In a hallway of the Lancaster County Courthouse last Tuesday, people waited anxiously for a chance to settle, one way or another, some of the thorny issues besetting their families.

Amid the people waiting for child custody and guardianship hearings were mothers and children — and men alleged to be the fathers of those children.

Some of the men seemed nervous. Some seemed aggrieved. Some said they were hopeful. All were there to undergo genetic tests to determine paternity.

Twice a month, the Lancaster County Office of Domestic Relations schedules genetic testing sessions at the courthouse. Often, the tests are conducted at the request of men facing the prospect of paying child support.

According to AABB, formerly known as the American Association of Blood Banks, more than a million people underwent DNA tests to determine parentage in 2004.

The demand for biological family relationship testing has grown so dramatically that a company called Identigene now offers home paternity testing kits, which are sold over the counter in pharmacies in some states or can be ordered online.

Clearly, the quest to establish parentage is not confined to those who appear on Maury Povich's daytime talk show, seeking to find their children's "baby daddies."

Christine Rosen, a fellow at the Ethics & Public Policy Center in Washington, D.C., wrote an article in The Wall Street Journal recently about the issue of "paternal discrepancy" — the term applied to situations in which men are unknowingly raising the biological children of other men.

Rosen mused that the

" 'Who's Your Daddy?' problem" generally "has had little impact on the public consciousness unless it involves celebrities," such as Anna Nicole Smith.

But, she wrote, this "might be about to change." She cited research published in 2005, which indicated that in developed countries, roughly one man in 25 is unknowingly raising a child who is not his biological offspring.

It may be difficult to measure whether infidelity is on the rise, Rosen noted, but the increasing interest in paternity tests suggests that "suspicion about it might be."

The way it was
Dr. Elizabeth Panke, an expert on genetic testing, wrote in last May's Journal of Urgent Care Medicine: "For many generations, defining the parent-child relationship was easy. The woman who gave birth to the child was the child's legal mother; to a large extent, fatherhood was assigned on a social basis.

"With the advent of DNA testing, however, the social definition of fatherhood is increasingly being replaced by a genetic test."

In a telephone interview, Panke — the founder of Genetica DNA Laboratories Inc. in Cincinnati — said biological-family relationship testing is used for reasons other than establishing paternity.

In this post 9/11 world, people seeking to immigrate to the United States have to produce proof of a biological relationship to a sponsoring relative who resides here. Her laboratory regularly collects DNA specimens from U.S. residents hoping to sponsor relatives.

Wealthy people sometimes undergo testing to generate genetic profiles, which are kept with their wills in case, after their deaths, long-lost relatives materialize, claiming a biological relationship — and a stake in their estates.

The vast majority of genetic family relationship testing, however, is used to establish parentage.

Easy to collect
Such testing has become more prevalent, in part, because DNA samples are more easily collected now. Blood no longer needs to be drawn to ensure a reliable genetic test.

Now, the preferred method for collecting a DNA sample is the buccal swab ("buccal" simply refers to the mouth or cheek). The insides of cheeks are rubbed with cotton swabs, removing cells.

While Panke can attest to the increasing use of DNA testing, she is reluctant to comment on the reasons people feel uncertain about the parentage of their children.

"Speculating about people's behavior is not my area of expertise," Panke said.

Diane Fralich is the director of the Lancaster County Office of Domestic Relations, a section of the county Court of Common Pleas. Her office is charged with establishing and enforcing child support arrangements. The office also helps clients to establish paternity for their children.

"It doesn't matter what circumstances brought them here," Fralich said. "We need to establish paternity so we can get support to their children."

Last year, nearly 4,500 cases were filed with Fralich's office. Paternity was established for more than 1,000 children last year — in most cases, the fathers voluntarily acknowledged paternity.

The court ordered genetic testing to resolve paternity in roughly 400 cases.

In 2007, 17 percent of the men who were tested were excluded — that is, they were found to not have fathered the children they were alleged to have fathered. (Men are required to pay the costs of the genetic testing if it reveals them to be the biological fathers of the children in question.)

Bruce R. Martin, the deputy director of the Domestic Relations Office, said that in the early 1980s, clients who underwent paternity testing had to go to Columbia Hospital for blood tests.

The blood tests were traumatic for many children, despite the phlebotomists' best efforts to minimize the trauma. Babies sometimes were immobilized in papoose restraints, for the tests.

"They tried to do as much as they could but the process itself was invasive," Fralich said.

In the mid-1980s, the Domestic Relations Office started to use a form of blood test called the HLA test, which examined white blood cells. The HLA tests were held to be more accurate than earlier tests, but they could not be conducted on children younger than 6 months.

This delay in testing meant that child-support arrangements also were held up. It took an additional two months for the results to be returned.

"The process was so long that people dropped out," Martin said. "The father disappeared, or the mother gave up."

At least five years ago — officials weren't sure of the precise year — the buccal swab technology was adopted by the Domestic Relations Office.

The swab tests "just streamlined the entire process," Fralich said.

"Now, we get results within two weeks," Martin said, noting that the "science is so good," and the veracity of the results is so widely accepted, that the whole legal process has become more efficient.

Disprove paternity
The tests, essentially, seek to disprove paternity. According to information from LabCorp, the North Carolina company that analyzes the DNA samples, when paternity cannot be disproved, the lab will continue to test until it can determine a probability of paternity that is greater than 99 percent.

