II 

116TH CONGRESS 

2D SESSION S. 4635 

To respond to international trafficking of Cuban medical professionals by 

the Government of Cuba, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 21, 2020 

Mr. MENENDEZ (for himself and Mr. RUBIO) introduced the following bill; 

which was read twice and referred to the Committee on the Judiciary 

A BILL 

To respond to international trafficking of Cuban medical 

professionals by the Government of Cuba, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Combating Trafficking of Cuban Doctors Act of 2020’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Sense of Congress. 

Sec. 4. Annual report and determination on international trafficking of Cuban 

medical personnel. 


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Sec. 5. Reestablishing the Cuban Medical Professionals Parole program. 

Sec. 6. Role of the Pan American Health Organization. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) In 2019, the Government of Cuba main4 tained an estimated 34,000 to 50,000 medical per5 sonnel in more than 60 countries under conditions 

6 that represent forced labor, according to the Depart7 ment of State. 

8 (2) Since the outbreak of the COVID–19 pan9 demic in early 2020, the Government of Cuba has 

10 deployed approximately 1,500 medical personnel to 

11 at least 20 countries. 

12 (3) The Department of State’s 2020 Traf13 ficking in Persons report ranked Cuba in Tier 3 and 

14 included evidence regarding Cuba’s foreign medical 

15 missions and the Government of Cuba’s long16 standing failure to criminalize most forms of forced 

17 labor, specifically noting allegations that Cuban au18 thorities coerced participants to remain in foreign 

19 medical missions by— 

20 (A) ‘‘withholding their passports and med21 ical credentials’’; 

22 (B) ‘‘using ‘minders’ to conduct surveil23 lance of participants outside of work’’; 

24 (C) ‘‘restricting their movement’’; 


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1 (D) ‘‘retaliat[ing] against their family 

2 members in Cuba if participants leave the pro3 gram’’; or 

4 (E) ‘‘impos[ing] criminal penalties, exile, 

5 and family separation if participants do not re6 turn to Cuba as directed by government super7 visors’’. 

8 (4) On July 26, 2019, the United States im9 posed visa restrictions under section 212(a)(3)(C) of 

10 the Immigration and Nationality Act (8 U.S.C. 

11 1182(a)(3)(C)) against certain Cuban officials and 

12 other individuals responsible for the coercive labor 

13 practices of Cuba’s overseas medical missions. 

14 (5) The United Nations Special Rapporteur on 

15 contemporary forms of slavery and the United Na16 tions Special Rapporteur on trafficking in persons, 

17 especially women and children, in their letter to the 

18 Government of Cuba on November 6, 2019— 

19 (A) noted reports of coercive labor prac20 tices through the Government of Cuba’s foreign 

21 medical missions; 

22 (B) highlighted reports by Cuban medical 

23 professionals that they received regular threats 

24 from Cuban officials while working overseas, in25 cluding sexual harassment of women; and 


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1 (C) expressed concern that the practices 

2 referred to in subparagraphs (A) and (B) con3 stitute slavery and trafficking in persons. 

4 (6) In July 2013, the Cuban Ministry of Health 

5 signed an agreement with the Brazilian Ministry of 

6 Health to formalize an arrangement for Cuban doc7 tors to provide medical services in Brazil that— 

8 (A) required the administration of former 

9 Brazilian President Dilma Rousseff to transmit 

10 a monthly payment through the Pan American 

11 Health Organization (referred to in this section 

12 as ‘‘PAHO’’) to the Cuban Ministry of Health 

13 for the medical services provided by each Cuban 

14 doctor serving in Brazil; and 

15 (B) prevented participating Cuban doctors 

16 from seeking employment in Brazil outside of 

17 the formal structure of the agreement. 

18 (7) In implementing the agreement described in 

19 paragraph (6), the Cuban Ministry of Health acted 

20 through the for-profit Cuban Medical Services Trad21 ing Corporation (referred to in this section as 

22 ‘‘CMS’’)— 

23 (A) to pay each Cuban doctor approxi24 mately 25 percent (averaging $790) of the 


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1 monthly payment received from PAHO (aver2 aging $3,158); and 

3 (B) to retain approximately 75 percent of 

4 the monthly payment for each doctor received 

5 from PAHO. 

