Civil Surgeon Tuberculosis Evaluations for Foreign-Born Persons Seeking Permanent U.S. Residence

Abstract

Foreign-born persons in the United States seeking to adjust their status to permanent resident must undergo screening for tuberculosis (TB) disease. Screening is performed by civil surgeons (CS) following technical instructions by the Centers for Disease Control and Prevention. From 2011 to 2012, 1,369 practicing CS in California, Texas, and New England were surveyed to investigate adherence to the instructions. A descriptive analysis was conducted on 907 (66 %) respondents. Of 907 respondents, 739 (83 %) had read the instructions and 565 (63 %) understood that a chest radiograph is required for status adjustors with TB symptoms; however, only 326 (36 %) knew that a chest radiograph is required for immunosuppressed status adjustors. When suspecting TB disease, 105 (12 %) would neither report nor refer status adjustors to the health department; 91 (10 %) would neither start treatment nor refer for TB infection. Most CS followed aspects of the technical instructions; however, educational opportunities are warranted to ensure positive patient outcomes.

Doctors as migration brokers in the mandatory medical screenings of immigrants to the United States

“…The guidelines are developed by the CDC, and are periodically updated. Public health research indicates that many civil surgeons do not follow technical instructions from the CDC when detecting tuberculosis, with some not reporting or referring TB patients to the health department or starting treatment (Bemis et al 2016). This is evidence that the outsourcing of medical screenings to private physicians can further distance these screenings from public health prerogatives, such as limiting the spread of TB.…”