THE ALIEN MEDICAL EXAMINATION PROGRAM OF THE PUBLIC HEALTH SERVICE I. INTRODUCTION Guarding the United States against the introduction of disease from abroad is one of the oldest and most important missions of the Public Health Service, one of the seven operating agencies that make up the Department of Health, Education, and Welfare. This mission is at present the responsibility of the Service's Division of Foreign Quarantine. The Division of Foreign Quarantine has two complementary functions: (1) prevention of the importation of quarantinable and other dangerous communicable diseases and (2) provision for the medical examination of visa applicants abroad and the medical inspection of all aliens arriving at ports of entry throughout the country. PREVENTION OF THE IMPORTATION OF DISEASE Under the Public Health Service Act, as amended, Part G: Quarantine and Inspection, sections 361-369 (42 U.S.C. 264-272), and foreign quarantine regulations (title 42, Code of Federal Regulations, pt. 71), the Division carries out a program of quarantine, sanitation, public information, medical intelligence, and international activities. PROVISION FOR MEDICAL EXAMINATIONS OF ALIENS Under the Immigration and Nationality Act of 1952 (Public Law 414, 82d Cong.), including sections 221(d), 234, and 236 (8 U.S.C. 1224 and 1228); and section 325 of the Public Health Service Act, as amended; and regulations for medical examination of aliens (title 42, Code of Federal Regulations, pt. 34), the Division of Foreign Quarantine examines aliens at major U.S. consulates and at ports of entry to detect excludable conditions specified in immigration law. These conditions include (1) dangerous communicable diseases; (2) feeblemindedness, insanity, psychopathic personality, epilepsy, narcotic drug addiction, chronic alcoholism, and other mental and emotional disorders; and (3) physical defects that may limit the alien's ability to earn a living. The remainder of this report is devoted to a detailed description of the alien medical examination program of the Public Health Service. 21 21-472-63 II. HISTORICAL HIGHLIGHTS EXAMINATION OF ALIENS AT PORTS OF ENTRY The Immigration Act of 1891 assigned to the Public Health Service (then known as the Marine Hospital Service) the responsibility of performing medical examinations of aliens at ports of entry. The Service's mission: to determine whether arriving aliens were afflicted with diseases which made them ineligible for admission to the United States under the health requirements of the act. The objective of the program was to safeguard the Nation against the entry of mentally disordered or deficient persons, persons who might become public charges because of a physical defect, and persons suffering from loathsome or dangerous contagious diseases not covered by national quarantine law and regulations. The alien medical examination function at ports of entry has been continued under subsequent legislation, as shown in chart 1, and has been performed by the Division of Foreign Quarantine concurrently with its work of guarding the Nation_against the introduction of communicable diseases from abroad. In performing the alien examination function at ports of entry, the Division acts as medical. adviser to the Immigration and Naturalization Service. CHART 1 ALIEN MEDICAL EXAMINATION PROGRAM OF THE PUBLIC HEALTH SERVICEHIGHLIGHTS OF LEGISLATIVE HISTORY LAWS AUTHORIZING MEDICAL EXAMINATIONS AND STATING EXCLUDABLE MEDICAL Act of March 3, 1891 CONDITIONS Public Health Service (then Marine Hospital Service) responsible for medical examination of aliens at ports of entry. Excludable aliens included: Idiots. Insane persons. Persons likely to become a public charge. Persons suffering from a loathsome or dangerous contagious disease. Act of February 15, 1893 Authorized President to suspend immigration from countries in which cholera or other infectious or contagious diseases existed. Act of March 3, 1903 Added to excludable aliens: Epileptics. Persons who had been insane within 5 years prior to application for admission. Act of February 20, 1907 Added to excludable aliens: Imbeciles. Feebleminded persons. Persons with physical or mental defects which might affect ability to earn a living. Persons afflicted with tuberculosis. Act of February 5, 1917 Added to excludable aliens: Persons of constitutional psychopathic inferiority. Chronic alcoholics. Persons who had had one previous attack of insanity. Authorized Secretary of Treasury to assign medical officers of U.S. Public Health Service abroad for duties connected with enforcement of act, on request of Commissioner, Immigration and Naturalization Service, approved by Attorney General. Act of May 26, 1924 Provided for issuance of immigration