A class-action lawsuit alleges that the Pan American Health Organization has collected more than $75 million “by enabling, managing, and enforcing illegal human trafficking of Cuban medical professionals in Brazil.”
Lawyers for the PAHO argue that the trafficking claims “are grossly inaccurate” and “bear almost no resemblance to reality.”
Undeterred, lawyers for four Cuban doctors named as plaintiffs in the suit have asked U.S. District Court Judge James E. Boasberg to allow additional discovery in the case.
On Sept. 18, they wrote:
“Plaintiffs seek only information about and copies of agreements PAHO has executed in connection with Mais Médicos,” a Brazilian health program that employed Cuban doctors. See Exhibit A and Exhibit B.
Lawyers for the PAHO oppose additional discovery. “Plaintiffs are not entitled to an extra bite at the apple simply because they wish one,” they wrote on Sept. 22.
The class-action suit was filed in U.S. District Court in Miami on Nov. 30, 2018. As the months dragged on, the case appeared to stall and no new documents were filed in the lawsuit from July 2, 2019, to April 3, 2020. (See “Was lawsuit over Cuban doctors a publicity stunt?“).
But on April 3, 2020, the suit was transferred to U.S. District Court in Washington, D.C. where it has been advancing.
The PAHO contends that it is immune from prosecution. Their lawyers add:
…while the substance of Plaintiffs’ allegations is separate from the grounds for dismissal that PAHO advances here, PAHO believes it is important to note that Plaintiffs’ claims are grossly inaccurate; indeed, they bear almost no resemblance to reality. The program at the heart of Plaintiffs’ claims, Mais Médicos, was a highly successful public-health endeavor. It was lawfully established and operated by the Brazilian government to provide much-needed medical care to roughly 60 million people, including millions living in the most remote, underserved areas of the Amazon basin, many of whom had never before seen a doctor. And because not enough of Brazil’s own doctors and other health professionals were willing or available to provide this care, Brazil permitted doctors from other countries to serve in the program. Many of those doctors, including the Plaintiffs here, were Cuban nationals employed by the Cuban government. Plaintiffs allege that their government underpaid and mistreated them during their participation in the program. But they have not sued Cuba, nor provided any colorable legal basis for holding PAHO accountable for the alleged conduct of one of its Member States. PAHO strongly opposes human trafficking, and thoroughly rejects Plaintiffs’ allegations that PAHO was involved in or had any knowledge of human trafficking in connection with Mais Médicos. PAHO provided lawful technical cooperation and administrative support to Member States that requested assistance with the implementation of a national public-health program in Brazil that facilitated universal health coverage and access to health services to impoverished populations and neglected regions in that country. PAHO’s activities in support of the program complied with all applicable law and PAHO’s governing charter and rules.
Nations of the Americas founded the PAHO in 1902 to find ways to work together to solve “transnational public-health problems, including lack of access to health care, epidemics, and the spread of communicable diseases.”
PAHO’s lawyers write:
“This lawsuit has already imposed significant burdens on PAHO, consuming funds that would otherwise be available to further PAHO’s public-health mission — at a time when the coronavirus pandemic has made that mission more important than ever. PAHO respectfully requests its immediate dismissal from this lawsuit so that it can focus its attention and resources on helping Member States combat the pandemic as well as other ongoing public-health crises.”
PAHO lawyers say Mais Médicos or More Doctors benefited more than 60 million people. They wrote:
Under the program, tens of thousands of health-care professionals from all over the world — including some 20,000 Cuban physicians over a five-year period — went to Brazil to render urgently needed medical care to Brazilian residents.
Because of the critical shortage of doctors and other health professionals in the country, the Brazilian government implemented the Mais Médicos program by enacting legislation to:
(1) strengthen the health care infrastructure in that country,
(2) increase medical school enrollment and specialization of medical personnel, and
(3) address the emergency shortage of doctors available to provide primary health care particularly in poor and neglected regions of the country.
To implement the third pillar of the program, the law authorized the government to allow medical professionals from other countries to provide medical services to Brazilians in locations where Brazilian doctors were not available.
The law also enabled the Brazilian government to secure the services of qualified doctors from other countries and to work with international organizations to do so. As a result, Brazil engaged in diplomatic discussions with other countries, including Cuba, and with international organizations such as PAHO. These discussions resulted in the establishment of two separate bilateral international agreements between PAHO and the ministries of health of the governments of Brazil and Cuba. Pursuant to those agreements, each country called upon PAHO to support the Mais Médicos program by providing technical cooperation and support in accordance with its public-health mission and responsibilities to Member States.
This international technical cooperation continued through the administrations of two Brazilian presidents and is still ongoing today. According to the operative complaint, however, President Bolsonaro, who took office in 2019, prompted Cuba to withdraw from the program when he announced that, contrary to Cuba’s wishes, Brazil would begin to “pay [Cuban doctors] directly and provide them with an opportunity to qualify to stay in Brazil long-term.”
Plaintiffs are four physicians selected, trained, and employed by the Cuban government to provide medical services to Brazilian citizens in the Mais Médicos program; they served in Brazil between 2013 and 2017, before leaving the program for the United States. Plaintiffs claim that their service in Mais Médicos amounted to “forced labor” under the Trafficking Victims Protection Act.
