CDC forces US family to leave daughter in China.

August 9, 2009 9:07 AM

CDC forces US family to leave their daughter in China and return home without her.New CDC regulations had been instituted for China beginning July 1, which state that new immigrants must pass a series of TB tests to enter the country. Children like Harper, who have been tested and treated, are caught in limbo - her tests indicate she is non-contagious, but the CDC refused to issue her a needed visa to enter the US, in part because her tests were done at a non-CDC approved lab in China. There are between 5-10 of these labs in all of China. Her parents are living Sophie's Choice - either leave one of their legal children alone in China, or stay with her, lose their jobs, and leave their other legal child alone in the US.

They came home heartbroken. And they aren't the only family, just the first one. Harper is 4 years old - how do you explain to an orphaned 4 year old that she finally has a Mum and Dad and a sibling and a real family, that the adoption is complete and she is finally going to have home and family, and then tell her that can't happen? The videos of them saying goodbye to their daughter are heartbreaking, see
here, and here.


They have been blogging about their trip. If she was their natural born daughter, she would not have been denied access back to the US. The new rule does not apply to those children, just those adopted in other countries.

posted by kristin (28 comments total)

"The couple had specifically requested TB tests and x-rays, as well as Harper's hospital records prior to coming to China, but their requests were not accommodated until after the adoption was completed."

It sounds as if the adoption agency/entity that they were working with was either less than honest with them or not professional enough to understand/research the regulations as regards children with a history of TB.

This is tragic and sad, and it means a one month delay in the family getting back together (if I'm reading this correctly), but I don't see the outrage in this.
posted by HuronBob at 9:19 AM on August 9

Wow, that article, and this post, just might have a bit of an agenda.

If I'm reading correctly, the CDC/DHS policy (considering the relative reputations of the CDC and the DHS, for the time being I'm going to go ahead and think of this as a Homeland-Security policy) does not refer to international adoptions, but to new immigrants who test positive for tuberculosis. And it doesn't ban them from entering the US entirely, but rather requires them to complete treatment in their home countries. While I'm no expert in either immigration or medicine, this really doesn't sound like a bad policy.

I'm sympathetic to the adoptive parents, especially because it sounds like someone misspoke or misled them or lied to them or something. I'm sympathetic to the kid, who is stuck in the middle of something she probably can't understand.

But the author's framing of this law as discrimination against adoptive children, let alone Mr. Scruggs' words on his blog about how 'Dr. Tom Frieden is the head of the CDC and bears responsibility as the man who keeps adopted children away from their mommies and daddies,' is wildly oversimplified at best and intentionally misleading at worst.
posted by box at 9:25 AM on August 9 [2 favorites]

Nobody misspoke to them or lied to them - the CDC changed the rules to the game while this family was making travel plans, which meant there was no way to get what the CDC wanted in the timeframe they demanded its a bureaucracy problem, not a health issue, that keeps Harper separated from her parents and family, alone in China.

The 'agenda' is this - they are the legal parents of that child, she is non-infectious, and she cannot enter the US. These kids were previously allowed to come home, and as of last month, they cannot, and there is no solid scientific reason why she cannot.
posted by kristin at 9:32 AM on August 9

I'm sympathetic for that family, and from the article it does seem like the real threat is minimal.

But I have no real expertise in these matters, and the CDC has quite a bit. I don't expect every policy they enforce to be 100% correct or 100% fair to 100% of the families, and as a result I have a level of tolerance for people falling through the cracks. That's callous, I know, but tuberculosis kills 1.5 million people every year and I'm pretty okay with inconveniencing this one family in defense of policies which (imperfect though they may be) have kept the U.S. from suffering from the global TB epidemic.

If the policies are flawed scientifically, say so. But turning this into a sob story for how the evil CDC overlords don't want little Chinese orphans to have parents is counterproductive.
posted by Riki tiki at 9:34 AM on August 9 [2 favorites]

Nobody misspoke to them or lied to them.

