1 ADAM PERTMAN, ADOPTION NATION: HOW THE ADOPTION REVOLUTION IS TRANSFORMING AMERICA 51 (2000).

2 Lois and Juliana Hannon's international adoption experience inspired this section. Lois adopted Juliana from a Romanian orphanage where no one spoke English and no medical records were kept for Juliana. After arrival in the United States, physicians diagnosed Juliana with severe developmental problems due to early sensory deprivation. In 1993, Lois Hannon co-founded the Parent Network for the Post-Institutionalized Child to help other adoptive parents coping with similar circumstances. See id. at 151-53.

3 See id.

4 See Jerri Ann Jenista, The Visa Medical Examination: The Facts, at http://www.fwcc.org/visamedical.html (Apr. 6, 2002) (noting that the U.S. visa exam only determines whether a child has an excludable condition and does not ensure that a child is physically, emotionally or developmentally “normal”) [hereinafter Jenista, Visa].

5 Half of international adoptees have an acute illness within one month of arrival in the United States. See Jenista, Jerri Ann, Infectious Disease and the Internationally Adopted Child, 6 CURRENT OPINION INFECTIOUS DISEASES 576 (1993)CrossRefGoogle Scholar, available at http://www.comeunity.com/adoption/health/infectious-disease.html [hereinafter Jenista, Infectious Diseases].

6 Older international adoptees have adjustment issues with food, so they may be obsessed with, steal or hoard food. Hostetter, Margaret & Johnson, Dana E., International Adoption: An Introduction for Physicians, 143 AM. J. DISEASES CHILD. 325, 331 (1989)CrossRefGoogle ScholarPubMed.

7 Past losses of family members can prevent a foreign-born adopted child from making anything more than minimal attachments. See SUSAN PARTRIDGE ET AL., LEARNING FROM ADOPTION DISRUPTION: INSIGHTS FOR PRACTICE 49-50 (1986).

8 Children suffering from Reaction Attachment Disorder may indiscriminately bestow affection on strangers. See Cindi Lash, Child Frustrates Professional Parents: Therapist, Physician Husband Thought They Could Raise a Troubled Girl. They Couldn’t, PITTSBURGH POST-GAZETTE, Aug. 14, 2000, at A-9 [hereinafter Lash, Professional Parents].

9 “Severe malnutrition can cause a genetically olive-skinned, black-haired child to be pale and blond or red-haired.” JEAN NELSON-ERICHSEN & HEINO R. ERICHSEN, HOW TO ADOPT INTERNATIONALLY: A GUIDE FOR AGENCY-DIRECTED AND INDEPENDENT ADOPTIONS 160 (2000).

10 Reaction Attachment Disorder is defined as trouble bonding due to early deprivation. The symptoms are autism-like. See David Tuller, Adoption Medicine Brings New Parents Answers and Advice, N.Y. TIMES, Sept. 4, 2001, at F7.

11 Harlan Tenenbaum, Adoption 101, GPSOLO, Oct./Nov. 2001, at 51 (citing to the National Council for Adoption's statistics that, at any given time, one million couples in the United States are looking to adopt).

12 PERTMAN, supra note 1, at 25 (stating that domestic adoption can take between eighteen and twenty-four months and cost thousands of dollars, all with the pervading fear that the birth mother will reclaim her child).

13 Nicholson, Alfred J. et al., Health Screening of International Adoptees, 156 MED. J. AUSTL. 377, 377 (1992)CrossRefGoogle ScholarPubMed.

14 Kim Clark & Nancy Shute, The Adoption Maze, U.S. NEWS & WORLD REP., Mar. 12, 2001, at 62.

15 PERTMAN, supra note 1, at 23 (referencing INS Statistics Office, which states 1,700 international adoptions occurred in 1964; while in 1998, 15,724 children were adopted from abroad).

16 See Intercountry Adoption Act of 2000, Pub. L. No. 106-279, 114 Stat. 825 (2000) (providing for the implementation of the United States’ ratification of the Hague Convention on Intercountry Adoption).

