STUDY OF IMMIGRATION AND POPULATION PROBLEMS THURSDAY, AUGUST 8, 1963 HOUSE OF REPRESENTATIVES, COMMITTEE ON THE JUDICIARY, Washington, D.C. The subcommittee met at 10 a.m., in room 327, Cannon House Office Building, Hon. Michael A. Feighan (chairman) presiding. Present: Messrs. Rodino and Poff. Also present: Walter M. Besterman, legislative assistant. We are very pleased today to welcome Dr. James G. Telfer, Chief, Division of Foreign Quarantine, Bureau of Medical Services, U.S. Public Health Service. Dr. Telfer is accompanied by Dr. Louis Jacobs, consultant in psychiatry for the European Office and Dr. James V. Lowry, Chief, Bureau of Medical Services, Public Health Service, and also Mr. Earle Simrell, Bureau of Medical Services and from the Division of Foreign Quarantine Mr. Cosmo Zang, Mr. Ralph Riggs, and Mr. Robert Taylor. We expect testimony on the alien medical examination program which is a very important part of the procedures required by the Immigration and Nationality Act. We are very pleased to have had the prepared statement which was presented to the members of the subcommittee, all of whom have had an opportunity to read it. I wish to compliment you on it, Dr. Telfer. It is our custom for the witness to make a preliminary statement if he wishes, a résumé of his prepared statement, or whatever he might wish to state, after which we shall make interrogation, and at the conclusion of the interrogation the prepared paper will be included in the hearing record. Dr. TELFER. Yes, sir. Mr. FEIGHAN. You may proceed in whatever manner you would like. Inasmuch as the House is going into session at 11 o'clock perhaps a very brief résumé would be desirable at this time. 1 STATEMENT OF DR. JAMES G. TELFER, CHIEF, DIVISION OF FOREIGN QUARANTINE, BUREAU OF MEDICAL SERVICES, PUBLIC HEALTH SERVICE, ACCOMPANIED BY DR. LOUIS JACOBS, CONSULTANT IN PSYCHIATRY FOR THE EUROPEAN OFFICE, AND DR. JAMES V. LOWRY, CHIEF, BUREAU OF MEDICAL SERVICES, PUBLIC HEALTH SERVICE Dr. TELFER. Mr. Chairman and members of the committee, thank you very much for your kind word of reference to our paper prepared by the Division of Foreign Quarantine. The Division of Foreign Quarantine of the Public Health Service has the responsibility for the prevention of the introduction of disease into this country and the medical examination of all aliens. Aliens are examined to detect conditions excludable under the terms of the Immigration and Nationality Act. Since 1891 aliens have been medically examined or medically inspected by the Public Health Service at the ports of entry. Since 1926 the Public Health Service has medically examined some of these aliens at the foreign cities where they have made application to come to the United States. Examination before leaving for the United States avoids for most the many difficulties of aliens leaving their abode abroad, coming to the United States, and then being found to have an excludable medical condition. All of the immigrants and a small proportion of the nonimmigrants are examined abroad. EXAMINATIONS BY AMERICAN AND FOREIGN PHYSICIANS Aliens are examined by the Public Health Service at such cities as there are Public Health Service stations for this purpose. This presently accounts for about 60 percent of the total. The other 40 percent are examined preparatory to receiving visa by local panel physicians selected by the American consular officials. This is a less reliable expedient. The Public Health Service gives consultative assistance as facilities permit. A very important aspect of the program for examination of visa applicants abroad is that the part conducted by the Public Health Service is self-supporting. Each examinee, with a few specified exceptions, pays a fee for his examination to the Department of State. The money is deposited to the general funds of the U.S. Treasury. As more complete coverage is provided so that a lesser percentage of examinations are performed outside of the Public Health Service by panel physicians, more fees are collected. However, all examinations are provided within the funds appropriated for the purpose. We have charts which are large replicas of those charts and maps which are in the paper which was presented and I can explain them for you. 1 All charts appear in the formal report beginning on p. 21. OUTLINE OF PROCEDURES This chart depicts the medical aspects of visa issuance and entries into the United States. It shows the line of procedure and flow as an alien in this foreign country applies for visa. He goes to the consular officer and in the consular officer's office he is questioned by his staff in certain ways and the application process is undertaken. In the course of that examination the consular staff looks for conditions which might raise suspicion of an excludable medical condition. If they find that, they, on sending the man for medical examination, send that information along. The applicant receives an examination by a physician and his assistants help him. This examination includes questioning the person, giving him a physical examination, and in the case of aliens who are over the age of 10 years there are chest X-rays and those over 14 years a serological test is given. If the applicant is found to be normal the consul is informed. If the applicant is found to have one of the medical excludable conditions, or significant abnormalities, a notification to this effect is made to the consul. The American consular officer is the person who has the authority to grant or not grant a visa, and he takes this all into consideration and makes his decision. Of course, there may be various differences from the average routine. There may be cases which require a further examination procedure over a course of days, and that sort of thing, in which event the consul and the doctor get together, and then the consul will notify the alien just what is necessary to complete his examination. The consul may pass the man, grant him a visa, or he may refuse. In the case of certain conditions the consul will grant a visa either under waiver as provided for in the act or go to the Immigration and Naturalization Service for possible waiver. Then there is a possibility that the visa will be issued under that circumstance. The alien, having his visa, may come to the United States, and at all of the ports of entry he will be met by a representative of the Division of Foreign Quarantine, who is the first man, the smiling, cheerful soul in the tan or blue uniform who meets all persons entering this country, the first Government official to meet them. He performs a medical inspection. If everything is in