, the anger seems to be more so with the Scruggs for leaving her due to whatever personal reasons they have. Where is the anger at the bio family for abandoning her in the first place instead of bowing to financial pressure to abandon, as it all comes down to finances now doesn't it?

I do remember the attorney from a few years ago who obviously was an adult, and he was instructed not to leave the US in the first place as well as denied re-entry. He disobeyed local health deptartment orders for him to not leave and he was highly contagious to boot. He snuck out of the US then attempted to return. Totally different scenario than that of a non-contagious child in China who was adopted by US citizens.

The panel of doctors declared this child not to be contagious at all. There was no reason to deny entry to an already adopted child who was not contagious but the CDC sees the child as not a citizen therefore, no entry. Maybe the CDC policy should be corrected for all children adopted through ag 14 or whatever the age of adoption is.

Jeff and Madeline said...

"Where is the anger at the bio family for abandoning her in the first place instead of bowing to financial pressure to abandon, as it all comes down to finances now doesn't it?"

Do you know this to be a fact, that this was the reason for abandonmen? I met my daughter's birth family a little over a month ago and there are several other families that have as well, not all of our children't families abandoned due to finances. Also, adding the first family into the discussion is comparing apples to oranges. We are talking about a family who agreed to adopt--treat, love, and assume responsibility as if a bio child--a little girl who has already faced serious loss in her life and then they (supposedly being educated through their agency and hopefully other literature--we know this is oftentimes a joke) added to that loss with another abandonment.
Their jobs, money issues, whatever is not the issue. The issue is leaving a child behind whom you took responsibility for, adopted in the eyes of the Chinese (and most anyone who has adopted and feels the moment they received their child was the moment they were adopted whether legal in the new country or not), and whom you (as they new parents) owe safety, stability, and comfort.
I will just say this, what if she was brought to country immediately after adoption and she exhibited extreme loss behaviors and PTSD (been there so I know what I am talking about) due to the fact that she is an older child coming into a new family. It may be essential that one of them stay home with her--hence, job loss or extended time off, what then? Disruption due to finances? The fact is adoption has unexpected turns of events and sometimes best laid plans have to change, they needed to be prepared for that. Mortgage the house, one parent gets two jobs when coming home, borrow from family and friends, take the money offered for you to stay with the child, cash out a 401K, whatever. She is THEIR child and there is no reasonable excuse that she was left behind--we are talking a child with loss issues already.
Blaming the CDC is a way to deflect responsibility. Regardless of the CDC's rule being unfounded in the opinion of some or unfair as it does not apply to bio situations as stated, it does not change the fact that the CDC did not make the call for the family to return to America without their DAUGHTER. There are always new situations/conditions/etc that are not expected in international adoption, if you cannot be prepared for them or at the basic level willing to accept that you may have to stay longer, come up with more money, etc. maybe it is not for you. I am no fan of agencies, but I don't know of one out there that tells their clients (whether that is in person or in the fine print) that international adoption is set in stone and there will be no unexpected issues--trust me, they do--they cover their asses.

Jeff and Madeline said...

A friend just sent me this link--food for thought.

Lisa said...

I agree with Wendy. Also, I'd like to reiterate a point Malinda made: no one is supposed to travel into the US with TB. Period. So, it comes down to - if this child were the parents' bio child, would she have been treated differently? Cleared more quickly to travel? It doesn't take 6 weeks to decide whether or not she is contagious.

malinda said...

FWIW, I don't think it's accurate to say the Scruggs family "abandoned" their new daughter. They took steps to have her cared for in China, and do apparently intend to go through with the adoption. Unfortunately, that's not a distinction that Harper will understand.

Nonetheless, the kind of economic devastation faced by a rural Chinese family who abandons because of inability to pay fines or have no pension and need a boy to support them in old age is not exactly comparable to two professionals who've maxed out their credit cards.

Jeff and Madeline said...

So true Malinda. Harper will not see being left behind as a temporary issue due to financial concerns, she will see it as another loss, another time of being abandoned.

andrea chiu said...

Thank you for sharing your thoughts and for inspiring us.
Keep it up and continue on what your doing. Visit my site too.