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Days 64 & 65: AOS Paperwork and Crazy Doctors

December 16-17, 2014

Besides the obvious requirement of getting married within 90 days, part of the K1 visa also requires you file for the Adjustment of Status (AOS) within that same period of time. After that, you’re good until the bureaucracy decides to get around to your application and grant you, first, an employment authorization, and then eventually the green card. Part of the stack of AOS paperwork to be sent is the medical exam and medical records. When most foreign fiancé(e)s enter the country, they’ve already completed their full medical exam and it’s just a matter of filling out the remaining paperwork and mailing it in with the (very high) fee. But sometimes, that person may be missing one or two vaccinations depending on whether they were in stock in the country where they did their exam, and whether or not it’s flu season at the time. When Efrem did his medical exam they were in their flu season (SA has seasons opposite ours), but they were out of the flu vaccination. So we thought that before we could file his AOS paperwork, we would have to get that one vaccine for him and have it recorded on his vaccination record, since we were now in the middle of flu season here.

The catch is, not just any medical professional can be involved in the immigration process. You have to specifically go to a Civil Surgeon that’s designated by the government (I guess). So I went about looking up who and where the civil surgeons were in the area, and, surprisingly there were quite a few. So I just picked the one that was the easiest to get to. I called the office, explained that Efrem was needing a flu shot (only a flu shot) to complete his records for the immigration process and that this doctor was listed as a Civil Surgeon. I had to repeat myself a couple of times, but she said understood and gave us an appointment telling us we needed to bring this and that, the same old packet of paperwork.

The appointment day came, and we went to the office. It was nearly deserted save for the woman at the desk, who I realized was the one I was talking to on the phone. With everything involving Efrem’s process I always choose to be over prepared rather than under, to have more documentation than I need in case I read something wrong. I gave her the full I-693, the medical examination form, but as I had stated to her on the phone, he only needed the flu vaccination as he had already done the exam in Johannesburg and they had run out of that vaccine. The lady was rather old and not very friendly. I try not to make too many assumptions, but based on the over patriotic, republican, “art” installation they had in the waiting room, and the office’s location uptown in a wealthier neighborhood, I had a feeling they didn’t see too many brown folks.

I didn’t go into Efrem’s appointment with him, but in retrospect, maybe I should’ve. The appointment seemed to be taking much longer than I anticipated given that he only needed one shot. Then the nurse/receptionist comes out and is like, ‘Your husband fainted, we have him laying down, he’s asking for you.‘ Well I knew Efrem didn’t particularly like needles and so I felt kind of bad. I thought I’d go in to the room and just comfort him. But when I saw him, rather than being sad I was really confused. His arms were covered in bandaids. I asked him what the hell they did to him. He told me they gave him all these extra shots, a TB test, AND took blood saying something about syphilis.

Now I was furious. I had made it perfectly clear to them that he only needed a flu shot, and they chose to do the entire medical exam over again. I asked the nurse why did they do all this. And she smugly looked at me saying that this is what the US Government requires, that he had to have a full medical exam. I kept saying to her, I told you over the phone that he had already had an exam and only needed a flu shot. And she just kept talking over me telling me that once “THEY” get “HERE” they have to do the whole exam over again. I knew that wasn’t true, I’d triple checked that fact. This was just becoming some xenophobic/racist bullshit. When I wouldn’t let up about the fact that her statement was blatantly false, she decides she doesn’t want to deal with me anymore and directs me to the doctor.

The doctor, also very old and white, was sitting in his chair holding Efrem’s vial of blood up in the air, inspecting it like some mad scientist. I was upset but still very calm, and asked the same question, “why did you redo his medical exam, he only needed a flu shot?” Without a beat, he catches this crazy attitude and starts yelling at me. “THAT’S WHAT YOU ASKED ME TO DO!

I still stayed calm, and I said no, I asked you to give him a flu shot. And then he continues yelling about, ‘NO, first we have to do a TB test, then we have to make sure he doesn’t have SYPHILIS, and then we have to give him vaccinations.‘ (Mind you, the number of times both the nurse and doctor have shouted and overemphasized the word syphilis at this point was absurd, like making sure to let us know that “we-don’t-let-no-dirty-syphilis-having-immigrants-in-OUR-country.”) I told him, he already had a TB test, already had a chest x-ray, we even have the films of x-ray at home. The only thing he required was a flu shot. The old man just kept yelling, yelling with pure disgust in his voice, the same bullshit over and over. And I asked him. ‘Why are you yelling at me?‘ Answer–‘BECAUSE YOU’RE TELLING ME I DON’T KNOW HOW TO DO MY JOB.‘ (Mind you, he’s still holding that vial full of Efrem’s blood in the air throughout all of this.)

