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Public Comments
Revision of 42 CFR Part 34 (Medical Examination of Aliens) Updated Screening for Communicable Disease of Public Health Significance – Interim Final Rule (IFR)
The comments below represent comments received during the comment period. Note: Comment period closed as of 12:00 midnight, December 5, 2008.
The general policy for comments and other submissions from members of the public is to make submissions available for public viewing on the Internet as soon as possible and without change, including any personal identifiers or contact information.
Public Comments
Comment # 1:
From: Bk1492@aol.com [mailto:Bk1492@aol.com]
Sent: Monday, October 06, 2008 6:37 AM
To: CDC Part 34 IFR Public Comments (CDC); americanvoices@mail.house.gov
Subject: public comment on negligent federal register notice
the below regulation is much too negligent to truly protecf american citizens and their children in schools, who are the most vulnerable. we have sneaking illegal immigrant criminal freeloaders all over this country due to the negligence of homeland security dept, who should be picked up and deported. we have millions who have sneaked into this country with none of these health issues inspected and our govt agencies have stood by and let this happen, causing immense spending on health care by american citizens. this dept is negligent. homeland security is negligent. our borders should be secure. it is time that every immigrant have to prove their status. new jersey is inundated with illegals who cant even speak english who should be picked up - there are millions of them here. this regulation is negligent and does not protect americans. this govt has allowed this horrible decimating condition to continue. but then bush cheney administration has been inept in all areas of government. it is time to strengthen this regulation and shut down all immigration. america is overwhelmed with immigrants and american taxpayers are paying the health costs for these criminals.
b. sachau
15 elm st
florham park nj 07932
Comment # 2:
From: Victoria Neilson [mailto:vneilson@immigrationequality.org]
Sent: Tuesday, December 02, 2008 12:38 PM
To: Part 34 IFR Public Comments (CDC)
Subject: Immigration Equality Comments on Docket No. CDC-2008-0002
Attached please find Immigration Equality's comments on the CDC's Interim Final Rule amending 42 CFR 34.
Thank you for your attention to this matter.
Sincerely,
Victoria Neilson
Legal Director
Immigration Equality
40 Exchange Place, 17th Flr.
New York, NY 10005
(212) 714-2904 x. 25
vneilson@immigrationequality.org
www.immigrationequality.org
Put your money where your heart is
Comment # 3:
From: Robert Gordon [mailto:drgordon@pilotdr.com]
Sent: Tuesday, December 02, 2008 3:01 PM
To: Part 34 IFR Public Comments (CDC)
Subject: Revisions to Medical Screening Process request
Download the original attachment
December 01, 2008
Stacy M. Howard
Division of Global Migration and Quarantine Centers for
Disease Control and Prevention
U.S. Department of Health and Human Services
1600 Clifton Road, NE., E03
Atlanta, Ga. 30333
Dear Stacy M. Howard,
I have been a Civil Surgeon since the late 1980s and have reviewed "Docket N. CDC-2008-002, Medical Examination of Aliens-Revisions to Medical Screening Process". I have also had the opportunity to provide expert testimony for James Mitzelfeld, Michigan Eastern district U.S. Prosecuting Attorney in a case related to a Civil Surgeon who was cutting corners with the I-693 exam procedure. After review of the "Docket" I would like to bring up a concern that I have had for years. Other then initial review of professional documents and site visit there is rarely contact with the U.S.C.I.S. or related departments. Regarding the Immigration Exam process, unless there is an abundant problem with the I-693 form completion or someone complains about the Civil Surgeon there is no review of quality of performance.
In all aspects of medical licensing or government exams, such as State Licensing or FAA Flight Physicals there is periodic assessments for basic competency. Until recent mail and email correspondence the only time the Immigration Department contacted the Civil Surgeon was to mail you the original procedure manual. I have also tried to join the periodic Immigration Attorney/Local Immigration department meetings, but was denied access because I'm not a member of their Attorney organization and can't join because I'm not an Attorney. These meeting would allow me personal contact with the department to clear up any medical or procedural questions I have had.
I think it is long over due to add to the 42CFR some form of periodic, quarterly or twice a year, local meetings and yearly or biannual national meeting of the Civil Surgeons with the Immigration Department and the CDC to review the entire procedure of the exam and update any new concerns. With the new threats to public health with the shift in the immigration population to areas of less vaccinated peoples and more frequent and serious disease outbreaks that this procedure is needed to help insure that the Civil Surgeons we depend on to protect the health of the nation are serious and well trained participants.