17 Jenista, Visa, supra note 4.

18 Clark & Shute, supra note 14.

19 Tuller, supra note 10. In 1990, there were two to three adoption medicine specialists; today there are more than a dozen in the United States and Canada. Id.

20 PERTMAN, supra note 1, at 55.

21 These orphans were typically the offspring of American soldiers and Korean women. Id.

22 Id. at 22.

23 Id. at 55.

24 Clark & Shute, supra note 14, at 65. Russia began allowing international adoptions in 1991. See Cindi Lash, Overwhelmed Families Dissolve Adoptions: More American Parents Find They Can't Cope with Troubled Russian Children, PITTSBURGH POST-GAZETTE, Aug. 14, 2000, at A1 [hereinafter Lash, Overwhelmed].

25 PERTMAN, supra note 1, at 55. To satisfy U.S. demand for Caucasian infants, Romanians started seeking healthy infants through “baby brokers” rather than placing older, needy orphans with the American families. By 1991, 2,594 Romanian children had been adopted into American homes. In June 2000, the Romanian government ordered a three-month moratorium on international adoption to clean up the corruption. Id. at 72-73.

26 Clark & Shute, supra note 14, at 65 (noting that over 1,000 Romanian orphans were adopted by American families in 2000). The conditions in Romanian orphanages were discovered after the 1989 revolution which ousted Nicolae Ceausescu, the country's long-time dictator, and his wife, Elena, the nation's chief deputy. See PERTMAN, supra note 1, at 55, 72.

27 Dave Newbart, Conditions in Many Orphanages Improve with International Funds, CHI. SUN-TIMES, Jan. 9, 2000, at C14 [hereinafter Newbart, Conditions].

28 Id. In 2000, children in Chinese orphanages had a ninety-percent survival rate due, in part, to a fee of $3,000 per child and an increase in foreign donations. Id.

29 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 153, 163 (noting that the majority of these children suffer from mental health delays and malnutrition, although most problems are remedied in a relatively short amount of time in a loving, healthy environment). For a compilation of medical ailments associated with internationally adopted childen, and the countries in which these ailments most commonly occur, see id. at 151-63.

30 See Jeffreys, Darya P., Note, Intercountry Adoption: A Need for Mandatory Medical Screening, 11 J.L. & HEALTH 243, 257 (1996-97)Google Scholar (noting that physicians often found parasites among children from Korean orphanages).

31 Tenenbaum, supra note 11, at 51. In 1985 there were approximately 8,500 international adoptions finalized in the United States. See Lange, W. Robert & Warnock-Eckhart, Ellen, Selected Infectious Disease Risks in International Adoptees, 6 PEDIATRIC INFECTIOUS DISEASES J. 447, 447 (1987)CrossRefGoogle ScholarPubMed. In 1987, Americans adopted approximately 10,097 orphans from 79 countries. See Hostetter & Johnson, supra note 6, at 325.

32 Tenenbaum, supra note 11, at 51.

33 Id. (according to statistics from the National Council for Adoption); see generally Shannon Minter, Lesbian and Gay Parents and Their Children, GPSOLO, Oct./Nov. 2001, at 36 (addressing the family law needs, including adoption laws, of the more than 1.5 million same-sex couples living in the United States). As more same-sex couples are able to adopt legally in the United States, the number of these couples seeking to adopt internationally will also increase.

34 Tenenbaum, supra note 11, at 51.

35 Id. High infertility rates in the United States and less available domestic children contribute to the demand in the international adoption market. Not surprisingly, the number of international adoptions by Americans is continuing to grow. See Hostetter & Johnson, supra note 6, at 325.

36 Newbart, supra note 27, at 12 (stating that China's purpose is to protect her children and ensure safe American homes while the United States’ purpose is to prevent the arrival of children who eventually land in public care).

37 See generally id.

38 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 37.

