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that of India is approximately 449,999,000, and under this bill, the maximum number that could possibly come in from Greece would be the same as the maximum possible number from India and that would be when you take it away-and the recollection of my arithmetic, I hope, is correct, that would give a person in Greece 83 times a better chance to get into the United States, at least theoretically, than it would the person from India and then you could say that is another discrimination against them in India.

The truth of it is, Mr. Secretary, it is almost impossible to draw an immigration bill which is selective in nature that does not have apparent possible discriminations in some instances and hardships in others, is that not so?

Secretary CELEBREZZE. Yes. As I said, there have to be some limitations. You cannot throw the gates open and say "Everybody come to America."

The point I have been arguing is the basic principle involved in these unused quotas. It is hard for these other nations to understand when you have unused quotas why they have such a low quota.

Senator ERVIN. Thank you very much, and I am sorry I have taken so long. You have made a very eloquent statement of your views. Senator HART. Mr. Secretary, before you leave I wonder if you could add to the record some impressions that you have developed as a result of the reception in Florida of the large number of Cuban refugees?

As I understand it, some 270,000 Cuban refugees have entered this country since 1959. I think your Department's figures show that some 180,000 registered at the Cuban Reception Center in Miami. Secretary CELEBREZZE. That is correct.

Senator HART. And about 85.000 or 90,000 of those persons have been resettled under a Federal program, the administration of which is principally in your hands. Is that figure of 85,000 to 90,000 correct? Secretary CELEBREZZE. 86,000 have been resettled and they have been resettled in every State in the Union, the District of Columbia, Puerto Rico, and the Virgin Islands.

Senator HART. Now, are you in a position to comment on the experience of these refugees and their adjustment to community life, or across the country?

Secretary CELEBREZZE. They have made a very good adjustment to community life, but a great many of them, as you know, Senator, are professional people doctors, architects, and so forth-but because of their present status, they are having a difficult time becoming licensed to practice in their professions. If I am not mistaken, you introduced a bill to give them a residence status which would then make them eligible to become licensed in these particular areas.

Senator HART. Such a bill was introduced, Mr. Secretary.

Secretary CELEBREZZE. What we are trying to do, Mr. Chairman, is put them on the same footing as we did the Hungarian refugees in 1957 or 1958 and to give them residence status so that they can get licensed in these particular States, because we need these skills.

Senator HART. That would mean the status would be adjusted and, thereby, they would be permitted to practice in the professions.

They would then demonstrate their ability under State license examinations, and they would be eligible, at least, to take the examinations.

Secretary CELEBREZZE. Yes; we would change their status. Their status is now what we refer to as temporary parolee. We would change that to a residence, permanent resident so they can receive their license.

Senator HART. Now, if that change of status is permitted, it would offer a broader employment opportunity to some of these people and might reduce the extent of the financial assistance your Department now finds itself responsible for; is that right?

Secretary CELEBREZZE. Yes, to a degree; but I think more than that, in the field of physicians and in the dental profession we can use them. We have a shortage, and we can use them in those areas. There are only about 8,000 or 9,000 cases out of the total one hundred and eightysome-thousands that came in that are receiving assistance. Most of them have done very well in resettling.

Senator HART. I think that resettlement program is a very big plus both for your Department and for the Department of Justice and all those who participated in it. Basically, it is the willingness of the American people to absorb them.

Secretary CELEBREZZE. Yes, and the private organizations that worked with us, the various religious groups did a magnificent job in cooperating with us.

Senator HART. One last question on that.

Senator JAVITS. Would you spell out the names of the religious groups?

Secretary CELEBREZZE. Mr. Chairman, Mr. Thomas, who is in charge of the refugee program, will read that into the record. There are four major voluntary agencies.

Mr. THOMAS. There are four voluntary agencies, Mr. Chairman, who have worked with us in this great cooperation with this program, and they are the National Catholic Welfare Conference; the Church World Services of the National Council of Churches; the U.H.I.A.S., which is the United Hebrew Immigrant Aid Society, and the International Rescue Committee. Those four agencies have been very helpful.

Senator HART. Thank you. This is the last question I have. Based on the experience you have had over several years now with this large number of Cuban refugees, do you believe that most of them would return to Cuba if conditions permitted?

Secretary CELEBREZZE. No, I do not think so. I think most of them would stay here. There again, Senator Hart, it is a difficult question to answer with any degree of positiveness depending upon many factors. Some would, of course, want to go back home to Cuba, depending on what exists there, but my guess would be that once they get into the mainstream of American life, once they can practice their professions, that a great majority will want to stay here, no doubt, and some will want to go back.

Senator HART. Thank you, very much.

Senator JAVITS. Mr. Chairman, I think that last point the Secretary made should be clarified with the added statement that the count of those that want to go back should not be confused with the count of those who wish to fight for freedom for their former country even if they do not want to go back.

