Families in Crisis: When Foreign Adoption Goes Wrong

Certainly, the walls of her North Royalton office were papered with smiles, photographs of the hundreds of parents and children that Margaret Cole and her international adoption agency, European Adoption Consultants (EAC), had brought together since 1992.

And Cole herself was charming, her brown curls bouncing as she talked with a farm-girl lilt and a tone of amazement about how she started this agency, which had recently processed its 1,000th adoption. How she rebounded from personal tragedy when her fifth child, a baby girl, died from SIDS by deciding she wanted to adopt. How the Ohio adoption agencies she approached were reluctant to let her adopt an infant because she was over 40 and because her tragedy was so terribly fresh they were afraid she hadn't finished grieving. How she decided she would open her own agency to both find a child for herself and help other parents, planning to reach far overseas into Russian, Chinese and other foreign orphanages where so many children waited for a future. How she started from nowhere, so unfamiliar with what was required that she called the auto-licensing bureau to see if she could get an agency license there.

But some parts of her story were puzzling. When asked how she found her all-important facilitators — the EAC operatives (often foreign nationals) who find children in the foreign country that are available for adoption and arrange all the overseas details to make sure the adoption proceeds without a hitch — her account seemed strange.

After she got her license from the state of Ohio, Cole says, she bought some new suits, headed for Moscow without knowing a soul and started looking around for people. "I would go out on the streets, into restaurants, asking for anyone who spoke English," Cole says. "I'd tell them I was the director of an adoption agency, and I was here to make contacts. Then I'd go back to my room and wait for messages and people would call me." Cole makes no mention of asking about these would-be facilitators' qualifications, backgrounds or criminal records. When asked how she managed to avoid crooks and charlatans, she says, simply, "I just have radar."

But her radar didn't extend a few miles into Cleveland's East Side, where one of the nation's leading researchers of issues surrounding international adoption is based. Case Western Reserve University's Victor Groza has conducted groundbreaking studies of the psychological and behavioral anomalies among children adopted from Romanian orphanages. His work has become a critical resource for people concerned about the effects of institutional life on foreign adoptees — in fact, he wrote the section on international adoption for the 1997 supplement to the Encyclopedia of Social Work. But Cole said she had never heard of him. This was troubling: Surely the director of an agency that places so many children from Russian orphanages should be familiar with important research in the field.

Still, it seemed to be a wonderful story, the kind people love to read and magazines love to print. A story about a local woman who struck out on her own to become one of the major players in a phenomenon that has brought some 18,000 orphans from Eastern Europe and the former Soviet Union into the United States for adoption over the past decade. And it was a story in which everyone seemed to win: Cole has her agency and her adopted Russian daughter, hundreds of other parents have the children they've always wanted, and a thousand children will grow up in pleasant, middle-class homes instead of lonely, often Dickensian orphanages.

Cole's public relations agent, Bob Fruchter from Showtime Advertising and Public Relations, approached Cleveland Magazine with this story. He pitched it successfully here and to Hearst Entertainment, which at press time was considering a movie of the week about Cole's life.

And the story is true, at least for many people. Cole holds a picnic for her adoptive parents and their children every year; this year's picnic, held at the zoo, drew some 1,500 people — an affirmation, it would seem, of her success. Her quarterly magazine prints stories written by families who are ecstatic with their adopted children and consider Cole's work a blessing. Some of the parents have even named their children after her.

"We had a great experience with EAC," says Theresa Liska. In 1994, she and her husband, Dennis, chose to adopt a little boy from Russia who had a congenital heart defect, knowing that he might not survive. Their son, Steven, had to have open-heart surgery within eight weeks of their return home from Russia, but since then, he's been fine. "Margaret and her staff have always been very supportive, very open and honest. It's hard for me to comprehend someone not being happy with them," Theresa says.

Another couple, Greg and Ingrid Ochalek, also report that their EAC experience was a tremendously positive one. They adopted a 5-year-old girl earlier this year whose mother had died the previous year of cancer. Their daughter, Taylor — who resembles Ingrid so much that strangers assume she is their biological child — has picked up English quickly, is thriving in kindergarten and dazzles her new parents daily with her rapid progress.