39 Clark & Shute, supra note 14, at 64.

40 Jerri Ann Jenista, Prepared Testimony by Jerri Ann Jenista, M.D., F.A.A.P., of the American Academy of Pediatrics before the House Committee on International Relations Subject— “The Intercountry Adoption Act of 1999”, FED. NEWS SERV., INC., Oct. 20, 1999, at In the News, [hereinafter Jenista Testimony].

41 PERTMAN, supra note 1, at 57 (citing INS visa counts for 1989-1998, which found Guatemalan adoptee arrivals rose from 202 to 911).

42 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 27-29 (introducing the various types of adoption agencies and their capabilities and services).

43 Jenista, Infectious Diseases, supra note 5.

44 See Part III infra for a detailed discussion of pre-adoption medical examinations.

45 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 113 (noting that the average stay for prospective adoptive parents in the potential adoptee's home country is two weeks).

46 Id. at 30.

47 See Newbart, supra note 27, at 12.

48 Id. at 3. In December 2001, the INS Commissioner wrote a letter outlining the United States’ suspension of processing Cambodian orphan petitions due to “questionable documentation” of the orphan status of several Cambodian infants. James W. Ziglar, Commissioner, Letter to Prospective Adoptive Parents of Cambodian Orphans, U.S. Dep't of Justice, Immigration & Naturalization Serv. (Feb. 7, 2002). The Commissioner wrote, “I hope you will understand and agree that until the Government of Cambodia puts in place a transparent, regularized, and consistent adoption process, the processing of Cambodian orphan petitions for immigration to the United States must remain suspended.” Id.

49 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 103-08.

50 Jenista, Infectious Diseases, supra note 5.

51 Jenista, Visa, supra note 4 (arguing that the visa medical examination is cursory and only shows concern for the health of the American public, not the child).

52 An excludable condition is a condition for which a child would be prohibited from emigrating to the United States. See NELSON-ERICHSEN & ERICHSEN, supra note 9, at 152.

53 Id. at 150 (providing a sample medical examination form that lists diseases for which a doctor should test). One noted Adoption Medicine specialist believes that HIV is included as an excludable disease for “purely political reasons.” Jenista, Visa, supra note 4; cf. Lange & Warnock-Eckhart, supra note 31, at 447 (stating HIV would likely not be placed on the list of excludable visa exam diseases).

54 Jenista, Visa, supra note 4 (stating that most international adoptees will only have brief medical examinations prior to being granted entrance visas).

55 Jenista, Infectious Diseases, supra note 5.

56 Jenista, Visa, supra note 4.

57 Id.

58 Id. See discussion infra Part V.

59 Clark & Shute, supra note 14, at 66.

60 Adoption Medicine specialists recommend that all physicians treating international adoptees should witness the adoptive parents meeting their new child at the airport with the accompanying family members, friends, balloons, videos, hugs, laughter and tears. See Hostetter & Johnson, supra note 6, at 328.

61 Jenista, Infectious Diseases, supra note 5.

62 NAT’L ADOPTION INFO. CLEARINGHOUSE, Summary of Laws Regarding International Adoptions Finalized Abroad: 50 States and 6 U.S. Territories, at http://www.adoptionlaws.org/summary_of_laws_regarding_international.asp (Nov. 5, 2002) [hereinafter NAT’L ADOPTION, Summary of Laws].

63 Id. There is no current national law governing adoptions finalized abroad. This will change once the United States fully implements the Hague Convention. Readoption in the parents’ home state is necessary for a number of reasons: future custody disputes, property division, child support and protection of full faith and credit of the other states. See NELSON-ERICHSEN & ERICHSEN, supra note 9, at 169. California requires readoption of a child whose adoption was finalized abroad if INS requires a readoption; California law also permits parents to readopt their international adoptees in the state if the parents so choose. CAL. FAM. CODE Div. § 8919 (West 1997); see also NAT’L ADOPTION INFO. CLEARINGHOUSE, Review of State Statutes Regarding International Adoptions Finalized Abroad, at http://www.adoptionlaws.org/review_of_state_statutes_regarding.asp (Nov. 5, 2002) [hereinafter NAT’L ADOPTION, Review of State Statutes].