From the article (my emphasis): "Though Harper was diagnosed with TB two months prior to being adopted, her parents, Jay Scruggs and Candace Litchford, were not aware of this prior to traveling to China to adopt her. In fact, they were told that she did not have TB, and had 3 negative PPD tests."
posted by box at 9:38 AM on August 9

In a normal country this would have been taken care of with a hundred bucks at the border.
posted by Meatbomb at 9:39 AM on August 9 [5 favorites]

I was a stepfather for 5 years and the kids survived fine even with me as a parent. Excepting maybe some slight confusion I caused telling them Jesus had a brother Larry. This is a roller coaster ride for the whole family for sure but little Harper Yue Ye Scruggs and her new family will be just fine.
posted by vapidave at 9:42 AM on August 9 [1 favorite]

I find myself struggling with two mindsets about this situation.

First, it seems horrible that a couple would travel thousands of miles to adopt a child, be seemingly misled by the adoption agency about the status of the child's health, and then find themselves up against immigration laws which require the child to be left in the country of origin. I did not read every page of the blog, so it is unclear to me whether the parents were aware of this potential problem when they began the process, or whether these regulations kicked in mid-stream and snuck up on the couple. I'm sure it is heartbreaking to have to return home without the child they had gone overseas to pick up, although the general impression I get from the article is that, if they wait a month or so, they will eventually find their adopted child in their State-side home.

Second, I am weary of all the overseas adoptions. I don't understand the point. There are babies born here in the US every day who are unwanted and who wouldn't have to be screened for TB, wouldn't have to undergo immigration procedures at all. I often find myself a bit curious as to the motivation for foreign adoption, as it seems like some sort of cultural superiority complex. They Have Life So Awful There, We Will Bring Them Here And All Will Be Well. I would welcome a more clear understanding on this, perhaps to overcome my own negative attitudes.

[Possible Important Personal Information: I was adopted as an infant by two people who were unable to conceive on their own. My sister was also adopted, 2 years later, also after birth. (She and I are not genetically related at all.) We were raised with full knowledge of our adoptions all our lives, but there's no confusion about Mom and Dad being Mom and Dad, ever. This all took place 40ish years ago, so I'm sure the landscape for adoption and how it works has changed in the meantime.]

So, I feel terrible for the parents. And I don't object to the CDC protecting the populace at large from potentially harmful diseases from overseas. And I wish more people who want children would look in their own backyard before heading to Asia or Africa or whereever else. I hope it's okay that I can think all those things at the same time.
posted by hippybear at 9:43 AM on August 9 [10 favorites]

...she is non-infectious...

Not proved, and that's the point. They got tests from an uncertified Chinese lab.

Remember contaminated pet food? Remember contaminated milk products? Remember contaminated toothpaste? The Chinese only seem to care about being honest about testing when they're forced to be.

The CDC is saying that they won't accept the lab test because they don't trust the lab that did the test -- and considering the recent past of Chinese behavior, that's a fair concern.

I can understand why the parents are angry, but they're directing their anger at the wrong target. The adoption agency is the villain here, not the CDC.
posted by Chocolate Pickle at 9:44 AM on August 9 [4 favorites]

A natural born child of an American citizen would not have to endure this. Dr. Tom Frieden is the head of the CDC and bears responsibility as the man who keeps adopted children away from their mommies and daddies.

A natural-born child of an American citizen like Mr. Scruggs would not have been living in an orphanage in China for the last several years and therefore would not have TB.

Dr. Tom Frieden's job is to oversee the enforcement of CDC's public health policies and regulations, the aim of which is to protect US citizens and residents from the spread of contagious diseases. That Scruggs writes about him in such an inflammatory (and false) way while linking to his contact information is repugnant.

TB has become a serious issue in many urban areas of the US (like Los Angeles). There are recent cases of airline passengers with drug-resistant TB arriving in the US, resulting in the airline and health officials scrambling to round up all the passengers for testing.