Those who undergo genetic testing at the Lancaster County Courthouse are required to bring photo identification, "just to make sure that Joe Smith doesn't send in his brother, Bob," Martin said, noting, "It just adds to the credibility of the test."

The men, women and children are photographed, and the adults are fingerprinted. A technician swabs the insides of each person's mouth four times — twice on the insides of each cheek — to extract DNA.

The technician adheres to a strict set of procedures, to ensure what forensic experts call a legally unassailable "chain of custody." The DNA samples then are sent to LabCorp for analysis.

Still the pain
The process is less traumatic than when blood needed to be drawn. Still, for some people, there is another kind of pain involved.

Last Tuesday morning, one couple exchanged angry words as they, and the 3-month-old infant girl they took turns holding, waited to undergo the genetic testing. The 19-year-old woman said her former boyfriend needed to "step up and be a man."

The man, who said he was 36, said his ex-girlfriend was depriving him of contact with the infant. He said he couldn't wait to take the paternity test; he said he intended to sue for custody.

Across the corridor, a trio of modestly dressed women stood quietly with a small girl. The women wore traditional Old German Baptist Brethren garb — prayer caps, long frocks, capes. The little girl, who wore a pixie haircut and a too-large plaid dress, was a foster child, and so the women with her said they could not say why she was at the courthouse for genetic testing.

An African-American woman, wearing a Muslim head-scarf, was there with her 4-year-old son. The boy's father wasn't denying paternity, the woman said. He just needed proof of paternity for "his insurance and other reasons," she said.

Yet another young woman had brought her infant son for testing. Her mother came along, to lend moral support.

This young woman had not intended to ask for child support from her baby's father, she said.

She broke up with her boyfriend, she said, after his mother suggested she have an abortion. Determined to have the baby, the young woman said she invited her ex-boyfriend to prenatal appointments but he never came. He was not at the hospital when the baby was born, she said.

She doesn't really know what he wants now, she said. All she knows is that his family had insisted on a DNA test and had engaged a lawyer to pursue visitation rights. When she learned of this, her own lawyer advised her to file for child support.

"My daughter keeps everything in," the baby's maternal grandmother said, cradling her grandson. "But I know she's extremely worried. ... This is her life, this tiny handful."

A 28-year-old woman named Michelle had brought her 2-month-old son for genetic testing, at the behest of the baby's alleged father, a 28-year-old man who said his first name was Jason.

"I thought there was a chance he might not be mine," Jason said, noting that he and Michelle "were together off and on ... I just needed to know 100 percent."

Jason said he has another child, with another woman. He noted, "I don't think either of my kids look like me."

Michelle said she was expecting him to ask for the DNA test. "I have no problem with it at all," she said with an air of resignation. "This is just for (child) support.

"It's just holding the other person responsible, making sure the responsibility is shared between them," she said, adding, "because it takes two to make a baby."

Another couple, who said their first names were Kathy and Rafael, had the DNA test with their 9-year-old daughter.

Rafael pointed to the waiting area outside of the conference room where the genetic testing was being conducted. "A lot of people look angry and stressed," he said. "It's not good — especially when it comes to your child."

By contrast, he and Kathy quietly joked with one another, and with their daughter.

"I've been in her life since day one," Rafael said, giving his presumed daughter an affectionate nudge. And as for Kathy, he said, "We're both in agreement. ... We're not at each other's throats."

"We're cool," Kathy agreed. "We have a child together. We have to be all right. ... I like him as a person. He likes me, hopefully. We work together to take care of her."

They were there to have the test, Rafael said, because they wanted to be absolutely sure he was their child's biological father.

"We didn't want to wait 22 years and be on 'The Maury Show,' " Rafael joked, adding in a voice meant to be his daughter's, at age 22, " 'I've been looking for you, Dad!' "

Growing industry
Dr. Panke said that biological family relationship testing has many benefits. But she said she worries that genetic testing — like other relatively new technologies — "is ahead of our ethical knowledge of how to use the technology."

The DNA testing industry is largely unregulated, she said. "Anybody can open a laboratory," Panke said.

And DNA testing "can cause a lot of harm in the wrong hands," she asserted.

She is appalled, for instance, by companies offering so-called "infidelity testing." People can furtively collect DNA evidence from the undergarments of their spouses and lovers, and ship the specimens off to be analyzed for evidence of betrayal.

"It should be against the law to have DNA tests on someone without their consent," Panke maintained.

Identigene, the company that makes home paternity testing kits, offers one kit it calls the "Discreet" Paternity Test (for "when only you need to know"). The kit is intended to be used by those who want to surreptitiously test for parentage, by sending in items such as fingernail clippings, "sweaty T-shirts," dental floss, chewed gum and undergarments.

Home testing may be convenient, but it is very easy to contaminate a sample, inadvertently or purposely, Panke said. This raises the possibility of either fraud — of one party trying to deceive another — or of important decisions being based on faulty information.

"Contamination is such a big risk, and (people) make such big, big decisions about family life and children based on those results," Panke said.

The increasing accessibility of genetic testing poses a more fundamental question, Panke believes. She thinks society needs to decide "what makes a parent."

It's her personal view, she said, that biology plays a role in determining parenthood, but it does not necessarily define it.

Society, Panke said, is going to have to "think through these things."

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Suzanne Cassidy is a staff writer for the Sunday News. Her e-mail address is scassidy@lnpnews.com.