Plaintiffs further claim that PAHO is partially responsible for these alleged forced-labor practices by the Cuban government, on the theory that PAHO supposedly helped create the Mais Médicos program. Plaintiffs place particular emphasis on PAHO’s alleged role in supposedly transferring funds from Brazil to Cuba and on payments that PAHO allegedly received in connection with the program.
Lawyers for the PAHO are Patrick J. Carome, David W. Bowker and Daniel S. Volchok of the Washington, D.C., firm, Wilmer, Cutler, Pickering, Hale and Door.
“There are acts of the foreign legislature, orders of the foreign president, and rulings by the foreign courts, all confirming the legality of the public-health program in question. In that circumstance, it is not for a U.S. court to second-guess the program’s wisdom or legality.”
On Aug. 10, 2020, lawyers for the Cuban doctors – Ramona Matos Rodriguez, Tatiana Carballo Gomez, Fidel Cruz Hernandez, and Russela Margarita Sarabia – filed a document in opposition to the PAHO’s motion to dismiss. They wrote:
Plaintiffs are Cuban physicians now living in the United States. Plaintiffs’ complaint alleges that between 2013 and 2018, the Government of Cuba forced them and thousands of others to work in a “medical mission” in Brazil, using political pressure, threats to their economic well-being, threats against their family members, and other forms of intimidation.
In Brazil, their movements and contacts with the outside world (including with their own children) were restricted, while they were compelled to render medical services—and engage in acts of political propaganda—for a small fraction of the money the Government of Brazil paid for their services. Ninety percent of Brazil’s payments were divided between the Government of Cuba and Defendant PAHO.
Cuba generates billions of dollars each year by sending its medical professionals to work in foreign countries and confiscating the lion’s share of their wages. Revenue from these foreign labor missions comprises the largest single element—over 50%—of the Cuban national budget. Over several decades, the Cuban government has “exported” hundreds of thousands of its own citizens to dozens of countries as part of this lucrative enterprise. Cuba’s medical missions were notorious enough that, in 2006, the United States instituted the Cuban Medical Professional Parole Program to “allow Cuban medical personnel conscripted to study or work in a third country . . . to enter the United States.”
Approximately 3,500 individuals trafficked to Brazil defected to the United States, among them Plaintiffs, and Plaintiffs bring this suit on behalf of all of them.
If the medical mission to Brazil — called the Mais Medicos program — was not unique in generating large revenues for the Cuban regime, it was unique in a different respect: it was enabled, managed, and enforced by an international organization, PAHO. From its base in Washington, D.C. — and even as the United States Government was paroling trafficked medical professionals into this country on humanitarian grounds — PAHO facilitated the scheme to traffic Plaintiffs and thousands of others to Brazil. Among other things, PAHO routed well over $1 billion paid by Brazil for the doctors’ services to Cuba through its bank account in Washington, D.C. Id. For this, PAHO was compensated handsomely, as it was allowed to keep 5% of the doctors’ earnings — more than $75 million — for itself.
Plaintiffs allege that PAHO violated the Trafficking Victims Protection Reauthorization Act (“TVPRA”) and the Racketeer Influenced and Corrupt Organizations (“RICO”) Act, as well as international law. They seek compensation from PAHO for their unpaid wages and those of approximately 3,500 other Cuban doctors trafficked to Brazil who are now living in the United States. PAHO seeks to evade accountability, claiming immunity as an international organization
and asserting that comity borrowed from the governments with which it conspired protects it from suit. The Court should reject its arguments.
PAHO is not entitled to immunity under the Charter of the United Nations (“U.N. Charter”) or the Constitution of the World Health Organization (“WHO Constitution”) because neither instrument has force of law in U.S. courts, and neither instrument affords PAHO the absolute immunity it claims. PAHO is also not entitled to immunity under the International Organizations Immunities Act (“IOIA”) because the conduct in which Plaintiffs allege it engaged is commercial
in nature, involves a taking of property in violation of international law, and has a domestic nexus.
In its opening statement and throughout its brief, PAHO rejects Plaintiffs’ factual allegations detailing PAHO’s role in organizing, managing, enforcing, and profiting from Cuba’s trafficking of Plaintiffs and thousands of others. In their place, Defendant offers public relations talking points about the benefits of the Mais Medicos program in Brazil and PAHO’s work in general. But PAHO’s motion cannot be decided on the basis of those assertions; rather, the Court must credit Plaintiffs’ factual allegations. But even if PAHO’s counterfactual could be considered, the supposed benefits of Mais Medicos could not justify modern day slavery.
Lawyers for the plaintiffs are Charles J. Cooper, Michael W. Kirk, Haley N. Proctor, Jonathan W. Cuneo, Peter Gil-Montllor and Samuel J. Dubbin. They write:
The complaint details PAHO’s role in planning and executing a conspiracy to evade domestic and international law, and even PAHO’s own rules. When an international organization designs a program, the first question is not usually “how are we going to break the law?” In this case, it was. These concerns are not only documented in Plaintiffs’ lawsuit here, but they have been publicly expressed by several independent institutions, including the governments of the United States and Brazil, PAHO’s own auditor, and other international organizations and human rights advocacy groups. The time has come for PAHO to answer to the victims for its actions.
Sept. 4, 2020: PAHO reply in support of motion to dismiss
May 12, 2020: Plaintiff’s amended complaint
April 3, 2020: Change of venue order