order, papers, identification, the appearance of the alien, he is passed on to the Immigration and Naturalization Service for permission to actually enter. If there is some suspicious thing that requires further evaluation a medical hold is issued. The Immigration and Naturalization Service then sees that this person is held for further medical examination. In some instances there is a certifiable condition which is already documented and there is no question. The certification to the Immigration and Naturalization Service is made immediately. At the port of entry the person who actually decides whether the person may come in or may remain is the Immigration Service representative. He may be admitted into the United States; again there is possibility in certain instances of waiver; or he may be refused entry and not allowed into the country. EXAMINATION STATIONS This map depicts places in the world where the Division of Foreign Quarantine has examination units for examination of aliens abroad. Actually these are in other countries except for along the Mexican border where the examinations are performed in our quarantine station which is just on our side of the border but it is done for the consular office which is in the sister city on the Mexican side. Mr. POFF. It is difficult at this point to see whether that red dot on the map is on the island of Cuba. Dr. TELFER. Actually looking at it closely it is quite clear. It shows that it is in Kingston, Jamaica, CLASSES OF CERTIFICATION This chart illustrates the medical examinations and notifications abroad. This is for the fiscal years 1958 through 1962. It shows the total numbers of examinations and related thereto the numbers of notifications. The largest bar is for the number of immigrants. This represents the smaller number of refugees and parolees. These are the students and exchange visitors, some of whom are required to receive medical examination, and then some of the other nonimmigrants receive examination. This actually is a small proportion of the total number of nonimmigrants who enter the country. Of those receiving notifications, this coloring represents those we notify the consul have class A or excludable conditions. This color shows those who receive class B for a physical condition which may interfere with ability to earn a living. This class C represents variances from the normal upon medical examination which is documented as a matter of medical record and for identification purposes but means nothing insofar as refusing visa or refusing entry to the country. This chart offers a presentation of the relative numbers of people who are examined in various parts of the world. The medical notifications issued during fiscal year 1962 are shown on this chart. This represents the notifications arising from medical examinations abroad and notifications made to the consular officer. About 1 in 3 persons examined were classed as having notifiable conditions. Of all notifications this 3 percent represents those notified as having an actually excludable condition under the act. This 29 percent represents those who have a condition which may interefere with their ability to earn a living. Class C, 68 percent, represents the medical items which are included for the record. From there we go to a breakdown of the notifications for a class A excludable condition. We see that of all these class A conditions there are notifications issued in 70 percent for what we refer to as class A-2. This classification is used for statistical purposes in keeping our records. This is the group found to have tuberculosis. Twenty percent are what we call class A-1, the group having what we call mental conditions, meaning those who have excludable conditions under the first five paragraphs of section 212(a) of the act. What we term class A-3 represents those who are excludable for having the other dangerous contagious diseases. These dangerous diseases are established in regulations of the Public Health Service and, as this shows, 72 percent of all the notifications under this category are for different types of venereal diseases. Under the group which show a mental condition, the largest percentage, 43 percent, receive notification because of feebleminded ness. The next largest group consists of those found to have previous attacks of insanity, 33 percent. Those insane at the time of examination represent 12 percent. There are 10 percent who have psychopathic personality, epilepsy, or mental defect, and 2 percent are notified to the consul because of drug addiction or chronic alcoholism. This map illustrates the parts of the world in which the medical examinations are conducted by physicians not directly related to the Public Health Service, local physicians selected by the consular officials. Mr. FEIGHAN. There are quite a large number of them. Dr. TELFER. There are many places, sir. Of course, with this great number it represents just 40 percent of all the medical examinations done. QUARANTINE STATIONS The medical inspections conducted at ports of entry are shown here. This is a map showing the major quarantine stations at which we have full-time staff on duty, and at these stations a great majority of all medical inspections of aliens is performed. About one-third of all these inspections are conducted at the New York Quarantine Station. Mr. FEIGHAN. What is that mark at the top right across the border? Dr. TELFER. We have an agreement with the Canadian Government whereby we conduct a joint quarantine operation on the St. Lawrence Seaway. It is here in Canada, in the city of Montreal. Dr. LOWRY. Our personnel are stationed there as well as Canadian personnel. EXAMINATIONS AND WAIVERS Dr. TELFER. This chart shows the numbers of medical examinations, inspections, and certifications of aliens in the United States of America for fiscal years 1958-62. It shows there has been a steady rise in total number of inspections and examinations performed, and a rather proportionate increase in those who are certified. This is a graphic depiction of the experience with the provision of the act which allows waiver of medical excludability in cases of certain aliens with tuberculosis. These people have tuberculosis and they are allowed to enter the country under safeguards. The law became effective in September of 1957 and then in 1958 there was a very large number of cases processed, and there had been a backlog of cases accumulating in various places which raised the total number of such processing up considerably in 1959 and then it has continued at a high level. Experience with this we feel has been very 21-472-63- -2 |