6 (8) Between 2013 and 2019, according to the 

7 digital platform Diario de Cuba, the Government of 

8 Cuba— 

9 (A) garnished the salaries of more than 

10 20,000 Cuban medical professionals who served 

11 in Brazil under the Mais Me ́dicos program; 

12 (B) frequently confiscated their passports; 

13 and 

14 (C) prohibited family members from ac15 companying them. 

16 (9) Cuban doctors were the only medical profes17 sionals participating in the Mais Me ́dicos program to 

18 have their salaries directly garnished by their gov19 ernment, while doctors of other nationalities serving 

20 in Brazil received the full amount of the payments 

21 made for their medical services under the program. 

22 (10) The Government of Cuba stated that 

23 Cuban doctors unwilling to return to the country 

24 after their participation in foreign medical missions 


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1 would not be permitted to return to their homeland 

2 for 8 years. 

3 (11) In February 2019, Brazil’s Ministry of 

4 Health announced the termination of the Mais 

5 Me ́dicos program. 

6 (12) The Government of Cuba realized profits 

7 in excess of $6,300,000,000 during 2018 from ex8 porting the services of Cuban professionals, of which 

9 foreign medical missions represent the majority of 

10 the services and income. 

11 (13) Countries in which similar abuses to those 

12 suffered by Cuban medical professionals in Brazil 

13 have been reported to have occurred include Angola, 

14 Guatemala, Mexico, Qatar, and Venezuela. 

15 (14) In Venezuela, a group of Cuban doctors 

16 reported in 2019 that they had been directed, and 

17 often coerced, to use their medical services to influ18 ence votes in favor of the Maduro regime, includ19 ing— 

20 (A) by denying medical treatment to oppo21 sition supporters; and 

22 (B) by giving precise voting instructions to 

23 elderly patients. 

24 (15) The term ‘‘severe forms of trafficking in 

25 persons’’ is defined under section 103(11)(B) of the 


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1 Trafficking Victims Protection Act of 2000 (22 

2 U.S.C. 7102(11)(B)) as ‘‘the recruitment, harboring, 

3 transportation, provision, or obtaining of a person 

4 for labor or services, through the use of force, fraud, 

5 or coercion for the purpose of subjection to involun6 tary servitude, peonage, debt bondage, or slavery’’. 

7 SEC. 3. SENSE OF CONGRESS. 

8 It is the sense of Congress that— 

9 (1) the Government of Cuba subjects Cuban 

10 doctors and other medical professionals to state11 sponsored human trafficking; 

12 (2) the Government of Cuba should fully com13 pensate Cuban medical professionals who have par14 ticipated in, or who are currently participating in 

15 foreign medical mission programs in other countries, 

16 including Brazil’s Mais Me ́dicos program, for the 

17 full amount of wages paid to the Government of 

18 Cuba; 

19 (3) the Government of Cuba should immediately 

20 and transparently respond to requests for informa21 tion from the United Nations Special Rapporteur on 

22 contemporary forms of slavery and the United Na23 tions Special Rapporteur on trafficking in persons, 

24 especially women and children; and 


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1 (4) foreign governments that sign agreements 

2 with the Government of Cuba or the for-profit 

3 Cuban Medical Services Trading Corporation or 

4 other companies affiliated with the Government of 

5 Cuba to procure the services of Cuban medical pro6 fessionals directly assume legal risks related to their 

7 participation in forced labor arrangements. 