So wait another month, Scruggs family. The rules are there for a reason.
posted by grounded at 9:45 AM on August 9 [2 favorites]

Would this work different if, say, the parents had been adopting from Great Britain?

And in any case, the policy seems quite silly. If you come from a visa waiver country, there wouldn't be anything to stop you from coming in with TB (aside from if you were actively sick and looked it and the immigration agent realized it.) So it seems silly to make a fuss over a case where there's absolutely no medical reason to think the person is going to spread TB while letting millions of possible carriers in for months at a time as tourists...
posted by R343L at 9:51 AM on August 9

Even more importantly, they learned that there have only been two documented cases in the world of children who have transmitted TB. Given the fact that children are not inherently capable of spreading the disease, the legislation was obviously written for adults.

I do not think "not inherently capable" means what the author thinks it does.

Also, she's wrong.
posted by timeo danaos at 9:52 AM on August 9

she is non-infectious...there is no solid scientific reason why she cannot [come home]

The article does not bear that out:

there have only been two documented cases in the world of children who have transmitted TB

So very rare but not impossible.

Harper had chest x-rays indicating that the medications were working, and that her lungs were clearing.

Clearing but not cleared.

the CDC would not accept the sputum culture processed in the hospital in China because it was not done by a CDC approved lab, was not the right type of test, and was only one of three positive tests results that would be required.

So it looks like there is actually not insignificant doubt as to whether the child is completely clear of TB.

You have to understand something about the US approach to TB. Most countries use the TB vaccine, which means that the only reliable ways to diagnose TB in vaccinated patients are a chest X-ray or cultures. Those tests can only show current infection, not whether the patient has ever been exposed. This is a problem because TB can recur even after appearing cleared if it has not been completely eliminated from the body. Thus, a child might appear okay then (because of missed meds or bad luck) develop active TB later in life.

In the US, we rely on the TB skin test, which is positive if the person has ever been exposed to TB. But if someone has had the vaccine, they'll show a false positive on that test. So, the US takes extraordinary precautions with people who can't use the skin test because it's impossible to know if they've just had the vaccine or have had the disease. Unfortunately, this kid seems to have fallen on the wrong side of those extraordinary precautions.
posted by jedicus at 9:53 AM on August 9 [2 favorites]

Would this work different if, say, the parents had been adopting from Great Britain?

Probably, because of the radical difference in incidence of TB between China and GB. Oh, wait...you wanted it to be a racial issue. I see what you did there.
posted by kjs3 at 10:08 AM on August 9

I'll take a gallon of infant tears over a TB outbreak.
posted by Inspector.Gadget at 10:10 AM on August 9

Would this work different if, say, the parents had been adopting from Great Britain?

You bet, because British labs are trusted.
posted by Chocolate Pickle at 10:14 AM on August 9

kjs3: No, I didn't want to make it a racial issue. I wondered if there was a differential between countries we have a closer / longer relationship with. If TB is so horrific that we can't even risk letting one child in that is very unlikely to transmit it (note part where apparently there are only two cases of children transmitting it to another ever), it would make sense that we should be more even-handed about possible TB carriers. And that would include treating people coming from a country we have a long and very close relationship with the same as any other.
posted by R343L at 10:24 AM on August 9

...note part where apparently there are only two cases of children transmitting it to another ever...

Please note the "she's wrong" link above.
posted by Chocolate Pickle at 10:31 AM on August 9

Would this work different if, say, the parents had been adopting from Great Britain?

Er, well are you seriously comparing GB to China in regards to health care? GB is Ranked ~18th and China ~144th.

(the US is ~37th btw,
posted by edgeways at 10:32 AM on August 9

> Would this work different if, say, the parents had been adopting from Great Britain?

And in any case, the policy seems quite silly. If you come from a visa waiver country, there wouldn't be anything to stop you from coming in with TB (aside from if you were actively sick and looked it and the immigration agent realized it.)