In the past departmental costs were brought up as a reason to not require this. In my area the average cost of one exam is well over $100.00. To charge a fee for the total local and national exam equivalent to 3-5 exams would be equivalent to or less then, what physicians spent on CME course for general licensing.
For the health of the country please consider the above.
Sincerely yours,
Robert J. Gordon, D.O.
Civil Surgeon for U.S.C.I.S.
Senior A.M.E. for F.A.A.
965 S. Main
Plymouth, Michigan 48170
734-455-3530
DrGordon@DrGordonImmigration.com
Comment # 4:
-----Original Message-----
From: Alison Yager [ayager@hivlawproject.org]
Sent: Thursday, December 04, 2008 5:22 PM
To: Part 34 IFR Public Comments (CDC)
Subject: Comments, Docket Number: CDC-2008-0002
Dear Sir/Madam,
Please find attached our comments on the "Interim Final Rule on Medical Examination of Aliens- Revisions to Medical Screening Process", Docket
Number: CDC-2008-0002. Should you have any difficulties downloading the Microsoft Word document, I have also pasted the comments below for your convenience.
Thank you very much for your attention to this matter.
December 4, 2008
U.S. Department of Health and Human Services Centers for Disease Control and Prevention 1600 Clifton Road, NE., E03 Atlanta, GA 30333
VIA EMAIL
To: part34publiccomments@cdc.gov
Re: Interim Final Rule on Medical Examination of Aliens- Revisions to Medical Screening Process
Docket Number: CDC-2008-0002
To Whom It May Concern:
HIV Law Project thanks the U.S. Department of Health and Human Services for the opportunity to submit comments in response to the proposed Interim Final Rule on Medical Examination of Aliens. We write to address a significant omission in the rule-- the failure to remove HIV from the list of "communicable diseases of public health significance" (hereinafter "communicable diseases") while proposing other changes to the very regulation that contains this list.
This failure constitutes a repudiation of the national consensus as recently expressed by Congress's repeal of the statutory entry ban for those with HIV, and echoed by Center for Disease Control (CDC) Director Julie Gerberding who has stated a commitment to removing HIV from the list of communicable diseases. We urge HHS to act swiftly to revise the proposed rule to conform with Congress's clearly stated intent to end this discriminatory, punitive, and irrational bar. Doing so will finally end a shameful practice that keeps the United States in company with countries such as Libya, Saudi Arabia, Iraq, and Sudan.
HIV Law Project was founded in 1989 to provide quality legal and advocacy services in New York City for underserved HIV-positive persons, including women and their families, undocumented and recent immigrants, and communities of color. HIV Law Project was the first, and remains the only, organization in New York City focused exclusively on legal advocacy for these communities, and has therefore developed special expertise in the issues facing HIV-positive immigrants.
The President, Congress, and the Director of the CDC have Called for the Removal of HIV from the List of Communicable Diseases
On July 30, 2008, President Bush made history by signing into law the Congressional repeal of the statutory entry bar for people with HIV. In doing so the Executive and the Legislature affirmed our long-standing commitment to human rights and dignity and rejected a discriminatory and irrational practice.
Subsequent to this historic legislation, CDC Director Julie Gerberding publicly stated her commitment to repealing the HIV ban. In a response to a Washington Post editorial condemning HHS for failing to rewrite the rules in order to allow the admission of people with HIV/AIDS into the country, she wrote, "HHS has clearly stated our intent to remove HIV infection as an inadmissible condition for entering the United States. We are already preparing the revised rule."
We are encouraged by the actions of President Bush and Congress, and by Director Gerberding's commitment to revising the rule. We urge the CDC and HHS to expedite the removal of HIV from the list of communicable diseases of public health significance in order to fully realize the intent of this legislation.
The Proposed Regulation is a Violation of International Human Rights
The HIV entry bar violates human rights enumerated in the International Covenant on Civil and Political Rights, the UN Declaration of Human Rights, and the UN Guidelines on Human Rights and HIV/AIDS. Specifically, the UN Guidelines on Human Rights and HIV/AIDS advise that regulations purporting to safeguard the public health from the spread of HIV should be narrowly drawn to avoid impinging on human rights.