8 SEC. 4. ANNUAL REPORT AND DETERMINATION ON INTER9 NATIONAL TRAFFICKING OF CUBAN MEDICAL 

10 PERSONNEL. 

11 (a) ANNUAL REPORT.—Not later than 180 days after 

12 the date of the enactment of this Act and annually there13 after until the date specified in subsection (c), the Sec14 retary of State shall submit a report to the Committee 

15 on Foreign Relations of the Senate and the Committee 

16 on Foreign Affairs of the House of Representatives that— 

17 (1) identifies the countries that are hosting 

18 Cuban medical personnel who are participating in 

19 foreign medical missions for the Government of 

20 Cuba; 

21 (2) to the extent feasible, includes an estimate 

22 of— 

23 (A) the number of Cuban medical per24 sonnel in each country; and 


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1 (B) the value of the financial arrangement 

2 between the Government of Cuba and the host 

3 country government; and 

4 (3) describes the conditions in each country 

5 under which Cuban medical personnel live and work. 

6 (b) DETERMINATION ON HUMAN TRAFFICKING.—In 

7 each report submitted pursuant to subsection (a), the Sec8 retary of State shall determine whether— 

9 (1) the Cuban medical personnel in each coun10 try identified in the report are subjected to condi11 tions that qualify as severe forms of trafficking in 

12 persons (as defined in section 103(11) of the Traf13 ficking Victims Protection Act of 2000 (22 U.S.C. 

14 7102(11))); and 

15 (2) Cuba’s foreign medical missions program 

16 constitutes proof of failure to make significant ef17 forts to bring the Government of Cuba into compli18 ance with the minimum standards for the elimi19 nation of trafficking in persons (as determined 

20 under section 108 of the Trafficking Victims Protec21 tion Act of 2000 (22 U.S.C. 7106)). 

22 (c) SUNSET.—The Secretary of State is not required 

23 to submit the report otherwise required under subsection 

24 (a) after the date on which the Secretary submits a second 

25 consecutive annual report under such subsection that inVerDate Sep 11 2014 19:32 Oct 05, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4635.IS S4635

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1 cludes a determination under subsection (b) that Cuban 

2 medical personnel are no longer subjected to trafficking 

3 in persons. 

4 SEC. 5. REESTABLISHING THE CUBAN MEDICAL PROFES5 SIONAL PAROLE PROGRAM. 

6 (a) IN GENERAL.—The Secretary of Homeland Secu7 rity, in coordination with the Secretary of State, shall rein8 state the Cuban Medical Professional Parole program to 

9 authorize the admission into the United States of Cuban 

10 medical personnel conscripted to study or work in a third 

11 country under the direction of the Government of Cuba. 

12 (b) AUTHORITY.—The Director of U.S. Citizenship 

13 and Immigration Services may exercise its discretionary 

14 parole authority under section 212(d)(5)(A) of the Immi15 gration and Nationality Act (8 U.S.C. 1182(d)(5)(A)) and 

16 subsections (c) and (d) of section 212.5 of title 8, Code 

17 of Federal Regulations, to permit eligible Cuban nationals 

18 to come to the United States, including for urgent human19 itarian reasons or significant public benefit. 

20 (c) ELIGIBILITY CRITERIA.— 

21 (1) IN GENERAL.—A Cuban medical profes22 sional is eligible for consideration of parole under 

23 the Cuban Medical Professional Program if he or 

24 she— 


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1 (A) is a Cuban national, citizen, or person 

2 habitually residing in Cuba; 

3 (B) is a medical professional who, at the 

4 time he or she seeks such parole, is conscripted 

5 by the Government of Cuba to study or work in 

6 a third country; and 

7 (C) is not inadmissible under section 

8 212(a) of the Immigration and Nationality Act 

9 (8 U.S.C. 1182(a)). 

10 (2) ADMISSION OF FAMILY MEMBERS.— 

11 (A) IN GENERAL.—The spouse and unmar12 ried children accompanying the primary appli13 cant in the third country referred to in para14 graph (1)(B) shall be eligible for parole under 

15 the Cuban Medical Professional Program in 

16 conjunction with an application from an indi17 vidual described in paragraph (1). 