visas. Followed in 1925 by first assignment of Public Health Service medical officers abroad to examine visa applicants. Public Health Service Act, July 1, 1944 Surgeon General to provide for making, in United States or other countries, such physical and mental examinations of aliens as required by immigration laws, subject to administrative regulations prescribed by Attorney General and medical regulations prescribed by Surgeon General with approval of Secretary. Act of June 27, 1952 Aliens ineligible to receive visas and excluded from admission (except as otherwise provided in act): Feebleminded persons. Insane persons. Persons who had had one or more attacks of insanity. Persons afflicted with psychopathic personality, epilepsy, or a mental defect. Persons afflicted with tuberculosis in any form, or with leprosy, or any Other persons certified by examining surgeon as having a physical defect, disease, or disability, when determined by consular or immigration officer to be of such a nature it might affect person's ability to earn a living, unless person affirmatively established he would not have to earn a living. Act of September 11, 1957 (amended by act of Sept. 9, 1959) Authorized immediate family member of a U.S. citizen, of a resident alien, or of an alien who had been issued an immigrant visa, to receive a visa and be admitted as an immigrant notwithstanding affliction with tuberculosis, subject to controls prescribed by Attorney General after consultation with Surgeon General. Act of September 26, 1961 Inserted former temporary "tuberculosis waiver" provision as standing section (212(f)) of Immigration and Nationality Act. Deleted words "leprosy" and "tuberculosis in any form” from section 212(a)(6), Immigration and Nationality Act (leprosy and tuberculosis now included in Public Health Service regulations--42 CFR 34.2-as "dangerous contagious diseases"). LAWS RESULTING IN SPECIAL MEDICAL EXAMINATION ACTIVITIES Act of December 28, 1945 · Alien spouses and minor children of U.S. Armed Forces personnel to be examined on arrival and admitted notwithstanding excludable medical conditions, to be reported to local health officers. Displaced Persons Act of 1948 (amended 1950 and 1951) 455,075 applicants for immigration examined; 11,008 reported with excludable medical conditions. Refugee Relief Act of 1953 More than 200,000 refugees examined; 3,796 reported with excludable medical conditions. Act of June 27, 1952, parole provision (sec. 212(d)(5)) Basic authority for Hungarian Refugee Program, fiscal year's 1957-58-more than 38,000 refugees medically examined. Act of September 2, 1958 (amended by act of July 14 1960) Basis for examination of large number of Netherlands citizens and nationals who were displaced from Indonesia and applied for special allotment of immigrant. visas. ESTABLISHMENT OF MEDICAL EXAMINATIONS ABROAD The Immigration Act of 1924 provided for American consular visas for persons who intended to immigrate to the United States. The act required that prospective immigrants supply consular officials with a health report obtained from a local physician. The experience of the first year showed that consular officials could not depend on local physicians' medical reports for immigration visa purposes. Some other method seemed desirable. In 1925 the Surgeon General suggested that prospective immigrants be examined by Public Health Service Medical Officers in their country of origin, preferably when they applied for visas. His suggestion was adopted and that same year eight Public Health Service medical officers were assigned to U.S. consulates in Britain and Ireland. Their mission: to examine persons applying for immigration visas and to act as medical advisers to Department of State consular officials. Consular regulations issued in 1929 authorized immigrant-visa applicants to be examined by a member of a panel of local physicians approved by the Department of State in those localities where there was no Public Health Service physician on duty. The local panel physician system has been continued up to the present time. Determining the physical and mental health of an alien when he applies for a visa benefits both the United States and the alien. It benefits the United States because it excludes at the source the alien who might introduce a dangerous communicable or other excludable disease or who might become a public charge because of some physical or mental defect. It benefits the alien because it almost completely eliminates the possibility that he will be excluded for medical reasons on arrival in the United States. As an illustration, in 1906 nearly 3,000 immigrants were excluded for medical reasons on arrival at the port of New York alone, compared with