Greg points out that just as Taylor has enriched their lives, he and his wife are thrilled that they have had such a profound impact on hers. "One year ago, she didn't have clothes, and now she has so much," he says. "There are so many kids over there that need homes, and the Russian people are just not economically equipped to take care of them. When you see what those children face, you hate to think that someone might not rescue them." The Ochaleks, in fact, are planning to adopt another Russian orphan through EAC.

So this was supposed to be a feel-good story full of heartwarming testimonials — until phone calls to health-care, social-work and adoption professionals around the country began to blow it away.

Over the course of a four-month investigation, Cleveland Magazine uncovered a deep pit of antipathy toward Cole among many such professionals, as well as among parents who don't have happily-ever-after stories. We found that some EAC parents have received flawed information about their children's medical and social histories; these children went on to have significant problems, some of which might have been indicated by the information in their orphanage files, had it been communicated. We found that Cole has failed to fully educate prospective parents about the range of problems that plague children from foreign orphanages and that her parents are often unprepared for the challenges they face. And we found that even though Cole portrays her agency in warm, fuzzy terms — a haven for prospective parents where EAC's staff "holds their hand every single step of the way" — some parents say she has quickly dropped their hand when significant problems arose after they brought their children home.

Most of the professionals interviewed for this article asked to have their names withheld, as they worry that Cole and other directors of international adoption agencies will stop referring their clients for expert help. A few of the parents interviewed also asked to have their names withheld, as they don't want their children to read this piece someday and wonder if their parents would have adopted them had they known what they were getting into. The parents who were willing to put their names on their stories also fear that their children will reach this conclusion. Still, they don't want other parents to relive their painful experiences.

Certainly, not all these professionals and parents have the same perspective about Cole's motives. Some take the extreme view: that Cole preys upon the desperation of childless parents, eager to make a bundle selling babies. Others point to widespread abuses in the international adoption industry, saying that her agency is only one of many that fail to be as careful as they should. One medical professional ascribes Cole's problems to naivete, saying, "Margaret was naive when she got into this work, and she's stayed naive because she hasn't learned from experience and she refuses to take advice."

But whether spawned by naivete or greed, Cole's failure to fully educate many parents, provide them with accurate medical information about their adoptive children or help them if they have problems after they adopt has had a devastating and lifelong impact on some of the families she's helped create.

Lyn and Kevin Kelley only knew the feel-good story about Cole, told through a handful of newspaper clippings. Married 14 years without a child, they had investigated in vitro fertilization but decided their odds of success were too low. They believed their chances for finding an infant through a domestic adoption agency were slim, and they didn't want to pursue private adoption because they had heard too many stories about birth mothers reclaiming children. So they decided upon international adoption, and they chose Margaret Cole.

Two years later, the Kelleys face the greatest challenge of their lives as they struggle to meet the needs of their two sons, both of whom have special needs.

The Kelley boys were each 7 months old when adopted. Jordan, now 30 months, has been diagnosed with sensory integration dysfunction and has a range of developmental abnormalities. Adam, now 25 months old, has a form of cerebral palsy that only — his parents say with weary irony — seems to be a physical disability; equipped with his leg braces, he's closing in on his developmental milestones. Jordan, however, requires 30 hours of intensive therapy a week. Even though his mother provides 24 hours of that therapy, the Kelleys are paying a staggering $20,000 a year to help him recover from the withering effects of institutionalization, prematurity and malnutrition.

The Kelleys, along with other parents and professionals, are furious with EAC for several reasons. For one, they believe that while Cole's marketing and public-relations machines whirl away at top speed, she and her agency have failed to educate parents about the risks of adopting children from foreign orphanages.

EAC holds adoption seminars in a number of cities at which Cole and her staff discuss their services, but some parents say that these are primarily marketing venues, held to dangle images of beautiful babies in front of eager couples. When the Kelleys attended one, they heard Cole emphasize how she could get happy, healthy babies quickly — a hot selling point, especially to wistful couples who have spent years trying to conceive. The only caveat, according to the Kelleys, was that Cole said that these children were often accompanied by ominous medical records. The Kelleys said that Cole told the group of prospective parents not to believe everything they would read in these records, as orphanage authorities tend to make them sound forbidding in order to make the children eligible (according to a former tenet of Russian law) for foreign adoption. Plus, Cole told the parents, she and her staff carefully screen the videotapes of children sent by their Russian facilitators.

