Child's TB Complicates Adoption by Virginia Family

Harper Yue Ye, 4, has tuberculosis and is unable to join her new family.
Harper Yue Ye, 4, has tuberculosis and is unable to join her new family. (Courtesy of Jay Scruggs and Candace Litchford)
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By Henri E. Cauvin
Washington Post Staff Writer
Tuesday, August 11, 2009

The little girl wouldn't let go.

It didn't matter that her father said he would be back. It didn't matter that she had only met him 12 days earlier, not far from the Chinese orphanage that had been her home.

What mattered was that he had held her and called her his little girl and that he was going to bring her home, to a quiet cul-de-sac in Northern Virginia, where the shy 4-year-old would live with him, his wife and the 6-year-old boy they had adopted from Kazakhstan.

So when Jay Scruggs started to leave, Harper Yue Ye just held on.

"Papa, don't go!" she screamed in Cantonese after Scruggs kissed her and tried to hand her over to the foster family that would care for her until he could return.

Finally, the foster mother took the girl and Scruggs slipped out the door, the first step on a trip he wasn't ready to make, a day after his wife, Candace Litchford, had made the same wrenching journey back home to Alexandria.

So, instead of starting life with her new family in the United States, Harper remains in China, the visa she needs to enter the country blocked because of federal regulations aimed at limiting the number of immigrants entering the country with tuberculosis. If her parents had known she was sick, they would have waited for her to finish treatment before they visited, they said.

"You know, she loved us, she bonded with us and she attached to us, and we had to leave," Litchford said. "How's she supposed to trust us? We did everything to explain why, but how do you explain government to a child? You can't."

In 2007, the Centers for Disease Control and Prevention issued new tuberculosis testing and treatment rules for immigrants older than 2. The policy applies to all immigrants, including foreign children adopted by U.S. citizens, and has outraged several adoption organizations. Advocates said the rules will be particularly problematic for adoptions from Ethiopia, where the guidelines went into effect April 1, and in China, where they took effect July 1.

The testing and treatment requirements have been phased in over the past two years, focusing on countries with high rates of TB and high rates of immigration to the United States, said Katrin Kohl, deputy director of global migration and quarantine for the CDC.

The issue of children, Kohl said, was "heavily debated" as experts inside and outside the CDC worked on the regulations, which are part of federal immigration law.

Harper's parents said they understand the CDC's role in controlling tuberculosis, especially the multi-drug-resistant strains that have been a particular concern of public health officials worldwide. But they said that the CDC's policy is too sweeping when it comes to children, who do not pose the same risk of transmission as adults.

Harper was in a foster home for three years before being hospitalized with lung infections. When she was released, her foster family would not take her back, so she ended up in an orphanage. Hospitalized again, this time with TB, she eventually went back to the orphanage. She was living there when Scruggs, 38, and Litchford, 43, came into her life.

Some health professionals agree that children such as Harper pose little risk. "Kids catch TB from adults. Adults don't catch TB from kids," said Lee B. Reichman, executive director of the Global Tuberculosis Institute at the New Jersey Medical School.

Children do not carry enough of the bacteria to be a threat, Reichman said, nor do they have enough strength in their cough to pose a danger to people around them.

Harper is no longer coughing and has been receiving treatment for two months, her parents said.

"This kid can't infect anybody," Reichman said.

Although the risk of transmission from children "is lower, it is a possibility," Kohl said.

When Scruggs and Litchford learned that Harper had had lung infections, they worried that she might have TB. The adoption agency, Adoptions Together, told them the girl had tested negative.

With that assurance, the couple set out late last month to complete the adoption. On the day the adoption was to be finalized, they learned that Harper had tested positive for TB, they said. Soon after, they were told that she would have to complete several weeks of treatment and testing before her visa application could be reconsidered.

After trying for more than a week to obtain a waiver from the U.S. government, Litchford and Scruggs had to return home. Ivan, their son, would be returning from a visit with relatives. The couple's savings were depleted. And they could not afford to be away from their jobs any longer, lest they lose the health care Harper will need when she arrives.

All the little girl in pink shorts and a white T-shirt with a butterfly knows is that the parents she has come to know have gone away.

"Papa! Papa! Papa!"

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