64 NAT’L ADOPTION, Summary of Laws, supra note 62. Massachusetts offers full effect and recognition per MASS. GEN. LAWS ch. 210, § 9 (1998). See NAT’L ADOPTION, Review of State Statutes, supra note 63 (listing all fifty states and information as to whether the state has legislation relating to foreign adoptions).

65 NAT’L ADOPTION, Summary of Laws, supra note 62. New York has no statutory provision for international adoption. See NAT’L ADOPTION, Review of State Statutes, supra note 63.

66 8 U.S.C. § 1431 (2000) (as amended Oct. 30, 2000). On March 6, 2001, 75,000 children were the first group to have citizenship automatically conferred upon them under the new law. See Clark & Shute, supra note 14, at 69.

67 PERTMAN, supra note 1, at 23. The author notes that this argument is similar to the contested issue of domestic mixed-race adoptions.

68 COMM. ON ADOPTIONS, AM. ACAD. PEDIATRICS, ADOPTION OF CHILDREN 60 (2d ed. 1967).

69 Id.

70 Id.

71 PERTMAN, supra note 1, at 92.

72 COMM. ON ADOPTIONS, supra note 68, at 60.

73 Clark & Shute, supra note 14, at 66.

74 Janet McConnaughey, Case Shows Need for TB Screening: Medical Journal Calls for Tighter Standards, BISMARCK TRIB., Nov. 11, 1999, at A1; see NELSON-ERICHSEN & ERICHSEN, supra note 9, at 158 (noting the frequency of tuberculosis cases among internationally adopted children, especially those from orphanages in China and Eastern Europe).

75 McConnaughey, supra note 74, at A1.

76 Tuller, supra note 10.

77 Id.

78 Id.

79 Id.

80 Id. (noting that the Rye, NY physicians had probably never seen a case of rickets).

81 Id.

82 Clark & Shute, supra note 14, at 66.

83 Id. at 69.

84 Id.

85 Id.; see also Laura Johnston, Suddenly Parents, SOUTHEAST MISSOURIAN, Nov. 18, 2001, at C9 (noting that neither newly adopted child actually had any of the medical diagnoses on their histories); see also PERTMAN, supra note 1, at 61 (stating that orphanage officials and doctors will often report mythical illnesses to prevent foreign adoptions).

86 See, e.g, Rosemary Zibart, Welcome Home, My Daughter, PARADE MAG., Jan. 20, 2002, at 4-6.

87 Jenista Testimony, supra note 40.

88 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 152.

89 Id. (noting that most children recover in their adopted environments).

90 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 151.

91 Hostetter, Margaret K. et al., Unsuspected Infectious Diseases and Other Medical Diagnoses in the Evaluation of Internationally Adopted Children, 83 PEDIATRICS 559, 559 (1989)Google ScholarPubMed (finding that screening omissions are the main cause of the missed diagnoses).

92 Lange, W. Robert et al., Mycobacterium Tuberculosis Infection in Foreign Born Adoptees, 8 PEDIATRIC INFECTIOUS DISEASE J. 625, 625 (1989)CrossRefGoogle ScholarPubMed.

93 Jenista, Infectious Diseases, supra note 5.

94 Jerri Ann Jenista et al., Hepatitis B: No Guarantee, at http://www.fwcc.org/hepatitisb.html (Nov. 5, 2002) [hereinafter Jenista, Hepatitis] (noting that five percent of international adoptees have active hepatitis infections upon arrival in the United States).

95 Sokol, Ronald J., Letter to the Editor, Adoption of Hepatitis B Virus-Infected Foreign-Born Children, 85 PEDIATRICS 890 (1990)Google Scholar (discounting the theory that testing in the home country is too expensive for potential adoptive parents because the cost is minimal compared to the overall cost of adoption).

