CARA medical exam circular irks adoption agencies, docs

Officials will be held responsible for any problems not mentioned in initial medical report, but found in kids after adoption, says notice. Agency federation has responded by saying it will include a disclaimer with all such reviews

Adoption agencies across Maharashtra have expressed their displeasure over a recent circular issued by the Central Adoption Resource Authority (CARA) regarding the medical examination report (MER) of children put up for adoption. The Maharashtra State Federation of Adoption Agencies, which includes both government and private players, wrote to CARA on November 10, stating that they will include their own declaration in the MER. Paediatricians, too, have expressed their displeasure and are now reluctant to work with the agencies.

On October 9, CARA issued a circular to all specialised adoption agencies (SAAs), setting new guidelines for the medical report. According to the circular, ‘If a child referred under the normal category in the MER is later found to have medical problems during supplementary tests conducted by the family, all medical and travel expenses borne by them will have to be reimbursed by the adoption agency (both government and private). The agencies will be held responsible for laxity and the decision will be final in all respects.’

The circular also states that since integration of older children with adoptive family takes more time, agencies are required to allow meeting of children over three years of age at least twice before acceptance. In case of any disruption in in-country adoption, agencies are asked to ensure at least two counselling sessions before the parents are permitted to return the child, the circular stated.

There are 63 adoption agencies in Maharashtra registered with CARA and a special meeting was held in Pune on November 8, attended by their members. Kalasundar Veda, head of the adoption agencies’ federation, said, “After discussing with the members, we decided that a note will be added to the MER, mentioning that all details in the report are true on the day it has been filed and that neither the doctor nor agency officials will be held responsible if there is any deviation from this later. If any supplementary tests are performed after 15 days or more, and if any medical ailment or complication is found, the onus does not lie on the medical or agency officials. A letter stating the same has been sent to CARA.”

Once a child comes into the agency, s/he is screened for 18 different diseases such as skin ailments, lung diseases, HIV, and so on. These are all specified under CARA guidelines and the children are vaccinated accordingly.

If any medical anomaly is found, the further tests are then suggested. Many paediatric doctors in Pune have been doing this work on an honorary basis, but now, after the circular, are refusing to provide their services to the adoption agencies.

Dr Lalit Rawal, head of the Paediatric Association of India’s Pune chapter, said, “Most of the doctors do this work service on an honorary basis and therefore cannot be held liable for this. The reports filed will be done on the basis of screening tests and no doctor would wilfully change the reports. For instance, if a patient has done a 3D echocardiography and no heart problem is found at the time, there are chances that the same person could have heart trouble later.”

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