Secertary CELEBREZZE. I agree with that.

Senator JAVITS. It might be used another way.

Senator HART. If there are no further questions of the Secretary, we will excuse him. We have some idea of the scheduled burden he carries.

Senator ERVIN. Mr. Secretary, I read somewhere the figure of 7 million that I mentioned on welfare, and I realize as you pointed out that most of those were nonworkers, dependent children and elderly people, but I would like to ask whether the 7 million figure is correct because I do not want to use any figures that are not accurate and I do not remember where I got them.

Secretary CELEBREZZE. The 7 million is an accurate figure. The point I was trying to make is that many people only think of public assistance as relief for the unemployed, whereas most of the 7 million receive aid to dependent children, aid to the blind, aid to the disabled, and aid to the aged who could not work if they wanted to work. There is a misconception that 7 million people on welfare programs are receiving public assistance and are people able to work.

Senator HART. General Terry, I wonder if you could get a little closer to the microphone. I must apologize for having been absent in the earlier part of the hearing, but for the usual reason I was at another subcommittee meeting.

I inquire, sir, as to whether you have a prepared statement and whether you have given it.

Dr. TERRY. Mr. Chairman, I do have a prepared statement which I have not given. If I may make a suggestion and that is I would like to submit my prepared statement for the record and give the first portion of the statement to you at this time because I think it clarifies some of the points that have been raised here.

Is that agreeable, Mr. Chairman ?

Senator HART. That is all right. If there is no objection we will print the statement in full, as though read, and will now welcome such comments as you think will be helpful.

(The full, prepared statement of Dr. Luther Terry follows:)

DR. LUTHER L. TERRY, SURGEON GENERAL, U.S. PUBLIC HEALTH SERVICE

I. INTRODUCTION

Mr. Chairman and members of the committee, considering the progress that has been made, and is currently being made, in the treatment and education of the mentally retarded, in the care of the mentally ill, and in the treatment and control of epilepsy, the Public Health Service believes that our immigration policy regarding mental handicaps can be modified to serve humanitarian objec tives and at the same time protect the public health, safety, and welfare. Experience with the present law has indicated rigidities which result in unnecessary hardships, the separation of families and the exclusion of individuals who could be of great service to our country.

Since 1952 Congress has already amended the law to delete specific references to tuberculosis and leprosy, leaving these to be covered under "dangerous contagious diseases" subject to regulations of the Public Health Service. Congress has also authorized the waiver of exclusion on account of tuberculosis where adequate safeguards have been assured under regulations prescribed by the Attorney General after consultation with the Public Health Service. The Public Health Service has supported these amendments and supports the present proposals for further amendments to modernize the medical provisions of the immigration law and relate them more closely to the basic policies of the law.

II. CHANGES IN THE PRESENT LAW

The law now requires the exclusion of aliens who are "feebleminded" or "insane," who "have had one or more attacks of insanity," or are "afflicted with psychopathic personality, epilepsy, or a mental defect," or are "narcotic drug addicts or chronic alcoholics," or are "afflicted with any dangerous contagious disease" (except as family members with tuberculosis are admitted under conditions prescribed by the Attorney General). These are known as mandatory exclusions. The present law further provides for exclusion of any other aliens found to have a "physical defect, disease, or disability" when the consul or immigration officer determines that it may affect the alien's ability to earn a living, unless the alien establishes that he will not have to earn a living. In addition, any aliens, whether or not they have any mental or physical disability, are excludable if they are determined to be "likely at any time to become public charges."

The administration bills would change the term "feebleminded” to “mentally retarded,” would delete the word "epilepsy," and would extend the present provision for conditional admission of close relatives with tuberculosis so that it would apply also to family members who are "mentally retarded" or "insane," who "have had one or more attacks of insanity," or are "afflicted with psychopathic personality or a mental defect." There would be no change in the exclusion of the other categories mentioned.

No further comment seems necessary on the change from "feebleminded" to "mentally retarded" but I would like to comment on the deletion of "epilepsy" and the provision for conditional admission of family members affilicted with mental retardation or the specified mental disorders.

EPILEPSY

Epilepsy is a symptom of some disorder in the brain. When it is known what causes it-such as a brain injury-it is considered as a symptom rather than as a disease in itself. In applying the immigration law the Public Health Service interprets the term "epilepsy" as meaning only the epilepsy whose cause is not known. The alien who is found to be afflicted with this so-called idiopathic or true epilepsy is excluded under the present law. It is a mandatory exclusion, without regard to the alien's intelligence, his ability to earn a living, or his value to our society.