96 See Lange, supra note 92, at 625.

97 Tuller, supra note 10 (referencing Dr. Jenista's observations that Korea's medical records are detailed, and Guatemala's medical records usually have one line stating that the child is “alive”); see also Hostetter, Margaret K. et al., Medical Evaluation of Internationally Adopted Children, 325 NEW ENG. J. MED. 479, 479 (1991)CrossRefGoogle ScholarPubMed (noting that the lack of intestinal parasites among Korean children is likely due to a higher standard of living and the provision of appropriate medical care in government subsidized foster-care homes).

98 Hostetter, supra note 91, at 559 (noting that refugee children do receive standardized medical evaluations).

99 Jenista Testimony, supra note 40. For example, Russian physicians diagnose Chernobyl survivors with “vegetative dystonia.” This diagnosis is unrecognized in the United States. Jenista, Infectious Diseases, supra note 5.

100 Jenista Testimony, supra note 40; see also NELSON-ERICHSEN & ERICHSEN, supra note 9, at 160 (Russian medical evaluations often use archaic terms and diagnoses).

101 See Lash, Overwhelmed, supra note 24.

102 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 159 (noting that symptoms include bow legs and bony bumps on the child's ribs. Rickets is treatable with calcium and exposure to natural sunlight).

103 Dave Newbart, Parents Try Adoptions in China for Many Reasons, CHIC. SUN-TIMES, Jan. 9, 2000, at 13.

104 PERTMAN, supra note 1, at 22.

105 Dave Newbart, From China. With Love: Kids Join New Families, CHIC. SUN-TIMES, Jan. 9, 2000, at 12.

106 Newbart, Conditions, supra note 27, at 12.

107 Id.

108 Miller, Laurie C. et al., Developmental and Nutritional Status of Internationally Adopted Children, 149 ARCHIVES PEDIATRICS & ADOLESCENT MED. 40, 40 (1995)CrossRefGoogle ScholarPubMed (finding that twenty-eight percent of the children in her study had serious, previously unrecognized medical problems). Dr. Miller concluded that the delays could usually be partially or completely reversed. Id. at 44.

109 Hostetter & Johnson, supra note 6, at 330.

110 Id. at 329.

111 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 153.

112 Id.; see also Hostetter & Johnson, supra note 6, at 327 (finding that older children can only be aged by looking at teeth, puberty and possibly head circumference because malnutrition and neglect can have such severe effects).

113 See Hostetter & Johnson, supra note 6, at 327; NELSON-ERICHSEN & ERICHSEN, supra note 9, at 153.

114 See Hostetter & Johnson, supra note 6, at 327 (noting that the best results happen if the child is adopted before she reaches the age of three).

115 Id. at 329.

116 Jenista, Jerri Ann & Chapman, Daniel, Medical Problems of Foreign-Born Adopted Children, 141 AM. J. DISEASES CHILD. 298, 298 (1987)Google ScholarPubMed.

117 Tuller, supra note 10.

118 Hostetter & Johnson, supra note 6, at 325.

119 Clark & Shute, supra note 14, at 66. Adoption physicians need to be familiar with the treatment of these diseases and the child's past medical treatment. See Lange & Warnock-Eckhart, supra note 31, at 449.

120 See Clark & Shute, supra note 14, at 66.

121 Hostetter & Johnson, supra note 6, at 325.

122 Tuller, supra note 10, at F7 (defining rickets as a treatable bone ailment caused by malnutrition and a lack of vitamin D); see also NELSON-ERICHSEN & ERICHSEN, supra note 9, at 159.

123 Jenista, Hepatitis, supra note 94. “[I]llnesses endemic to other cultures may be unknown to many family physicians and may remain undetected … .” Jeffreys, supra note 30, at 262.

124 Jenista Testimony, supra note 40.

125 Id.

126 Clark & Shute, supra note 14, at 69.

127 Jenista Testimony, supra note 40.

128 See Jerri Ann Jenista, Dr. Jerri Ann Jenista, M.D. Pre-Adoption Medical Review, at http://www.comeunity.com/adoption/health/jenista4.html (Nov. 5, 2002).

