Navigating the “Roadblocks” of Obtaining Visas and International Registration

Due to increasing political tension, Middle Eastern citizens seeking to travel to the United States are finding new Immigration and Naturalization Service regulations difficult to navigate.

Because Houston is home to the largest medical center in the world, many patients wish to come here for health services, but are finding the registration procedures complicated and the time it takes a hindrance. Some may risk their health on this wait period, and have instead, chosen to seek medical attention in Europe or the United Kingdom because of their expedient visa approval times.

The Texas Medical Center’s International Affairs Advisory Council, whose membership is comprised of faculty and staff from various TMC institutions, is working to facilitate quicker entry for those international patients wishing to come to Houston, and ensure that these visits are successful – from arrival to departure. As proof, in 2000, a record number of more than 19,000 international patients sought health care here.

“We may be losing ground, because these folks have the impression that we don’t want their business, and that’s simply not true,” said Sandra Simpson, executive director of marketing and managed care at TIRR Systems, and international council chair.

Texas Medical Center patients and their accompanying family members or other visitors were affected if they met the following profile:

Admitted before Sept. 10, 2002

Male; 16 or older; born in, are a citizen of or have dual nationality with Iran, Iraq, Libya, Sudan, or Syria; last admitted to the United States as a nonimmigrant and planned to remain beyond Dec. 16. This group must have visited the downtown Houston District INS Office to register in person between Nov. 15 and Dec. 16.

For patients too sick to travel downtown, the office sent a representative to the patient’s bedside for registration. However, anyone traveling with the patient had to make the journey downtown. This applied to patients in all groups.

Admitted before Sept. 30, 2002

Male; born on or before Dec. 2, 1986; born in, are a citizen of, or have dual nationality with Afghanistan, Algeria, Bahrain, Eritrea, Lebanon, Morocco, North Korea, Oman, Qatar, Somalia, Tunisia, United Arab Emirates, or Yemen; and were last admitted to the United States as a nonimmigrant and planned to remain beyond Jan. 10. This group must have visited the downtown INS office to register in person between Dec. 2 and Jan. 10.

Since Sept. 11, 2002, special registration at the airport is required, and is part of the National Entry-Exit Registration System, known as NSEERS.

This federal regulation states, “Nonimmigrants from certain countries, as well as other individuals whom the Immigration and Naturalization Service or Department of State designate on a discretionary basis, are required to be processed under ‘special registration’ procedures as part of the National Security Entry-Exit Registration System.”

This registration system affects male or female inbound visitors, ages 14 to 45, who were born in, are citizens of, or have dual nationality with Iran, Iraq, Libya, Sudan or Syria; or are males born in, citizens of, or have dual nationality with Pakistan, Saudi Arabia, and Yemen. This group must visit the downtown INS office to register in person between the 31st and 40th day following the last entry admission.

“We anticipate other countries to be added,” said Walter H. Lee Jr., assistant director for inspections at Houston’s George Bush Intercontinental Airport’s NSEERS, “but we are given little, if any, notice when these changes take place.”

However, Lee said anyone from any country can be required to register if they are flagged based on intelligence or other agency information. He said a family from the Netherlands was recently visiting Houston, and the computer flagged them and required them to register.

“We want to encourage those coming to Houston from other countries and seeking medical attention, to get direct flights to Houston,” said Kathryn Stream, Ph.D., a Texas Medical Center senior vice president and international council member. “It will put less strain on ill patients if Houston is their point of entry, than if they were to land in New York, for example, take the time to register there, and risk missing a connection to Houston.”

The airport registration and exit processes are fairly simple, and take about 10 minutes each. Upon entry visitors are required to provide their name, birthdate, birthplace, information on their parents, information on their profession, passport information, names, addresses and locations of people and places they will visit, and the length of their visit.

If the length of their visit is unknown, for example due to medical treatment, the airport officer takes note, and if the visitor is here more than 30 days, they again must register at the downtown INS office. If they visitor is still here at one year, they must once again update their registration at the downtown office.

Visitors to the downtown INS office should be prepared for a long wait, as the office does not take appointments. They may arrive as early as 6 a.m., and be accompanied by a friend, translator or caregiver. Visitors should be prepared to wait most of the day, and be ready with required materials, something to read, medicines and a charged cell phone. Patient materials required are a passport, an INS arrival/departure card (Form I-94), INS extension receipts, approvals and copies, INS change of address (Form AR-11) copies and postal receipts, a physician letter, a billing letter, housing evidence and an airline itinerary.

Stream said the registration process is important for TMC patients from stated countries, so that they will be in the system upon exiting the country. She stressed the importance of the exit interview, and said that patients must understand that this process is equally as significant as the entry registration.

“If a visitor doesn’t report that they’ve exited the country, and for some reason, need to come back at a later date, which often is the case for patients seeking health care, they will not be allowed back,” she said.

The exit interview consists of departure information, and cross checking to see that visitors did what they said they were going to during their stay, as stated in the registration interview.

In order to make sure that these visitors actually leave the country, Lee said the airport inspectors check passenger lists to see that these international visitors actually boarded their flights and left the country.

“It is our hope that this process will soon become very smooth, and keep patient stress at a minimum. We need to keep the communication process flowing so that our clients will have a pleasant stay during what may be unpleasant courses of treatment. If we remain proactive with our partners at the INS, the transitions should be seamless,” Simpson said.

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©2006 Texas Medical Center

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