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XIII. APPENDICESAPPENDIX A:Dr. Ferraro’s Comment To The INS Regarding Determination OfChronological Age Using Bone Age And Dental Age StandardsTO: Director, Policy Directives and Instructions Branch,Immigration and Naturalization ServiceFROM: Nalton F. Ferraro, D.M.D., M.D.RE: Public Comment on Proposed Rule at 64 FR 39759(INS No. 1906-98)DATE: March 12, 2002I am an oral and maxillofacial surgeon and Associate in Surgery at Children’sHospital in Boston, Massachusetts; Associate in Surgery at Brighamand Women’s Hospital in Boston; member of the Courtesy Staff at FranciscanHospital in Boston; and member of the Courtesy Staff at MassachusettsGeneral Hospital in Boston. I am also a member of theCraniofacial Surgery Team at The National Birth Defects Center at FranciscanChildren’s Hospital and an Instructor at the Harvard School ofDental Medicine. My major research interests include: 1.) obstructivesleep apnea patterns in patients with craniofacial and maxillofacial deformitiesand surgery for obstructive apnea and maintenance of the upperairway in children; 2.) management of oral surgical problems in the chronically,critically ill pediatric and young adult patient and 3.) hemifacialmicrosomia: growth of costochondral mandibular grafts, progressivenessof the untreated hemifacial deformity and operations in the growingpatient. My complete curriculum vitae is attached for your inspection.Judging skeletal maturity to decide the timing for various operations isan important part of my surgical practice. I am submitting this commentbecause I am extremely troubled by the inaccuracy of the current INSpractice of using bone age and dental age standards to judge chronologicage among undocumented immigrants and asylum seekers – a practicethat, as I understand it, would be reaffirmed under the proposed regulations.This practice imparts an unwarranted scientific legitimacy to what Iunderstand to be a social-political-legal problem. I appreciate the desire togive some objectivity to the resolution of certain age claims in the absenceAPPENDIX A 199
of thorough documentation. However, a fundamental concept is beingignored in the current INS approach to “age testing”: chronologic age,dental age and skeletal (bone) age are not necessarily the same in a givenindividual. In fact, deviation among these three “ages” is common andwell appreciated in pediatric medical and dental practice. Discrepanciesamong these ages can amount to as much as five years; this is substantialwhen one is considering a span as short as the first two decades of life. A14-year-old female, for example, can be skeletally, dentally, and sexuallymature, but be four years short of legal adulthood.Every recognized authority on physical development has stressed thisfact. This is precisely the fact that one well-known INS practitioner, Dr. R.Trager at Kennedy International Airport, has ignored or failed to comprehendin his INS-sanctioned practice.The volume that Dr. Trager calls his“bible” (as quoted in the New York Times, “Crucial I.N.S. Gatekeeper:The Airport Dentist,” July 22, 2000), the venerable and classical work:Radiographic Atlas of Skeletal Development of the Hand and Wrist byWilliam Walter Greulich and S. Idell Pyle, explicitly recognizes this fact:Because of this variability, the chronological age of a child during theearly part of the second decade of life is often but little more than a measureof the length of time that he or she has lived; it bears no necessarilyclose relationship to the amount of progress which the child has madetoward attaining adulthood. (2ed. p. 2)Another citation:The chronological age at which boys attain puberty is quite as variable asthat of girls at the same period of life due to both genetic and environmentalfactors. This variability is strikingly illustrated by the photographsreproduced in Figure 5. [referring to illustrations in the Atlas] The boysshown were either fourteen years, fourteen years and one month, or fourteenyears and two months of age when the photographs were made.Despite their similarity in chronological age, they ranged from early prepuberalto an only slightly subadult stage of development. (p. 13).This Atlas was not designed to determine chronologic age. Rather, itwas designed to assess the skeletal (bone) age of an individual and compareit to the “average” or “typical”. It is a method of grading only thephysical progress of development. If, for example the average 18-year-oldmale has nearly completed skeletal growth and the bone growth plates ona radiograph are, on average, closed or nearly closed, this is graded as abone age (or “B.A.”) of 18 to 18.5 years. Any child whose hand-wristradiograph looks similar is given a bone age grade of 18-18.5 years. Thisgrade is independent of the chronologic age. It is also important to notethat the Atlas was based on data for white North American children.Applying these standards to children of other colors and from other200 FROM PERSECUTION TO PRISON
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From Persecution to Prison:The Heal
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CONTENTSAcknowledgements . . . . .