129 Robin Seaton Jefferson, FACES Helps Parents with Foreign Adoptions, ST. LOUIS POSTDISPATCH, Sept. 11, 2000, St. Charles County Post Section, at 8. Dr. Ladage is the mother of two adopted Chinese children. Id. Dr. Ladage believes that three to five percent of infant adoptees have long-term medical problems, and that the number increases to approximately thirty-three percent for adoptees over age two. Tuller, supra note 10.

130 See Jefferson, supra note 129.

131 Id.

132 Id.

133 ERICHSEN-NELSON & ERICHSEN, supra note 9, at 152; see also Jenista Testimony, supra note 40.

134 Hostetter & Johnson, supra note 6, at 327.

135 NELSON-ERICHSEN & ERICHSEN, supra note 9, at 160.

136 Hostetter & Johnson, supra note 6, at 327.

137 Id.; Part IV discusses adoption dissolution cases.

138 Id.

139 Id. at 329; see also Jenista, Visa, supra note 4. A Korean child with measles was not diagnosed before his post-adoption check-up. The child's infection circulated through the air system at the pediatrician's office and infected the unimmunized children. See Jenista, Infectious Diseases, supra note 5.

140 Hostetter & Johnson, supra note 6, at 329.

141 Id.

142 Id. at 331.

143 Id. at 325.

144 BARRY R. FURROW ET AL., HEALTH LAW: CASES, MATERIALS, AND PROBLEMS 173 (4th ed. 2000) (defining telemedicine as the “use of telecommunication to diagnose and treat a patient”) (quoting Kuszler, Patricia, Telemedicine and Integrated Health Care Delivery: Compounding Malpractice Liability, 25 AM. J. L. & MED. 297, 299-300 (1999)CrossRefGoogle ScholarPubMed).

145 See Miller, supra note 108.

146 See, e.g., Mohr v. Commonwealth, 653 N.E.2d 1104, 1112 (Mass. 1995). The court determined that there is a compelling need for disclosure so that parents can make timely and informed decisions regarding adoption. The court also found that adoption agencies have an affirmative duty to disclose all material information to adoptive parents. Id.

147 In 1997, an adoptive mother in Colorado was convicted of killing her Russian son because of his severe behavioral problems. See Tuller, supra note 10.

148 Lash, Overwhelmed, supra note 24.

149 Id.

150 Jenista Testimony, supra note 40.

151 Lash, Overwhelmed, supra note 24.

152 Id.; see discussion infra Part V.

153 See, e.g., Maley, John R., Note, Wrongful Adoption: Monetary Damages as a Superior Remedy to Annulment for Adoptive Parents Victimized by Adoption Fraud, 20 IND. L. REV. 709, 709 (1987)Google Scholar (noting the social and legal disdain for dissolution because the child is further traumatized and it breaks up the family unit). One family only made the decision to dissolve after their new child beat and threatened to kill their older biological daughter. Lash, Professional Parents, supra note 8. So many families were dissolving adoptions due to troubled Russian orphans that Russia temporarily suspended international adoptions in 1999. Lash, Overwhelmed, supra note 24.

154 See Maley, supra note 153, at 709.

155 Id.

156 Carroll, Elizabeth N., Note, Abrogation of Adoption by Adoptive Parents, 19 FAM. L. Q. 155, 175 (1985)Google Scholar (questioning whether children should go to the state or back to the agency when they are older, troubled and less likely to be readopted).

157 See Lash, Overwhelmed, supra note 24.

158 See id.

159 See id.

160 See Mohr v. Commonwealth, 653 N.E.2d 1104, 1110 (Mass. 1995) (recognizing the tort of “wrongful adoption” in Massachusetts; also recognized in Illinois, Minnesota, Pennsylvania, Washington and Ohio).