If, on the other hand, the alien is found to have epileptic symptoms caused by a previous brain injury or disease, all the facts and circumstances of that injury or disease, and its effect on his ability to function, are considered. The examining physician gives the consul or immigration officer a medical evaluation and the consul or immigration officer determines admissibility under those provisions of the immigration law which exclude aliens likely to become a public charge or “having a physical defect, disease, or disability, when determined by the consular or immigration officer to be of such a nature that it may affect the ability of the alien to earn a living, unless the alien affirmatively establishes that he will not have to earn a living."

With the proposed amendment, any alien with epileptic symptoms would be considered in the same way as an alien who has epileptic symptoms due to identifiable physical causes. That is, he would be considered in terms of his ability to earn a living and the likelihood of his becoming a public charge. We believe it is sound policy to consider epilepsy only as a symptom, for whatever bearing it has in each individual's functioning in our society, rather than as a disqualification in itself.

Conditional admission of family members with excludable mental disorders I would like to give the committee some examples of the kinds of cases of family members that would be eligible for conditional admission and the safeguards that are proposed for those now completely excludable for mental retardation or mental illness.

For some years now about three-quarters of those individuals found excludable for mental disorder have fallen into the statutory categories of the "feebleminded" or of those who have had a previous attack of "insanity." A typical situation in the exclusion for feeblemindedness is that of a child, most or all of whose family members have been granted immigrant visas to proceed to the United States. The child is often borderline in its retardation and either trainable or educable. The family must elect to remain abroad, refus

ing to be separated from the child, or leave the child behind with relatives or strangers. The medical notification of feeblemindedness allows the consul no alternative but to refuse a visa.

The second largest group, of which there are many examples, consists of those persons who have had a previous attack of major mental disease, but who are furetioning well at the time of their visa request. Recently a distinguished scientist, who was needed in this country, did not immigrate because his wife had had a previous attack of mental illness. She had been hospitalized on three occasions but had been a successful wife and mother for a number of years following her last hospitalization. She was, of course, excludable because of her past attacks and the consul had to refuse the visa to immigrate. The scientist would not leave his wife and family.

Another illustration of this cause of exclusion is that of the alien wife of an American serviceman. When she applied for a visa to come to this country with her husband, the medical examiner found her completely normal. The history, however, brought out the fact that as a girl she had had a severe depression and had spent a number of months in a hospital where she had been given courses of shock treatment. The prognosis under the new situation of a marriage and prospective immigration seemed to be quite good. Yet, under the law a visa had to be refused.

In all of these situations the proposed legislation would permit the immigration of the family as a unit. The Public Health Service realizes that in furthering this proposal proper safeguards will have to be set up to protect the health, safety, and welfare of this country. The following measures have been suggested for use in situations where a waiver is considered for a family member with excludable mental disorder.

First, in addition to the usual study of the history and the medical examination of the prospective immigrant overseas, a prognosis will have to be made. This prognosis will indicate to the consul and to the Immigration Service the usual course of the condition, the potential for treatment, and the probable duration of the required treatment program.

Second, before the alien is granted a waiver and allowed to immigrate an assurance will be required that on arrival in the United States he will have a complete study to determine his intellectual capacity, his adaptability to the social environment of the United States, and the need for any specialized care or training. Assurance will also be required for such care and treatment as may be necessary during the next 5 years. Adequate financial arrangements would have to be made by the alien or his sponsors for this care and treatment. Third, if a waiver is granted with the above assurances, the immigrant would, upon arrival in this country, proceed directly to the hospital or wherever he is to have the required study. After this study, the immigrant would follow the indicated course of care, such as continued inpatient treatment, outpatient care.. a combination of these, or discharge subject to periodic reexamination with no treatment required. Reports of the initial evaluation and periodic progress reports would be required by the Public Health Service during the ensuing 5 years. The committee, of course, recognizes that these proposals are based on the experience we have had for several years with the provision now in the law for the conditional admission of aliens afflicted with tuberculosis. We are approaching the problems involved in the extension of this policy to mental disorders fully recognizing that there are other and more difficult types of problems than those illustrated above. We certainly do not expect all aliens who are "feebleminded" or "insane" or "afflicted with psychopathic personality" or "a mental defect" to be admissible even if they are within the family relationship prescribed by the bill. The required assurances of care and support will be more difficult to obtain for those who present the more difficult problems. For example. both a mentally retarded child, with a hopeful prognosis, and a young adult excludable as a psychopathic personality, may be within the categories covered by the bill but that does not make them both admissible. It would be exceptional, to say the least, for a qualified institution to assure the necessary care for a "psychopathic personality" or someone dangerously "insane"; yet if this and the other required assurances were obtained in an exceptional case, the safeguards would still protect the public interest. We have reasonable confidence that these proposals will permit the admission or the reuniting of a family with adequate assurance of all the necessary care for the afflicted member of the family and without the likelihood of his becoming a public charge or otherwise being a detriment to the public health, safety, or welfare.

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