[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 2138 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 2138
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
June 17, 2021
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Combating
Trafficking of Cuban Doctors Act of 2021''.
(b) Table of Contents.--The table of contents for 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.
Sec. 5. Reestablishing the Cuban Medical Professionals Parole program.
Sec. 6. Role of the Pan American Health Organization.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) In 2019, the Government of Cuba maintained an estimated
34,000 to 50,000 medical personnel in more than 60 countries
under conditions that represent forced labor, according to the
Department of State.
(2) Since the outbreak of the COVID-19 pandemic in early
2020, the Government of Cuba has deployed approximately 1,500
medical personnel to at least 20 countries.
(3) The Department of State's 2020 Trafficking in Persons
report ranked Cuba in Tier 3 and included evidence regarding
Cuba's foreign medical missions and the Government of Cuba's
longstanding failure to criminalize most forms of forced labor,
specifically noting allegations that Cuban authorities coerced
participants to remain in foreign medical missions by--
(A) ``withholding their passports and medical
credentials'';
(B) ``using `minders' to conduct surveillance of
participants outside of work'';
(C) ``restricting their movement'';
(D) ``retaliat[ing] against their family members in
Cuba if participants leave the program''; or
(E) ``impos[ing] criminal penalties, exile, and
family separation if participants do not return to Cuba
as directed by government supervisors''.
(4) On July 26, 2019, the United States imposed visa
restrictions under section 212(a)(3)(C) of the Immigration and
Nationality Act (8 U.S.C. 1182(a)(3)(C)) against certain Cuban
officials and other individuals responsible for the coercive
labor practices of Cuba's overseas medical missions.
(5) The United Nations Special Rapporteur on contemporary
forms of slavery and the United Nations Special Rapporteur on
trafficking in persons, especially women and children, in their
letter to the Government of Cuba on November 6, 2019--
(A) noted reports of coercive labor practices
through the Government of Cuba's foreign medical
missions;
(B) highlighted reports by Cuban medical
professionals that they received regular threats from
Cuban officials while working overseas, including
sexual harassment of women; and
(C) expressed concern that the practices referred
to in subparagraphs (A) and (B) constitute slavery and
trafficking in persons.
(6) In July 2013, the Cuban Ministry of Health signed an
agreement with the Brazilian Ministry of Health to formalize an
arrangement for Cuban doctors to provide medical services in
Brazil that--
(A) required the administration of former Brazilian
President Dilma Rousseff to transmit a monthly payment
through the Pan American Health Organization (referred
to in this section as ``PAHO'') to the Cuban Ministry
of Health for the medical services provided by each
Cuban doctor serving in Brazil; and
(B) prevented participating Cuban doctors from
seeking employment in Brazil outside of the formal
structure of the agreement.
(7) In implementing the agreement described in paragraph
(6), the Cuban Ministry of Health acted through the for-profit
Cuban Medical Services Trading Corporation (referred to in this
section as ``CMS'')--
(A) to pay each Cuban doctor approximately 5 to 25
percent of the monthly payment received from PAHO;
(B) to retain approximately 70 to 90 percent of the
monthly payment for each doctor received from PAHO; and
(C) to permit PAHO to retain approximately 5
percent of such monthly payments.
(8) Between 2013 and 2019, according to the digital
platform Diario de Cuba, the Government of Cuba--
(A) garnished the salaries of more than 20,000
Cuban medical professionals who served in Brazil under
the Mais Medicos program;
(B) frequently confiscated their passports; and
(C) prohibited family members from accompanying
them.
(9) Cuban doctors were the only medical professionals
participating in the Mais Medicos program to have their
salaries directly garnished by their government, while doctors
of other nationalities serving in Brazil received the full
amount of the payments made for their medical services under
the program.
(10) The Government of Cuba stated that Cuban doctors
unwilling to return to the country after their participation in
foreign medical missions would not be permitted to return to
their homeland for 8 years.
