“Mais Medicos”

Program Factsheet

Cuban doctors who served in Brazil, who defected and came to the United States under the Cuban Medical Professionals Parole Program have filed a class action lawsuit against PAHO, alleging PAHO violated the U.S. Trafficking Victims Protection Act and Racketeering Influenced and Corrupt Organizations (RICO) Act in Federal Court in Miami.
  • Under former President Lula da Silva, Brazil first announced a medical services crisis in 2010. Brazil entered into a relationship with Pan American Health Organization (PAHO) in August of 2013 whereby it would provide “healthcare help and technical cooperation” for the “poor and downtrodden” through Mais Medicos.
  • Mais Medicos was initially designed as an “academic fellowship,” but it became quickly clear that the program was organized to avoid Brazil’s appropriations, labor, immigration and medical standards laws, and for Cuba to profit a substantial amount of money.
  • The program claimed it was short on applicants — at which point PAHO came to the rescue with roughly 5,000 doctors in an August 2013 legal agreement with Brazil’s Ministry of Health. According to official documents, the Cuban doctors saw less than 10% of monies paid by Brazil for their services.
  • PAHO signed an agreement with the Comercializadora de Medicos Cubanos, SA (SMC) – a company established by the Cuban government in 2012 — for the contracting of Cuban Doctors to work in Brazil. In total, Brazil received 15,000 doctors.
  • According to cables between the Cuban and Brazilian Embassies in 2012, SMC’s function was “coordinating commercialization of medical services in Cuba and in the outside.” (SMC does not appear on the OFAC sanctions list.)
  • Those cables showed that doctors would be subjected to Cuba’s standard rules for overseas medical missions, which constitute forced labor and human trafficking under national and international law:
  • Doctors worked for less than 10 percent of the fair market value for their professional services
  • Doctors were separated them from their families and restricted from interaction with locals
  • Doctors were restricted from moving freely in Brazil and deprived of proper identification and travel documents
  • Doctors were placed under 24-hour surveillance by Cuban intelligence officers in Brazil
  • Doctor were required to engage in political indoctrination of the local population
  • Over the past five years alone, PAHO has profited more than $75 million for itself through ‘Mais Medicos’ and sent more than $1.5 billion to Cuba through US bank accounts.
  • After President Bolsonaro determined it was a violation of Brazilian law to pay Cuba for the doctors’ services, Cuba terminated their relations with Brazil and called all the foreign doctors home.
  • The Brazilian government announced it would allow for doctors to stay in Brazil with full wages and condemned the Pan American Health Organization for its role in human trafficking at the United Nations General Assembly in 2019.

Cuban Doctors v. Pan American Health Organization (PAHO)

Second Amended Complaint
(Click on download icon to open)

Cuban Doctors v. Pan American Health Organization (PAHO)

What is the case about?

Cuban doctors were sent to Brazil from 2013 to 2017 to provide medical services to underserved populations in a program called “Mais Medicos” under the direction of the Pan American Health Organization (PAHO). The Doctors allege that the Mais Medicos program was an illegal, forced labor enterprise that  generated hundreds of millions of dollars for the Cuban government.  Brazil paid PAHO for the doctors’ services.  PAHO transferred 85% of the money to Cuba, paid the Doctors approximately 10%  and kept 5% for itself.  In all. PAHO pocketed some $75 million in illegal profits from human trafficking, and sent over $1.3 billion to Cuba that should have been paid to the Doctors.  

Cuban doctors who escaped the program came to the U.S,  have sued PAHO because it is an international organization based in Washington, D.C., and made decisions about the program and used its bank accounts in Washington to implement the scheme. 

What specifically is PAHO accused of doing?