"We went to one of her •medicine shows,' " Lyn Kelley says. "If you think about the Old West, where the medicine man used to stand on the back of the wagon and tout his magic potions, you'll know what I mean. She talks about how well cared for and happy the children are, and how they only need a mommy and a daddy and lots of love. She really tugs on your heartstrings."

But many of these children need much more than a mommy and daddy and lots of love — they need professional help, and right away. As the Russian economy flounders and the plight of families remains desperate, these children are often conceived and carried under the worst of conditions.

In an early interview with Cleveland Magazine, Cole described a sunbeam-like trajectory that lands these children in Russian orphanages. If Russian families experience a death or divorce, she explained, their child is often put into an orphanage temporarily because they can't care for it. "Then the child ends up getting adopted when the parents decide they can't support it," Cole says. "They decide they're never going to have enough money, never going to have a house. It's not that they don't love the child. It's just that they feel this is the way to give the child a better life. If it goes to America, that's their dream. That's mainly how it happens."

But this is hardly the bittersweet scenario others describe. "Parents have to understand who they're adopting," says Jerri Jenista, an Ann Arbor, Mich., pediatrician who reviews medical records for many adopting parents and has adopted five children herself. Jenista serves on a committee that is preparing medical recommendations for the American Academy of Pediatrics' legislative staff, which will then advise Congress on Hague Convention standards for accrediting international adoption agencies. "It's not that some college student has gotten pregnant and has to give up the baby," Jenista says. "It happens because of extreme poverty, abuse, alcohol use, drug use and a combination of those factors. You have to state this very clearly to parents, so they can prepare themselves if there are problems."

And after the babies are born and given up to the state, threats to their well-being continue. Many Russian and Eastern European orphanages are poorly staffed and practice assembly-line child care. Infants can lie on their backs all day and are rarely touched or spoken to; when they are fed, it's often through a large-holed bottle that literally pours liquid down their throats. Without a consistent caregiver hovering around to provide physical and intellectual stimulation — even eye contact and a smile — these children can fall behind in large and small motor-skill development, speech development and even cognitive abilities.

Dr. Dana Johnson, director of the International Adoption Clinic at the University of Minnesota and the father of an internationally adopted daughter, has examined more than 1,000 foreign adoptees. In his paper, "Adopting an Institutionalized Child: What Are the Risks?" (available on the Internet at www.adoption-research.org/risks.html), Johnson says, "What are the chances that my child will be normal on arrival? Let me be blunt. The chance of an institutionalized child being completely normal on arrival in your home is essentially zero."

"People don't understand how damaged these kids can get in a very short period of time," says Greg Keck, director of the Attachment and Bonding Center of Ohio in North Royalton. His center works with families whose children suffer from attachment disorder, a condition common to many foreign adoptees in which they have a difficult time forming trusting relationships with others. In addition, he conducts training sessions for families — including some who are working with a local attorney to adopt from Russia — giving them intensive preparation long before they set off for the orphanage.

"We tell them what has really happened to these children," Keck explains. "Once in a while, this discourages people from adopting, but not usually. The important thing is that they're prepared to deal with the problems right away. It's terrible when people wait years and years before they do something about the child's problems, then call us when the child is 6 years old. They just think the child is having an adjustment problem coming from another culture, but a healthy child will adjust pretty quickly."

"Parents need to be aware of the range of possibilities these children can present," says Adele DiMarco, coordinator of the Rainbow Center for International ChildHealth (RCIC) at Rainbow Babies & Children's Hospital, one of five centers around the country that specialize in the problems, medical and otherwise, of internationally adopted children. The center provides a two-hour consultation to parents who are debating whether or not to accept an agency's referral, providing expert screening of the child's videotape and medical report. "These children are coming with the odds against them," DiMarco continues. "With some intervention, they can do beautifully, but parents need to be prepared for having that intervention when they get back."