161 PERTMAN, supra note 1, at 61-62 (noting that domestic suits are down and international suits are climbing).

162 491 N.E.2d 1101 (1986).

163 See id.; see also Maley, supra note 153, at 723 (arguing that Burr does provide a cause of action when information, such as a child's medical history, is merely withheld rather than misrepresented).

164 See Jeffreys, supra note 30, at 255 (noting that parents often have no redress in the law, especially when they have signed liability waivers to proceed with the adoption); see generally Bebensee, Paula K., Note, In the Best Interests of Children and Adoptive Parents: The Need for Disclosure, 78 IOWA L. REV. 397 (1993)Google Scholar (noting that parents are left financially and legally vulnerable when they sign liability waivers or adopt independently).

165 8 U.S.C. § 1431 (as amended Oct. 30, 2000) (2001).

166 Hope for Children Act, H.R. 622, 107th Cong. § 2(a) (2001).

167 42 U.S.C. § 5107(a)(1). The Secretary also maintains a National Resource Center for Special Needs Adoption. 42 U.S.C. § 5113(b)(9).

168 32 I.L.M. 1134 (1993).

169 See id. Examples of such requirements include establishing a central authority and accrediting adoption agencies. Id.

170 See id.

171 See NELSON-ERICHSEN & ERICHSEN, supra note 9, at 31. For a complete list of the status of countries signing and ratifying the Hague Convention, see id. at 32.

172 See Status Sheet Convention #33 of the Hague Conference on Private International Law, at http://www.hcch.net/e/status/adoshte.html (Mar. 6, 2002). The United States signed the Convention on March 31, 1994. Id.

173 42 U.S.C. § 143.14901-14954.

174 PERTMAN, supra note 1, at 66 (“No doubt, the Hague convention would be imperfectly implemented, inconsistently interpreted, and frequently circumvented”); see also 42 U.S.C. § 14901(b)(2)-(3) (noting that the purposes of the Act include protecting the parties involved and assisting intercountry adoptions for U.S. citizens adopting abroad and foreigners adopting domestically).

175 Clark & Shute, supra note 14, at 69.

176 42 U.S.C. § 14911(a)-(b).

177 Id.

178 Id. § 14921(a).

179 Id. § 14923(b)(1)(A)(i).

180 Clark & Shute, supra note 14, at 69.

181 See NELSON-ERICHSEN & ERICHSEN, supra note 9, at 31.

182 See PERTMAN, supra note 1, at 41.

183 See, e.g., Jenista Testimony, supra note 40.

184 See Hostetter & Johnson, supra note 6, at 326. See discussion supra Part II.

185 See PERTMAN, supra note 1, at 41 (noting that Massachusetts, Colorado, Delaware and Connecticut require licensed agencies to meet specific state standards, while other states have fewer requirements).

186 See Bebensee, supra note 164 (addressing the need for disclosure of physical, mental and emotional medical needs in domestic adoption cases).

187 See discussion supra Part II.

188 PERTMAN, supra note 1, at 27 (“Adoptees are the only U.S. citizens who don't automatically have the right to obtain the records relating to their births.”).

189 See Jenista Testimony, supra note 40.

190 Id.

191 See 42 U.S.C. § 14912(e) (providing for the establishment of a registry for cases of adoptions involving immigration of children to the United States or emigration of children from the United States).

192 See Jenista, Visa, supra note 4.

193 Id.

194 Id.

195 Id.

196 Id.

197 See id. (detailing what medical problems the waiver does not exclude).

198 See Jenista Testimony, supra note 40 (stating that ERISA-covered plans are the only plans that must automatically cover adopted children); see also NELSON-ERICHSEN & ERICHSEN, supra note 9, at 151-52 (noting that adoptive parents must notify their insurance carrier within thirty days of placement or adoption).

199 See 42 U.S.C. § 300gg (noting that the preexisting condition exclusion is not applicable if a child is covered on the last day of the thirty-day period prior to the adoption or placement date).