(11) In February 2019, Brazil's Ministry of Health
announced reforms to the Mais Medicos program that--
(A) terminated the arrangement with the Government
of Cuba and PAHO; and
(B) allowed Cuban medical personnel to remain in
Brazil and be paid directly by the Brazilian Ministry
of Health.
(12) The Government of Cuba's response to the reforms
referred to in paragraph (11) was to order the Cuban medical
personnel to return to Cuba, rather than allowing them to be
fully and directly compensated. Most Cuban medical personnel
returned to Cuba, as ordered, although approximately 2,000
Cuban medical personnel remain in Brazil.
(13) The Government of Cuba realized profits in excess of
$6,300,000,000 during 2018 from exporting the services of Cuban
professionals, of which foreign medical missions represent the
majority of the services and income.
(14) Countries in which similar abuses to those suffered by
Cuban medical professionals in Brazil have been reported to
have occurred include Angola, Guatemala, Mexico, Qatar, and
Venezuela.
(15) In Venezuela, a group of Cuban doctors reported in
2019 that they had been directed, and often coerced, to use
their medical services to influence votes in favor of the
Maduro regime, including--
(A) by denying medical treatment to opposition
supporters; and
(B) by giving precise voting instructions to
elderly patients.
(16) The term ``severe forms of trafficking in persons'' is
defined under section 103(11)(B) of the Trafficking Victims
Protection Act of 2000 (22 U.S.C. 7102(11)(B)) as ``the
recruitment, harboring, transportation, provision, or obtaining
of a person for labor or services, through the use of force,
fraud, or coercion for the purpose of subjection to involuntary
servitude, peonage, debt bondage, or slavery''.
SEC. 3. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) the Government of Cuba subjects Cuban doctors and other
medical professionals to state-sponsored human trafficking;
(2) the Government of Cuba should fully compensate Cuban
medical professionals who have participated in, or who are
currently participating in foreign medical mission programs in
other countries, including Brazil's Mais Medicos program, for
the full amount of wages paid to the Government of Cuba;
(3) the Government of Cuba should immediately and
transparently respond to requests for information from the
United Nations Special Rapporteur on contemporary forms of
slavery and the United Nations Special Rapporteur on
trafficking in persons, especially women and children; and
(4) foreign governments and international organizations
that enter into agreements with the Government of Cuba or the
for-profit Cuban Medical Services Trading Corporation or other
companies affiliated with the Government of Cuba to procure the
services of Cuban medical professionals directly assume legal
risks related to their participation in forced labor
arrangements and human trafficking.
SEC. 4. ANNUAL REPORT AND DETERMINATION ON INTERNATIONAL TRAFFICKING OF
CUBAN MEDICAL PERSONNEL.
(a) Annual Report.--Not later than 180 days after the date of the
enactment of this Act and annually thereafter until the date specified
in subsection (c), the Secretary of State shall submit a report to the
Committee on Foreign Relations of the Senate and the Committee on
Foreign Affairs of the House of Representatives that--
(1) identifies the countries that are hosting Cuban medical
personnel who are participating in foreign medical missions for
the Government of Cuba;
(2) to the extent feasible, includes an estimate of--
(A) the number of Cuban medical personnel in each
country; and
(B) the value of the financial arrangement between
the Government of Cuba and the host country government;
(3) describes the conditions in each country under which
Cuban medical personnel live and work; and
(4) describes the role of any international organization in
each country hosting Cuban medical personnel.
(b) Determination on Human Trafficking.--In each report submitted
pursuant to subsection (a), the Secretary of State shall determine
whether--
(1) the Cuban medical personnel in each country identified
in the report are subjected to conditions that qualify as
severe forms of trafficking in persons (as defined in section
103(11) of the Trafficking Victims Protection Act of 2000 (22
U.S.C. 7102(11))); and
(2) Cuba's foreign medical missions program constitutes
proof of failure to make significant efforts to bring the
Government of Cuba into compliance with the minimum standards
for the elimination of trafficking in persons (as determined
under section 108 of the Trafficking Victims Protection Act of
2000 (22 U.S.C. 7106)).
