As the U.S. Immigration and Naturalization Service gears up to implement the complex new immigration law, one of many tasks facing the agency's Los Angeles district office is signing up scores of additional doctors to perform INS physicals.
For most of last year, just nine doctors handled about 2,000 physicals per month for aliens applying for permanent U.S. residence, according to district officials.
Applicants are checked for conditions such as tuberculosis, venereal disease, mental illness and alcoholism, which either must be treated or else may be grounds for exclusion from this country. Testing for acquired immune deficiency syndrome (AIDS) is not currently part of the physical, but a proposal to add it is under consideration in Washington.
A medical examination by an INS-approved physician will be required of amnesty applicants under the new law, which offers legal residence to illegal aliens who have lived in the United States since before Jan. 1, 1982, or who spent at least 90 days doing agricultural work in this country in the year that ended May 1, 1986.
When the INS starts accepting amnesty applications on May 5, it must be ready with a greatly expanded list of doctors to perform the physicals for a set $50 fee, according to Los Angeles District Director Ernest Gustafson.
"I don't want this to be a bottleneck," Gustafson said. "I'd like to have 100 doctors."
The need to sign up more doctors is just one of many things "that need to be tuned very well before May 5," Gustafson said. He estimated that 750,000 to 1 million illegal aliens will apply for amnesty in the seven-county Los Angeles district, which includes Orange County.
The INS plans to require amnesty applicants to undergo the same medical testing now performed on routine applicants for permanent residence, Gustafson said. When illegal aliens apply for amnesty, they will receive the list of approved doctors and be scheduled for an interview to which they must bring the results of their physical, he said.
The medical includes a blood test for syphilis, a chest X-ray and a physical examination.
If testing for AIDS is added to the immigration medical examination, then it may also be required of amnesty applicants, according to federal officials in Washington.
The U.S. Public Health Service announced last year that it was considering the addition of AIDS to the list of dangerous contagious diseases for which applicants for permanent residence must be tested.
James Brown, a Public Health Service spokesman, said this week that the question is still under study at the federal Centers for Disease Control in Atlanta. If a decision is made to require AIDS testing for immigration applicants, it would then be up to the INS to decide whether to include it as a requirement for amnesty applicants, he said.
Duke Austin, an INS spokesman in Washington, said it is not yet clear whether a decision by the Public Health Service to require AIDS testing for permanent residence applications would mean that the same test would be required of amnesty applicants. "If they find that as one of the excludable contagious diseases, then that's an issue that would have to be addressed," he said.
For many years, U.S. immigration law has included seven categories of health conditions that may lead to exclusion of prospective immigrants unless they receive treatment or waivers.
These include mental retardation; insanity; previous attacks of insanity; "psychopathic personality, sexual deviation or a mental defect;" drug addiction or chronic alcoholism; affliction with "any dangerous contagious disease," and any physical problem that "may affect the ability of the alien to earn a living, unless the alien . . . establishes that he will not have to earn a living."
The precise meanings of some of these categories have changed over the years along with developments in the medical field.
For example, homosexuality for many years was considered an excludable condition under the law's "sexual deviation" category, but this is no longer the case, according to Michael S. Burton, a Los Angeles doctor who has handled INS physicals for the past 15 years. Public Health Service guidelines say that this is in accordance with American Psychiatric Assn. policy.
Burton said that fewer than 10% of the applicants he sees have conditions falling into an excludable category. Most of those who do have a problem, he said, have readily treatable conditions such as venereal disease or tuberculosis that do not lead to denial of their applications.
Jean Hemphill, a supervisory immigration examiner in Los Angeles, said that when a physician's report shows that an applicant has one of the listed conditions, the report is forwarded to the Centers for Disease Control for determination of admissibility. Waivers are often available if the applicants get treatment, she said.
Hemphill said that additional physicians were added to the district's list of approved doctors in December, boosting the current total to 19. The district office also has on file letters from about 350 physicians who have at some time expressed interest in performing examinations for the agency, she said. A well-organized doctor with sufficient staff help can perform as many as 35 physicals a day, and still see some other patients as well, Burton said.
Gustafson said that with so many names on file, he foresees no problem in signing up enough doctors. The agency will send out letters to many of those who made previous inquiries, and then add to its list those who are qualified, he said.
"I don't see a problem of us meeting the numbers we have to have, now that we're getting the word out," he said.