So when he sees he’s not getting anywhere by trying to yell some sense into me, he starts playing the blame game: ‘Well you shouldn’t have given us the full form if you didn’t want a full exam.‘ I repeated myself again that I had told the nurse both on the phone and when we got here what we needed and what we didn’t need. Then he switched to, ‘Well clearly there were some communication issues with your husband, I asked him if he’d had a full exam and he said ‘no.’‘ In other words, he used the “speak American” trope. Efrem is fluent in English, has no issues with understanding what people are saying and communicating back. If there was any confusion it was probably because of the manner in which he was asking the questions, especially since he started out the appointment being belligerent, not to mention he was talking about needles around someone who’s scared of needles. (Needless to say, after we left, Efrem told me that he had told the doctor that he had already had all those procedures, but he insisted that they had to be done over again). So after I wouldn’t be hushed by either of those suggestions of it being our fault that he performed superfluous tests that we didn’t request,  he began yelling about how I should’ve been in the room with Efrem since he clearly doesn’t understand English (he just had to reemphasize that point).

You only have a couple of times to yell at me before I lose my entire mind. This was one time too many, and I came unglued. Now I was yelling, telling him he was wrong to do all of this, that we just wanted our paperwork so we could leave. Efrem, now vertical, was saying to me that we should just pay and go. So we go back to the front were the nurse was and she says, “That’ll be $200.”

My shouting resumed. I told her we were not paying them for procedures we didn’t ask for (consent to) and the nurse, still spewing her heinous xenophobia and racism, keeps going on about how those procedures were required “if he wants to be in this country,” and that if we wanted our paperwork signed that’s what it would cost. She, of course, had to say ‘syphilis’ just one more time. Then the doctor decides to chime in and shout through the door, “He’ll also need to come back in 3 days so we can read his TB test and schedule him for a chest x-ray.” I’m screaming now! Screaming that I’d already told him multiple times that he’s had a chest x-ray! That we had the films! and that we weren’t coming back to read an unnecessary TB test! Efrem, trying to just get us out of there, pulls out his card to pay. Then the nurse, who doesn’t even blink, states, “Cash only.”

Folks, at this point, what shred of sanity I had left completely vacated my body. The words that were coming out of my mouth…whew, thank goodness there was no one else in that office. Cash only? For a $200 bill? I told the woman that she had never communicated to us that this was cash only when we made the appointment, and then this *&%!# spits back, “Well maybe you should listen better.”  I’m sure I was seeing red at that point, because I was screaming all types of profanity, talking about how her old ass must be getting dementia. Anything that came to my mind came out of my mouth. Just gone. Efrem, normally the voice of reason, didn’t even try to hush me up like he usually would, he just let me go IN. The kraken was released in that office.

They decided they were going to keep his paperwork and told us to go to an ATM and come back with the money, so we could have the paperwork back. I guess they thought that would be leverage to get paid. I made it perfectly clear we wouldn’t be back in that office and we wouldn’t be paying them anything, in much more colorful words, of course.

I have never experienced that level of rage before. I stopped just short of grabbing everything off her desk and throwing it. I’m sure police would’ve been called at that point. Honestly, given the level of disgust they had in their eyes and tone of voice before things even got to that point, I’m surprised they hadn’t already called the police. 

There were just so many levels to the madness that occurred in the office:

  1. Their medical unprofessionalism and lack of ethics: You’ve got a nurse and doctor who hear what you need done but decide to do what they want anyway so they can get more money. If you’re going to tell me that it’s Efrem’s fault that you performed extra procedures because he doesn’t speak English well enough, well now you’ve let me know that you think informed consent can go to hell, which is a real ethical violation. If you don’t think you’re being understood then you need to ask for a family member or a translator, you don’t just do what the hell you want and say ‘oh-well-shoulda-spoke-American.’
  2. Xenophobia. The number of times the word syphilis was spit at us—basically insinuating their belief that immigrants are just filthy and that even if they got a medical exam “over there,” we here in the great U. S. of A. need to redo their (inept) work to make sure “they” aren’t bringing anything over “here.”
  3. Covert Racism: If you’ve been on the receiving end of covert racism, you know it’s not always explicable. It’s the body language, it’s the look of hatred that they have to be inconvenienced and deal with you in the first place, it’s the way they call you a nigger without calling you a nigger, it’s how they don’t touch you (shake your hand), it’s how they start interactions with negativity, it’s how quickly blame gets shifted on to you and your assumed lack of education, it’s the speed with which customer service and general moral, business, and medical ethics gets thrown out the window because they don’t feel you deserve the same treatment, it’s the way she spat out “cash only” like a check may bounce or our credit isn’t accepted.