This isn't really the same as entering the US on a tourist visa or being a US citizen. They screen everyone entering the country with the intent to live there regardless of race, economic background or citizenship. In the UK, I (and a few other Mefites as well!) had to go to London to an approved medical facility and pay £180 for the examination, including a chest X-ray and blood test. I also have to get all the required vaccinations before my green card interview (which is on Thursday), including starting the HPV course of vaccinations because I'm 25 years old and have a vagina, not 27 years old and have a vagina. This isn't about the kid being Chinese, it's about the set rules they have for non-Americans entering the US to live there on a permanent basis. Adoption doesn't make her any less in that category.
posted by saturnine at 10:35 AM on August 9

If TB is so horrific that we can't even risk letting one child in that is very unlikely to transmit it...

But it doesn't seem the point is to keep out just one li'l child out. The point is to keep all children without proper testing out, and this one child just happens to be part of that group for the time being.
posted by Ms. Saint at 10:39 AM on August 9 [4 favorites]

Second, I am weary of all the overseas adoptions. I don't understand the point. There are babies born here in the US every day who are unwanted and who wouldn't have to be screened for TB, wouldn't have to undergo immigration procedures at all. I often find myself a bit curious as to the motivation for foreign adoption, as it seems like some sort of cultural superiority complex. They Have Life So Awful There, We Will Bring Them Here And All Will Be Well. I would welcome a more clear understanding on this, perhaps to overcome my own negative attitudes.

We adopted domestically, and many of our friends also have. Many also have done international adoptions. It's not so much a cultural superiority complex--though it's true both for my daughter and for the internationally-adopted children of friends that their lives are dramatically different and better than they would have been otherwise--as making choices among many types of adoption, each with its own risks and costs.

For instance, there are babies here in the U.S., but it is very difficult to adopt, say, a white newborn. Few are released for adoption, waits can be years long, costs can be extraordinarily high, and many families will not meet the qualification requirements agencies are able to impose.

Many many available newborns have been drug- or alcohol-exposed, or born to mothers who had minimal prenatal care, if any at all. It varies from state to state, but a birthmother who surrenders her parental rights and places a child for adoption may have anywhere from no option to revoke (as in our case, an Illinois adoption) to as long as six months in some states, so there is a risk of accepting a placement and later losing the child.

Many babies born in the US who "need parents" have parents, and they will not be released for adoption until they've been through foster care, reunification attempts, and so on, until the parental rights are terminated. During this time, damage is being done--and a foster family hoping their foster child will be released for adoption may never have finalization (I have a friend who was only able to legally adopt her daughter when her daughter turned 18 and could consent to it herself), or they may lose a child, sometimes to birth parents they know are unfit but who have managed to jump through the appropriate hoops to have custody restored, which is the goal of the foster care system.

Another risk is birthfathers--we ended up in a 20-month custody dispute with our daughter's birthfather, who the birthmother had claimed was unknown, that went all the way to the appeals level and cost us $47,000 in legal fees. One of my friends who adopted internationally was sympathetic but said in so many words that one reason she adopted internationally was that by the time the child was released for adoption, there was no chance of that kind of custody problem happening. Nor would she have to deal with the complexities of an open or semi-open adoption, which are great options when they work but oh! the horror stories you hear.

On the other hand, we didn't choose international adoption because we didn't want to carry the risks associated with adopting a child who'd been institutionalized, the stress of knowing we had a match but having to wait months for the child to be released for adoption, or the possibility of the birthmother having been coerced into placing the child for adoption. In addition, it has happened more than once that other countries have changed their adoption laws without "grandfathering" in people who were already in the process of adoption--I know one woman who spent something like 4 months in Haiti with her daughter when this happened to her, and a few years ago many families who were in the process of adopting from Guatemala were left in limbo when Guatemala changed its adoption laws abrubtly. Sometimes a nation stops allowing adoptions at all. What is happening to this family adopting form China is not unique in international adoption.