The lawsuit alleges that PAHO knowingly provided labor for and profited from the Mais Medicos program to generate profits for the Cuban treasury.  The entire enterprise violated U.S. and international law by “exporting” Cuban Doctors to Brazil.  The program operated hand in hand with Cuba’s repressive controls over its population and human rights violations, which PAHO was well aware of.  The doctors had no practical choice but to accept the assignment because of the political repercussions and risks to themselves and their family members if they refuse a “patriotic” mission.  In addition, the doctors are not told where they will be posted or what work they will do, they are forced to sign contracts with no notice or negotiation. In addition, the doctors’ freedom of movement in Brazil is severely restricted and they are under constant surveillance by Cuban intelligence operatives, employed by PAHO.

PAHO paid the Cuban Doctors only a small fraction of the wages paid by the Brazilian government for the Doctors’ work, while doctors from other countries received the full amount paid by Brazil for the same work, which violates Brazilian law, World Health Organization rules, as well as other laws.   

What remedies are the Cuban Doctors seeking?

The Plaintiffs are seeking damages under two  laws, the Trafficking Victims Protection Act, (18 U.S.C. §§ 1589, 1590, and 1595) and the Racketeering Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. §§ 1961, 1962, and 1964).  Both these laws provide remedies to victims of forced labor such as the practices PAHO managed and profited from.  

What will happen next in the case?

PAHO will likely try to dodge the suit claiming immunities..  The issues will be heavily litigated and will likely take several months to resolve.

What does it mean for the case to be pursued as a Class Action?

The Federal class action rule allows Courts to permit individuals with similar claims to band together in one lawsuit against a common defendant.  After preliminary issues are resolved, the Plaintiffs will request to represent the full class: all the U.S.-resident Cuban Doctors from the Mais Medicos program.

What do I do if I believe I am affected by this lawsuit?

If you believe you would be a member of this Class, you do not have to take any action now.  If the Court certifies the case as a class action, it will set out a procedure for every possible member of the class to be notified. Until then, you do not need to do anything regarding this case.  You are, however, encouraged to continue to consult with this website for updated information.

What is the basis for the allegations in the Complaint?

This case was filed after consultations with individual Cuban Doctors from the Mais Medicos program who now live in the United States, and research into government and other public documents.  The research includes:  

  1. Interviews with, and review of documents from, Cuban Doctors who participated in the Mais Medicos program in Brazil, who defected and were granted humanitarian parole by the U.S. government under the Cuban Medical Professional Parole Program.
  2. Reports of the official Brazilian government auditors, the Supremo Tribunal Das Contas (“Tribunal”), which raised concerns about the legality of the Mais Medicos program under Brazilian law by the unequal treatment of Cuban doctors compared to others in the program. The Tribunal also requested documentation regarding the relationship between PAHO/WHO and Cuba. [LINK]
  3. Reports from PAHO’s official independent external auditor, the Tribunal De Cuentas De España in 2013-2016 which recommended that PAHO establish a financial reserve to account for possible financial liabilities from the Mais Medicos Program.   [LINK]
  4. Plaintiff Ramona Matos Rodriguez’s address to the Brazilian Congress describing the way the Cuban Doctors were being mistreated under the Mais Medicos program in Brazil, including how their every movement was heavily surveilled and overseen by Cuban intelligence officials connected to PAHO. 

Will PAHO try to move the case out of federal court in Florida?

PAHO filed a motion to transfer the case from the Federal Court in Miami to the Court in Washington, D.C.   Plaintiffs’ position is that PAHO’s presence throughout the United States and illegal actions affecting Cuban doctors in Florida, allow the lawsuit to proceed in the Federal Court in Miami.  The Magistrate Judge, the Honorable Alicia Otazo-Reyes, denied PAHO’s motion to transfer the case.   PAHO has appealed that ruling,.  Regardless of the venue, the main issue to be decided will be whether PAHO is entitled to immunity for its intentional actions that Plaintiffs allege violated U.S. and international law.

Can PAHO avoid compensating the Cuban Doctors if they win?

PAHO may claim that it doesn’t have to pay if we win. Plaintiffs disagree.  PAHO is based in the U.S., has assets here, and receives American taxpayer dollars.