New TB policy could disrupt overseas adoptions

By DAVID CRARY (AP)
August 10, 2009

NEW YORK — Advocates of international adoption are furious over a new federal policy related to tuberculosis testing that could disrupt plans for families adopting children from China and Ethiopia.

The policy already has forced one distraught couple from Virginia, Jay Scruggs and Candace Litchford, to leave China without the daughter they had spent two weeks bonding with.

"That was a cruel thing to put a 4-year-old child through," Litchford said in a telephone interview Monday. "How is she supposed to trust us now?"

The anger stems from a directive issued by the Centers for Disease Control and Prevention in 2007 intended to minimize the number of immigrants entering the U.S. with multi-drug-resistant tuberculosis.

Earlier this year, the CDC announced that immigrants over the age of 2 from Ethiopia and China — a country that for the past decade has been the leading source of foreign adoptions for American parents — would be subject to the new protocols. The policy applies to all immigrants, including children adopted abroad by U.S. citizens.

Adoption advocates say the required testing procedures — and treatment in the case of positive tests — could cause delays ranging from several weeks to 12 months for obtaining a visa to bring adopted children back to the U.S.

Several major adoption organizations are circulating a petition asking the CDC to exempt adopted children from the requirements. The groups contend that the risk of TB transmission is minimal for infected children under 12 and contend that adopted children, unlike some adult immigrants, are virtually assured of obtaining top-level health care as soon as they reach the U.S.

Chuck Johnson, chief operating officer of the National Council for Adoption, expressed fear that some children adopted by Americans would, because of the new delays, die in their homelands for lack of state-of-the-art medical care they might have received in the U.S.

"Some of these bureaucrats are going to have to answer for that," Johnson said.

Johnson and his allies are trying to mobilize congressional support for exempting adopted children from the policy. They are gathering testimonials from medical experts to back the contention that children, in contrast to adults, are extremely unlikely to transmit TB.

The CDC defends the policy as medically necessary.

"We agree it's a rare circumstance that children can transmit TB, but the reality is it can happen," said CDC spokesman Glen Nowak.

He also said the CDC did not have the legal authority to exempt children being adopted by U.S. families from rules applying to other immigrants.

As for Scruggs and Litchford, Nowak said, "We appreciate that this is frustrating. ... We are doing what we can to make this go as fast as possible."

The policy does not apply to children under 2. However, Thomas DiFilipo, president of the Joint Council on International Children's Services, noted that China was emphasizing special needs adoptions for older children, so that many hundreds of families could be affected by the rules.

Any policy change will come too late for Scruggs and Litchford, both architects from Alexandria, Va.

They traveled to China last month and met their adopted daughter, Harper, on July 27, but had to return home without her last week after a wrenching farewell that they captured on a video posted on their blog.

Litchford said she and her husband were aware of the new regulations and also knew that Harper — being adopted under the "special needs" program — had asthma-like health problems.

However, Litchford said they were told Harper tested negative for TB, so they went ahead with their trip, hoping to bring her home. After arriving in China, they were told that Harper actually had tested positive for TB and that, under the new CDC regulations, she would have to undergo a series of tests to ensure she was TB-free, with results not expected for at least six weeks.

The couple sought a waiver so they could leave with Harper in tow, but were unsuccessful and returned to the U.S. without her, in part for financial reasons and also because they had left their 6-year-old adopted son, Ivan, back in the U.S.

Litchford said Harper already had spent time in two hospitals and with a Chinese foster family that eventually decided it didn't want her.

"She's scared to death," Litchford said. "Every time she walks into a new situation, she thinks she's being left again. And then we had to leave her, the worst thing that could happen has happened."

In the video, Scruggs tries to assure Harper that he and Litchford will return to take her home. But the girl nonetheless bursts into sobs and clings to her father as he tries to leave.

Harper will stay over the next several weeks with a family near Guangzhou, and her parents hope she will be cleared for travel to the U.S. at some point in September.

"This is not an immigrant — it's not someone who has no address in the U.S. and no support network," Litchford said. "It's a child with a family who's going to care for her. But now we can't. We can't take care of our daughter."

Long term, the problems faced by Scruggs and Litchford may be alleviated by a bill recently introduced in Congress. It would extend U.S. citizenship immediately to children adopted abroad by American parents, replacing the current policy in which citizenship is extended only after the child reaches the U.S.

Had the bill been in effect this summer, Harper would not have been treated as an immigrant and would have been allowed to travel to Virginia with her parents.

Adoption advocates say the bill is unlikely to win approval this year, so they are hoping the CDC might ease the procedures for adopted children in the interim.

"I don't believe the CDC intentionally put this policy into place to harm adopted children — I just don't think they were considered in the mix," said McLane Layton, founder of Equality for Adopted Children. "The policy needs to be re-evaluated in this regard, the sooner the better."

Layton, one of most vocal critics of the CDC policy, has been following the difficulties of Scruggs and Litchford as they sought to bring home Harper.

"You wonder about the psychological and emotional impact it will have," Layton said. "When her parents come back, how much will it take for her to believe they're not going to leave her again?"

• Scruggs family blog: http://jayscruggs.livejournal.com
• Joint Council on International Children's Services: http://www.jcics.org