I certainly don't mean to say "adoption is bad!" I am a very happy adoptive mom myself. But when I was researching adoption options for us, it seemed to me that every type of adoption carried significant risks, and that each adoptive family needed to choose which risks they were willing to take. In adoption, there are no easy, safe options.
posted by not that girl at 10:46 AM on August 9 [14 favorites]

The reason people adopt from outside of North America is because the biological parents cannot change their minds and take their children back. (And also it tends to be easier to get younger children.) There are a lot of huge flaws in overseas adoption, and lack of knowledge of your biological family is one such problem, but most people do not want to save the poor people over there, they want to have a child but are unable to.

It seems like she's already received the approved tests and will be allowed to the US as soon as they have been analyzed and okayed by the CDC, just like anyone else. It's really unfortunate they were lied to about her TB results, and it's a terrible story for the family and for this little girl, but a TB outbreak would be another terrible story.
posted by jeather at 10:47 AM on August 9

This would make a good blog post. Well, not really, but it would make a better blog post than it does an editorializing MeFi post.

I'm not sure what the solution is supposed to be here. No public health rules and standards? Only those rules and standards that most folks like? Only rules and standards that do not affect cute young children, or don't negatively affect cute young kids? The real "news" here is that public health laws are almost always disliked by those who are at risk of infecting others (and their agents). I can understand that, but it isn't an instance of injustice, it's an instance of self-centeredness. In much of the US you can be imprisoned for refusing to take your TB meds if you have active TB.
posted by OmieWise at 10:50 AM on August 9 [2 favorites]

If TB is so horrific that we can't even risk letting one child in

Since my uncle and grandfather died of the disease, I'd like to note that it's pretty horrific in its ordinary form. And since the even worse drug-resistant variety - a significant problem in China - is a worldwide health concern, I'd rather that the CDC not make exceptions to their understandably stringent policies.
posted by Doktor Zed at 10:57 AM on August 9

If TB is so horrific

Oh, please fuck off. My best friend has to have dialyses 3 times a week since contracting TB ten years ago.

This would make a good blog post. Well, not really, but it would make a better blog post than it does an editorializing MeFi post.

Indeed, this is a terrible FPP. It's hard to imagine how it could be more slanted and ill-informed. GOB indeed.
posted by You Should See the Other Guy at 11:04 AM on August 9

not that girl: Thank you so much for sharing that. You've illuminated a lot of things for me. Birth parents can recall a child after adoption in parts of the US? Yowch. That seems unfathomable to me that any state's laws would allow that. I, too, find a lot of the circumstances of the foster-care system deplorable (not denigrating foster families with that statement!), and do not understand fully the complex issues involving forced foster care and parents trying to get their kids back and a lot of the pain and such involved in that.

Interestingly, my own parents were foster parents, all for infants, both before my adoption and continuing into after my sister arrived a couple of years later. None of those children were with the family for long, as I recall, and I'm unsure exactly as to why those babies were in foster care or what the circumstances were for their leaving the household. This was many years ago, and the drug epidemic was not as it is today, so I don't think it was that sort of situation. As for my sister and myself, we were infant adoptions and I do not believe either of us spent time in foster care. I know I was picked up from an adoption agency at 10 days old, and that's about all I know.

I offer genuine and heartfelt thanks to you and your family (and friends) who have adopted children. And my sympathies for the legal troubles you have encountered as you try to build your family. That sounds just awful, and again, I'm shocked that such challenges are even possible. It sounds as though the main reason overseas adoptions happen is as jeather states -- the chances for legal challenges are lessened.

Again thank you for sharing. I needed to read that.

(And this is genuinely NOT snark, but I found it somewhat interesting that your post mentioned that in the US, it is difficult to get WHITE babies to adopt. Is it somehow more culturally sensitive to adopt a non-white baby from outside the country than one native born? That could be an entire discussion / derail, but I am not sure that's appropriate here and isn't my intent.)
posted by hippybear at 11:07 AM on August 9

So "Sophie's Choice" was to take one child home with her and leave the other with caring professionals until the paperwork was straightened out in a few weeks? I must have skipped over that part.
posted by Floydd at 11:13 AM on August 9