3. Aliens over 10 years of age receive a chest X-ray. 4. The applicant is then examined according to the schedule. outlined in the appendix. The routine examination includes questioning of the applicant, evaluation of responses, and a physical examination. If all findings are normal, the consular authority is notified that the applicant has been passed medically. All abnormal findings are investigated by further laboratory testing, by additional X-ray studies, by more extensive psychological testing, or by more extensive questioning and physical examination, as indicated. Medical consultations are obtained as necessary from area and Division headquarters. At this point the consul may be notified that the medical examination is incomplete and that a particular condition is suspected. The consul is informed of the probable time necessary to complete the examination, and of the additional information or procedures that are necessary. At any point, if it becomes necessary to make the medical decision without benefit of further information, the decision is that the suspected condition is present. It is the responsibility of the applicant to provide the information which might rule out a condition that would interfere with his being granted a visa. A final diagnosis is then made. The physician classifies it as class A, an excludable condition; class B, a condition which may interfere with the applicant's ability to earn a living; or class C, a condition worthy of note but not of a character to interfere with the granting of a visa. A "notification" of the presence of a medical condition specified in the Immigration Act is made to the consul, who makes the final decision whether to issue a visa. Cases may be reexamined at the request of the consular authority. Reexaminations are most common in cases of "feeblemindedness" and communicable diseases. In the case of feeblemindedness, the medical examiner may have recommended reexamination at a later time and perhaps after changes in the environment of the applicant. In the case of communicable diseases, reexamination may have been recommended after treatment, or after a period of time necessary to establish evidence that a disease process has become inactive and has remained stable. For example, in cases of tuberculosis, evidence is commonly required to indicate that the condition has remained stable, for 1 year after it appeared inactive. In cases of apparently inactive pulmonary tuberculosis, a series of chest X-ray films taken quarterly for 1 year may afford the required evidence of stability. When the medical examination of a visa applicant is conducted by the Division of Foreign Quarantine, the applicant pays a fee of $10 to the consular office where he applied for a visa. The records of this transaction are maintained by the Department of State and the money collected is deposited in the general fund of the Treasury of the United States. Expenses of the medical examination other than for the services provided by the Public Health Service must be met by the applicant himself. These expenses include the cost of chest X-ray films at locations where the Public Health Service does not provide them and, in all locations, the cost of the blood test. Statistical analysis. From fiscal year 1958 to fiscal year 1962, the Division of Foreign Quarantine performed about 893,000 medical examinations abroad. Most of these, 90 percent, were for immigrants, about 5 percent were for refugees and parolees, and the remainder were for nonimmigrants. Details by fiscal year are shown in chart 3. There was a decrease of 19 percent from fiscal year 1958 to fiscal year 1959. Unsettled political conditions in many areas of the world, sharp currency devaluation in some countries, and the economic recession in the United States may account for the concurrent decrease in visa applications and medical examinations. From fiscal year 1959 to fiscal year 1962, on the other hand, there were steady increases each year, varying from 2 to 12 percent, which parallel closely the visa issuances reported by the Department of State. From 1958 to 1962, the Division of Foreign Quarantine issued 202,000 notifications. Of these, 11,000, or about 6 percent, were for class A conditions, which are excludable under immigration law. There were 189,000 examinations performed by the Division of Foreign Quarantine in fiscal year 1962. Of these, 97 percent were for immigrants, refugees, and parolees. Chart 4 illustrates fiscal year 1962 examinations and notifications by area. Nearly half of the examinations were performed in Europe. While the Hong Kong unit performed the fewest examinations, it issued the largest percentage of notifications. Table 2 shows the various localities where the Division of Foreign Quarantine performed medical examinations abroad in fiscal year 1962, types of examinations performed, and types of notifications issued. Chart 5 gives details on the notifications issued in fiscal year 1962. As shown in the chart, about 1 percent of those examined were issued notifications for class A conditions. |