But the Kelleys and other parents interviewed for this article say they never heard about any of the problems facing foreign orphans from EAC. And the omission was critical: Had they been prepared with a more realistic view of their children's conditions, they would have been able to have their children diagnosed and begin therapy sooner. Toward the end of Cleveland Magazine's investigation, Cole reported that she had just worked out an agreement with Keck's center for monthly training sessions with her families. Unfortunately, this development came too late for many of her parents. Between the beginning of our investigation, when EAC had just completed its 1,000th adoption, and its end, EAC had arranged about another 100 adoptions. This means that around 1,100 parents may have adopted through EAC without fully understanding the severe problems their children might have.

Adoption professionals and others often criticize international adoption agencies for not preparing families for the burden they are assuming, but some agencies' efforts stand out. Another area adoption agency, Family Adoption Consultants in Macedonia, doesn't place children from Russia but works with a few reputable out-of-state agencies that do. Family Adoption Consultants gives parents an extensive reading list containing all the current research about risk factors and meets individually with each family to discuss the risks; in addition, the agency's staff discusses a number of other issues, including the difference between parenting an adopted child and parenting your own biological child, as well as the additional responsibilities of adopting a child from a different race or culture. Each family is urged to have their child examined immediately upon return by RCIC or another expert in the care of internationally adopted orphans; parents are also connected to a support group.

"We go into great gory detail over all the ups and downs," says Barbara Irvin, the agency's director. "In some ways, it may hurt us because some people get too apprehensive. They might choose to go somewhere where they're being told, •Hey, it's no big deal. It's quick, it's easy, everything will be fine.' Sometimes we wonder if we should rethink this and not emphasize the risks so much, but we've decided to stay this course." Irvin's agency recently strengthened its program by meeting with a group of health-care professionals from RCIC, looking for suggestions for improving its services to parents.

When Cole is asked how rigorously she prepares her couples, she says she does her best; she says that at the very least, she always talks about the risk of fetal alcohol syndrome at the seminars, "unless someone distracts me and I forget." She also says that since February of this year, when Ohio law changed to mandate preadoptive training for both domestic and international adoption agencies, EAC has required prospective parents to attend a seminar plus an on-site, daylong meeting to discuss such issues as child development, separation and loss, and behavioral challenges. Her agency is also in the process of developing a series of post-placement classes for parents that will address a range of issues, from attachment disorder to diarrhea. Cole also says that earlier this year, she sent a letter to parents who adopted five years ago, hoping to learn how those children are doing so that she can alert new parents to what they might expect in the future.

In addition, Cole now has a substance-abuse specialist from Chicago view orphans' videotapes for evidence of fetal alcohol damage and other problems before she refers them on to families. One of the medical professionals interviewed for this article says this is a sign that Cole is trying to improve. Still, this person fears that families might accept this preview as a seal of approval and fail to seek their own consultation with an expert in the wide range of problems associated with international adoption.

While it is true that Cole has made some strides in parent education within the last few months, many parents and professionals are frustrated that she has taken so long to make these changes. They also are angered that she has not taken full advantage of the wealth of expertise available in this area, as well as from around the country, to improve other aspects of her business.

Some of these experts have even contacted Cole to offer help, but to no avail. RCIC's DiMarco called to suggest the center's services in training EAC social workers or in speaking at seminars, but EAC didn't pick up on the offer. Aside from telling parents about the center, EAC has little contact with RCIC. Yet Cole told Cleveland Magazine that she has a working relationship with the center. Another area expert, Wendy Schmidt, a pediatric occupational therapist who specializes in international children's health care and works with a number of post-institutionalized children throughout the area, called EAC and offered to speak at seminars or talk to individual parents. While her counsel could be especially valuable to parents — she can offer simple therapeutic exercises and insights that parents can use as soon as they pluck their children out of the orphanage — her offer was ignored.

And there are other resources that could help both Cole and her families, but she has failed to explore them fully. For instance, she's not a member of the Joint Council on International Children's Services, the oldest and largest professional association of international adoption agencies. This 120-member organization is working hard to establish industry standards for these agencies — which are not regulated by any one government entity — promote ethical practices and improve services to children. Joint Council members must subscribe to the organization's standards and can become involved in a number of committees that help develop best practices on a variety of issues — for example, how to aid the foreign orphans who will never be adopted or how to ensure that the agencies' foreign representatives thoroughly gather critical information. Earlier this year, the Joint Council's education committee issued a 30-page document to set minimum standards for parent preparation, including 12 pages of readings and questions for parents to consider, plus another 15 pages of resources.