It was all of these things–plus feeling horrible that Efrem had to be stuck with several needles instead of just the one, plus the ongoing frustration of having to jump through all these USCIS hoops and pay all of these fees, as well as our total vulnerability to the whims of all of these external organizations and people–that brought out my black rage like nobody, not even me, had ever witnessed before. The only thing that kept me from going completely off the deep end, was the real fear of the police being called.

We got down to the lobby of the building and I just sobbed uncontrollably. I had never felt so powerless, at least not in the US. They were still holding our paperwork hostage, and in my head, all I could hear was the word ‘syphilis’ being shouted repeatedly and all I could see was this doctor sitting in his chair, menacingly waving around a large vial of Efrem’s blood. The irony was definitely not lost on me (as a public health and Africana studies researcher) the multitudes of times throughout history that black people were taken advantage of by medical professionals, made the guinea pigs for medical research. While this was not that, all of that imagery compounded to make this situation all the more sickening for me.

We drove home, me still heaving from all that frustration. What should’ve been a quick appointment before work left both of us mentally and physically exhausted, and me walking into the office hours late. Efrem tried to call back and reason with the people about how they just need to sign for the flu shot and give us the paperwork, but they were too busy telling him how horrible I was, with all the subtext of ‘how dare she challenge our authority,’ and that they’d give us the paperwork when they got paid.

This was going to hold up our AOS application.

I got to work and researched a bit more. I found that on the Visa Journey website, many people, all over the country, had similar experiences with Civil Surgeons being crooked, trying to force people to redo the entire medical exam in order to get more money, and making xenophobic comments–basically trying to take advantage of people’s vulnerability at this stage in the process. It’s so bad nationwide that there was a thread on this website with a master list of Civil Surgeons NOT to go to (FYI, the one we went to wasn’t on this list, but I sure as hell added him).

The shitty part is, it’s almost impossible to have them removed from the designation of being a Civil Surgeon, there’s no way to make a formal complaint, because there’s no office listed on a website or directory that “houses” the officials who actually designate which doctors are Civil Surgeons. The most you can do is complain to the local medical board, but despite how awful they are, there isn’t enough to actually get any formal sanctioning by those boards. There really needs to be a method of lodging a complaint, since it’s clear that people going through this process the “correct way” (as so many people opposed to illegal immigration like to phrase it) are still being treated like shit.

I talked to my supervisor (a medical doctor) about possibilities of how and who to report this guy to (she again only knew of the state medical boards). However, she did let me know that we could also just go to a different civil surgeon and have him get a second flu shot; that getting a second dose of the vaccination wouldn’t be harmful, but it would be just like getting the flu twice in one season. That was best news I’d gotten all morning, and presented a viable alternative to giving into that doctor’s villainy.

Then, with some further researching through the Visa Journey forums, I also found out that not having the flu shot on your records is only a hold up in the AOS process if both the medical exam AND the time at which they read your application are during the flu season. In other words, if you get your medical exam outside of flu season (when there wouldn’t even be a vaccination) but your application is handled during flu season (when the vaccine would be available), then they won’t issue a Request For Evidence (RFE), because you would’ve been in compliance with procedures at the time you submitted, and instead they’ll move your case forward. Conversely, if you have your medical exam during flu season and don’t get the shot, and then they look at your case outside of flu season, they’ll again bypass issuing an RFE and mover your case forward because there won’t be a vaccine available to even get. I realized that by the time they look at his application, it will most likely be outside of flu season.

I explained to Efrem that we had two options, that we could go find another Civil Surgeon and he could get another shot, or we could just take a chance that we wouldn’t be issued and RFE and submit the AOS application without the additional medical records that were being held hostage. We decided to take a chance and move on with our lives with the notion that if we are issued an RFE,  we’ll probably be long over the trauma of this experience and ready to find a different civil surgeon. 

Now, we wait.

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