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The Bellevue/NYU Program for Surviv
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don, Miranda Ip, and Meriam Alrashi
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Significant symptoms of depression
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Detained asylum seekers participati
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persecution, yet most emphasized ho
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In many facilities, the response to
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years in detention, she finally got
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abuse For example, while being take
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They didn’t let me use the phone
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intensely personal events they had
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Limitations of this study include t
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Non-governmental organizations serv
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22 FROM PERSECUTION TO PRISON
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the late 1990s ranging from 10 to 7
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Historical BackgroundFor most of th
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international standards with the 19
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apply for asylum make up the majori
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tion judge. 57 Yet in many parts of
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York and Newark, New Jersey has had
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trict began denying parole to them
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Correctional Facility in 2000. “[
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men of which 750 were detained on i
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from that same country from seeking
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Detention Facilities in this StudyF
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high reliability in numerous langua
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York County Prison in York Pennsylv
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TABLE 2:Demographic Characteristics
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TABLE 4:Prevalence of Pre-Migration
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on a part time basis, researchers w
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Case #1(DK): “Loneliness and Fear
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TABLE 6:Hopkins Symptom Checklist-2
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TABLE 8:Harvard Trauma Questionnair
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think such services were available.
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When I am talking to you now it is
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After being granted asylum and rele
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“Being here is like going through
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In my country even though I became
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how long they were there - six mont
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Thoughts of SuicideSeveral asylum s
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here?’ I told the doctor, they br
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Another subject reported a positive
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substantial distance from their att
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eported that her experience in dete
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e somatic manifestations of the psy
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Case #2 (JG): “Health Care in Cha
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TABLE 11:Detainee Perceptions of He
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TABLE 13:Availability and Quality o
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detainees, or because they did not
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Difficulty Obtaining Specialized Ca
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Another detained asylum seeker repo
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One detainee who speaks French and
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Detention Facilities in this StudyS
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even though many reported having ex
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CASE #3 (HN): “SOLITARY CONFINEME
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Here, I’m scared. In [the detenti
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emote control and watch what he wan
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Whenever someone misbehaves, they t
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This subject was himself threatened
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One detainee reported several incid
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Some Process Exists to Respond to R
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There were no witnesses other than
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tion. An INS officer said they put
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There is an Anglican minister who c
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The dentists didn’t explain anyth
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tion between dental age and chronol
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Case #4 (LK): “Fifteen-Year-Old G
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TABLE 16:Treatment/Abuses Reported
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“There is no political asylum her
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I was crying. I was so afraid with
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save her life, but was not able to
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Case #5 (CR): “Begging for Mercy
Page 157 and 158: ehind and told me to sign. He physi
Page 159 and 160: days and it is now 2 years and four
Page 161 and 162: viewers asked for additional inform
Page 163 and 164: y study participants. In evaluating
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Page 173 and 174: absconding.” 250 Since the passag
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Page 177 and 178: Standards relevant to this study ar
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Page 181 and 182: which they are charged and a fair h
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Page 187 and 188: PunishmentThe Detention Standard on
Page 189 and 190: any time the detainee complains.”
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Page 193 and 194: while in detention, thus adding to
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Page 197 and 198: that effect. These officers should
Page 199 and 200: Besides their inaccuracy, these exa
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Page 203 and 204: appropriate staffing of such groups
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Page 211 and 212: Human development is complex and di
Page 213 and 214: 18. Country from which fleeing pers
Page 215 and 216: 9. Being close to death.10. Forced
Page 217 and 218: Complete for each health problem:5.
Page 219 and 220: Explain:(Interviewer: Write brief n
Page 221 and 222: 2. Depression SymptomsA How much we
Page 223 and 224: B. You said that you have experienc
Page 225 and 226: Explain:13. How was your physical h
Page 227 and 228: Yes ...........1No............22. W
Page 229 and 230: Explain:20. At the time of your arr
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