When asked why she hasn't joined the Joint Council, Cole says it is too expensive, that she can attend its conference without being a member, that there's plenty of information on the Internet and that her budget for that sort of thing is spent with Resolve. But Resolve is a national organization offering support, advocacy and information — including information about adopting — to people who are infertile. Being a member of Resolve might help Cole find new clients, but it doesn't do a thing to improve her knowledge of issues in international adoption. Moreover, the fee for joining the Joint Council is $2,200 a year for an agency the size of EAC — less than the $3,000 Cole says she pays to Resolve.

Cole also has not taken advantage of the Parents Network for the Post-Institutionalized Child (PNPIC), a national support organization and a comprehensive, well-respected source of information about post-institutionalized children. The organization was launched in 1993 by Thais Tepper, a Pittsburgh woman who adopted a boy from a Romanian orphanage in 1991 and spent the next several excruciating years trying to sort out his complex of behavioral and cognitive problems. Tepper held PNPIC's 1996 conference here in Cleveland, precisely because she'd been hearing from so many EAC parents and knew there was a concentration of families here that needed this information.

"At the time of the conference," Tepper says, "the speaker roster represented about half the experts in the United States who were working with internationally adopted children. Certainly, with three months' advance notice, Margaret could have arranged her schedule to attend. At the very least, her social workers could have attended or she could have used her mailing list to notify her clients."

However, Cole didn't attend. When asked about this, she said her schedule conflicted with the conference, but claimed she had sent one of her social workers — she just couldn't remember which one. But Tepper checked the sign-up sheets from the conference. Either there had been no EAC representative there, or Cole's social worker hadn't disclosed her affiliation.

Of course, all this wouldn't matter so much if EAC adoptions never went wrong. But that hasn't been the case: There have been some devastating outcomes.

To make matters worse, many of the parents interviewed say they made their decisions to adopt based upon misleading information supplied by EAC and that they were rushed into making their decisions. These terrible outcomes underline the need for greater parental education and other safeguards — and, again, prompt observers to wonder why Cole hasn't acted sooner to improve her services. "If you know you've placed children who are brain damaged, have fetal alcohol syndrome and other problems, wouldn't you try your damnedest to make sure that never happened again?" asks Tepper. She estimates that of the 5,000 people who have contacted PNPIC, she has probably heard from more EAC parents than from those adopting through any other agency. And definitely, she says, the most tragic stories have concerned EAC parents.

Cole didn't discuss any of these tragic stories in the first three interviews for this article. When asked about problem placements in the first interview, she mentioned only one case in which a couple didn't want their adopted child and EAC had to find the child a new home. In response to questions in the second interview, she also said that there had been some problems in the agency's early years. By Cole's fourth interview — when Cleveland Magazine had learned of some of EAC's tragic adoptions — Cole admitted to 43 known placements with poor outcomes and said she was glad this article would discuss some of them, since many prospective parents are so starry-eyed about adopting.

She didn't explain why she hadn't discussed any of these problem placements earlier.

All parents pursuing international adoption must get a home study from a licensed adoption agency or social worker, obtain approval from U.S. Immigration and Naturalization and complete a ream of other paperwork to be eligible. After they finish these preliminary steps, they are contacted by their agency with the referral for a specific child. The professionals interviewed for this article say that before parents accept or decline this referral, they should have adequate time to have the child's videotape and medical records reviewed by an expert in the health issues facing international adoptees. Many agencies — EAC claims to be one — follow this policy.

Not long after the Kelleys finished their paperwork, they received a call from Cole — at midnight — saying she had a "healthy, bouncing baby boy" for them to adopt — and they had to decide right then and there if they wanted him, without seeing either a medical report or pictures. The second time they adopted, Cole gave the Kelleys 24 hours to make a decision, this time with a videotape and medical records.

What the Kelleys didn't know about Jordan, their first child, was that he had been born premature, weighing about 3 pounds, and was found on a doorstep,