18 (B) APPLICATIONS.—A Cuban medical 

19 professional granted discretionary parole under 

20 section 212(d)(5)(A) of the Immigration and 

21 Nationality Act (8 U.S.C. 1182(d)(5)(A)) pur22 suant to this section may submit an application 

23 to U.S. Citizenship and Immigration Services 

24 seeking admission to the United States of his or 

25 her spouse and unmarried children. 


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1 SEC. 6. ROLE OF THE PAN AMERICAN HEALTH ORGANIZA2 TION. 

3 (a) FINDINGS.—Congress finds that the Pan Amer4 ican Health Organization (referred to in this section as 

5 ‘‘PAHO’’)— 

6 (1) has contributed to the health and well-being 

7 of the people in the Western Hemisphere for longer 

8 than a century, with the United States serving as a 

9 member state since 1925; 

10 (2) engages in technical cooperation with its 

11 member countries— 

12 (A) to fight communicable and noncommu13 nicable diseases and their causes; 

14 (B) to strengthen health systems; and 

15 (C) to respond to emergencies and disas16 ters; 

17 (3) as of August 24, 2020, had assisted dozens 

18 of countries in the Western Hemisphere region with 

19 their response to the COVID–19 pandemic, includ20 ing— 

21 (A) the provision of 6,200,000 COVID–19 

22 tests to 36 countries and territories; 

23 (B) 84 shipments of personal protective 

24 equipment to 29 countries; and 

25 (C) other technical support and training to 

26 its member states; 


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1 (4) has commissioned a third party review of its 

2 role in the Mais Me ́dicos program; and 

3 (5) has committed to undertake reforms to 

4 strengthen its internal oversight and risk manage5 ment for all future programs. 

6 (b) SENSE OF CONGRESS.—It is the sense of Con7 gress that— 

8 (1) PAHO is the preeminent multilateral orga9 nization dedicated to public health issues in the 

10 Americas; 

11 (2) PAHO— 

12 (A) has played a vital role in strengthening 

13 health systems in Latin America to address the 

14 COVID–19 pandemic; and 

15 (B) continues to provide essential health 

16 assistance to meet the needs of Venezuelans af17 fected by the ongoing humanitarian crisis in 

18 their country and displaced individuals in other 

19 countries in the region; 

20 (3) the United States should continue to sup21 port PAHO, including through payment of assessed 

22 contributions (in full and on time) and voluntary 

23 contributions, to ensure PAHO’s continued oper24 ations; 


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1 (4) PAHO’s role in the Mais Me ́dicos program, 

2 as described in section 2, was deeply concerning; and 

3 (5) PAHO should provide greater transparency 

4 about its role in the Mais Me ́dicos program and 

5 strengthen its internal oversight and risk manage6 ment. 

7 (c) REPORT.—Not later than 90 days after the date 

8 of the enactment of this Act, the Secretary of State and 

9 the Secretary of Health and Human Services shall submit 

10 a report to the Committee on Foreign Relations of the 

11 Senate and the Committee on Foreign Affairs of the 

12 House of Representatives that includes— 

13 (1) a review of and findings on PAHO’s role in 

14 the Mais Me ́dicos program between 2013 and 2019; 

15 (2) a summary of corrective actions to be taken 

16 by PAHO; and 

17 (3) recommendations for further corrective ac18 tions, as necessary. 

19 (d) ACCOUNTABILITY MEASURES.—The Secretary of 

20 State and the Secretary of Health and Human Services 

21 shall jointly— 

22 (1) take all necessary steps to ensure that 

23 PAHO undertakes governance reforms that 

24 strengthen internal oversight and risk management 

25 for all future programs; and 


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1 (2) not later than 30 days after the receipt of 

2 the results of the independent, third-party review of 

3 PAHO’s role in the Mais Me ́dicos program, provide 

4 a briefing to the Committee on Foreign Relations of 

5 the Senate and the Committee on Foreign Affairs of 

6 the House of Representatives that includes a de7 tailed summary of such results and the progress 

8 made in PAHO’s efforts to strengthen internal over9 sight and risk management. 

Æ 


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