only 23 in 1962 at all U.S. ports. After immigration medical examination units had been set up at consulates in Britain and Ireland, other European governments requested that units be established in their countries. By 1930 prospective immigrants to the United States were also being examined by Public Health Service physicians_stationed in Germany,__the Netherlands, Czechoslovakia, Austria, Poland, Belgium, Italy, Denmark, Norway, and Sweden. During World War II the alien medical examination program was discontinued everywhere except London. As the issuance of immigration visas was gradually resumed after the war, Public Health Service officers were reassigned to major consulates and the supervisory office for Europe was reestablished. Since World War II the Division of Foreign Quarantine has been involved in a number of special immigration programs at the same time that it has carried out a program of medical examinations for regular immigrants. Under the Displaced Persons Act of 1948, and amendments of 1950 and 1951, the medical examination work increased greatly. In 1948 examination units were opened in Germany, Austria, and Italy, and units were also set up for the examination of displaced persons at the resettlement centers of the International Refugee Organization in Europe and the Philippines. As far as possible, the medical examination work involved with displaced persons was integrated with the work of the regular immigration program. During the 4 years of the displaced persons program, 455,000 applicants for immigration were examined in foreign countries; 11,000 of them were found to have excludable diseases or conditions. Under the Refugee Relief Act of 1953, more than 200,000 refugees were examined for immigration between 1954 and 1957 in Austria, Belgium, Denmark, Egypt, England, France, Germany, and Greece; also in Iran, Italy, Jordan, Kuwait, Lebanon, the Netherlands, Norway, Sweden, Turkey, and the Far East. About 3,800 applicants examined under the provisions of this act were found to have excludable conditions. The mass migration of Hungarian refugees started in November 1956. Medical facilities of the Public Health Service were quickly established to examine great numbers of these refugees in Austria and to provide for emergency staffing of the Hungarian Refugee Reception Center at Camp Kilmer, N.J. At the peak of activity in December 1956 the Vienna and Salzburg offices together were examining about 1,500 refugees a day. More than 26,000 were examined in 7 weeks. By the end of the program 38,000 refugees had been medically examined. There were 1,600 cases of suspected tuberculosis found among these refugees. Refugees with conditions that normally exclude entry into this country were admitted under parole when there was assurance of sponsorship and treatment. From September 1958 to June 1961 the work of the Public Health Service medical examination unit in Rotterdam was expanded as a result of special legislation covering nationals of the Netherlands who had been displaced from their homes in Indonesia. Public Law 892 of the 85th Congress authorized the admission over a 2-year period of a number of refugees not to exceed the annual quota for the Netherlands of 3,136. Public Law 648 of the 86th Congress extended the program for 1 year and doubled the special quota for that year. CONTINUED GROWTH OF THE PROGRAM Over the past few years the alien medical examination and inspection programs have continued to grow both at the present units in Europe, Canada, Mexico, and Hong Kong and at points of entry here in the United States. This growth has been due to a general increase in the number of aliens entering the United States, new exchange programs, increased immigration from unrestricted areas, and immigration under special legislation. There has been an especially large increase in the number of examinations on the Canadian and Mexican borders. A unit was recently established at Kingston, Jamaica, to supervise the program in the Caribbean and Central American areas. III. PRESENT PROGRAM Certain classes of aliens receive a medical examination abroad when they apply for a visa or parole for entry into the United States. About 40 percent of the oversea medical examinations are conducted outside of the program of the Public Health Service. Those conducted within the program are performed by the Division of Foreign Quarantine. Aliens admitted at U.S. ports of entry are inspected by the Division of Foreign Quarantine to prevent the spread of communicable disease into the United States and to prevent the entry of aliens with excludable medical conditions. The procedures in this country and abroad are conducted under a variety of circumstances as illustrated in chart 2. |