[Many of these] restrictions. infringe on the principle of non-discrimination, for example when HIV status is used as the basis for differential treatment with regard to access to education, employment, health care, travel, social security, housing and asylum. (T)he publication of HIV status and the right to liberty of person is violated when HIV is used to justify deprivation of liberty or segregation. Such coercive measures are not the least restrictive measures possible and are often imposed discriminatorily against already vulnerable groups.
When vulnerable groups, such as women, gay men, ethnic and national minorities, and the poor are subjected to an HIV entry ban, the potential for human rights abuse is exacerbated. As a result, we undermine our country's fundamental principles of dignity, equality, and respect, particularly for those who belong to underrepresented groups.
UN Secretary-General Ban Ki-moon has joined the chorus of international condemnation of HIV travel restrictions. During his August 3, 2008 address to the International Aids Conference, he congratulated the United States for repealing the statutory ban to entry for people living with HIV. At the same time, he noted that discrimination against people with HIV, including restricting the ability of HIV positive individuals to travel, is an affront to commonly shared notions of human dignity and respect.
Since taking up the position of Secretary General of the United Nations, some of my most moving and inspiring experiences have been meetings with colleagues and others living with HIV. They are wonderfully courageous and motivated people, and should serve as an example to us all on how to act with dignity in the face of adversity. That they should be discriminated against, including through restrictions on their ability to travel between countries, should fill us all with shame.
Maintaining a standard of inadmissibility for those with HIV reflects an immigration policy based upon fear rather than informed public health policy. It is a discriminatory measure that violates international human rights and burdens vulnerable groups. The power to end this infringement rests with HHS: it is imperative that it do so now.
The Inclusion of HIV is Contrary to the Intent of the Law and is Unnecessary for the Maintenance of the Public Health
The proposed rule seeks to add diseases that are "quarantinable" to the list of diseases which are subject to an entry bar, and includes the following:
cholera, yellow fever, plague, and SARS. The proposed rule seeks to ensure, rightly, that the public health is protected from highly contagious and dangerous communicable diseases. However, the on-going inclusion of HIV in this list lacks any rational basis, perpetuates the stigmatization of individuals living with HIV, and is unsupported by medical evidence.
As the UNAIDS International Guidelines on HIV/AIDS and Human Rights points out,
Public health is most often cited by States as a basis for restricting human rights in the context of HIV. Although such measures may be effective in the case of diseases which are contagious by casual contact and susceptible to cure, they are ineffective with regard to HIV since HIV is not casually transmitted. These coercive measures drive people away from prevention and care programmes, thereby limiting the effectiveness of public health outreach. A public health exception is, therefore, seldom a legitimate basis for restrictions on human rights in the context of HIV.
The UN's International Guidelines make clear that not only is there no rational basis for an entry bar, but that as a coercive measure it may be pushing people away from the care and treatment that they need. The HIV ban reaffirms the stigma associated with HIV and encourages people to stay underground by avoiding testing. In effect, the ban undermines the public health by giving rise to higher numbers of people whose disease progresses undetected and untreated.
Public health goals are ill-served by preventing individuals who present no threat to the public health from visiting or immigrating to the United States. By continuing to treat HIV as a disease warranting fear and exclusion from the United States, HHS is engaging in a discriminatory, punitive, and irrational practice. We therefore request that HHS take immediate action to remove HIV from the list of communicable diseases.
In the words of Physicians for Human Rights, Health Action AIDS Campaign Director Pat Daoust, "If we are ever to effectively address HIV/AIDS from a public health perspective, we must first abolish all discriminatory practices against those infected with HIV. The travel ban is nothing more than a continuation of misunderstood, and offensive, practices that violate human rights and contribute to the stigma that fuels this pandemic."
There is no better time than now to end the HIV entry ban. The recent statutory repeal of the ban signals a sea change in policy regarding people with HIV. It shows we are a country that places paramount importance on the rights of all people, and that we are prepared to move beyond anachronistic, irrational fears about the transmission of HIV. It further demonstrates that we are ready to join the international community in rejecting discriminatory and coercive practices used against people with HIV.
But Congress cannot do it alone. HHS now has the power -and the
responsibility- to implement the will of the American public. It must remove HIV from the list of communicable diseases so that the United States can fully honor our tradition of treating all people with dignity, respect, and equality under the law.
Thank you very much for the opportunity to submit these comments.
Sincerely yours,
Tracy L. Welsh, Esq.
Executive Director
HIV Law Project
15 Maiden Lane, 18th Floor
New York, NY 10038
TEL 212.577.3001
FAX 212.577.3192
Page last modified: December 8, 2008