(c) Sunset.--The Secretary of State is not required to submit the
report otherwise required under subsection (a) after the date on which
the Secretary submits a second consecutive annual report under such
subsection that includes a determination under subsection (b) that
Cuban medical personnel are no longer subjected to trafficking in
persons.
SEC. 5. REESTABLISHING THE CUBAN MEDICAL PROFESSIONAL PAROLE PROGRAM.
(a) In General.--The Secretary of Homeland Security, in
coordination with the Secretary of State, shall reinstate the Cuban
Medical Professional Parole program to authorize the admission into the
United States of Cuban medical personnel conscripted to study or work
in a third country under the direction of the Government of Cuba.
(b) Authority.--The Director of U.S. Citizenship and Immigration
Services may exercise the discretionary parole authority under section
212(d)(5)(A) of the Immigration and Nationality Act (8 U.S.C.
1182(d)(5)(A)) and subsections (c) and (d) of section 212.5 of title 8,
Code of Federal Regulations, to permit eligible Cuban nationals to come
to the United States, including for urgent humanitarian reasons or
significant public benefit.
(c) Eligibility Criteria.--
(1) In general.--A Cuban medical professional is eligible
for consideration of parole under the Cuban Medical
Professional Program if he or she--
(A) is a Cuban national, citizen, or person
habitually residing in Cuba;
(B) is a medical professional who, at the time he
or she seeks such parole, is conscripted by the
Government of Cuba to study or work in a third country;
and
(C) is not inadmissible under section 212(a) of the
Immigration and Nationality Act (8 U.S.C. 1182(a)).
(2) Admission of family members.--
(A) In general.--The spouse and unmarried children
accompanying the primary applicant in the third country
referred to in paragraph (1)(B) shall be eligible for
parole under the Cuban Medical Professional Program in
conjunction with an application from an individual
described in paragraph (1).
(B) Applications.--A Cuban medical professional
granted discretionary parole under section 212(d)(5)(A)
of the Immigration and Nationality Act (8 U.S.C.
1182(d)(5)(A)) pursuant to this section may submit an
application to U.S. Citizenship and Immigration
Services seeking admission to the United States of his
or her spouse and unmarried children.
SEC. 6. ROLE OF THE PAN AMERICAN HEALTH ORGANIZATION.
(a) Findings.--Congress finds that the Pan American Health
Organization (referred to in this section as ``PAHO'')--
(1) has contributed to the health and well-being of the
people in the Western Hemisphere for longer than a century,
with the United States serving as a member state since 1925;
(2) engages in technical cooperation with its member
countries--
(A) to fight communicable and noncommunicable
diseases and their causes;
(B) to strengthen health systems; and
(C) to respond to emergencies and disasters;
(3) as of May 21, 2021, had assisted dozens of countries in
the Americas with their response to the COVID-19 pandemic,
including--
(A) supporting the delivery of 12,800,000 vaccines
to countries in the Americas through the COVID-19
Vaccines Global Access (COVAX) facility;
(B) providing more than 26,000,000 COVID-19 tests
in countries and territories throughout the Americas;
and
(C) 162 shipments of more than 50,000,000 articles
of personal protective equipment to countries and
territories throughout the Americas;
(4) has privately commissioned a third-party review of its
role in the Mais Medicos program; and
(5) adopted governance reforms to increase the oversight of
projects funded by voluntary contributions that present a high
level of institutional risk for PAHO during the 72nd Session of
the Regional Committee of the World Health Organization for the
Americas, which convened on September 28th and 29th, 2020.
(b) Sense of Congress.--It is the sense of Congress that--
(1) PAHO is the preeminent multilateral organization
dedicated to public health issues in the Americas;
(2) PAHO--
(A) has played a vital role in strengthening health
systems in Latin America to address the COVID-19
pandemic; and
(B) continues to provide essential health
assistance to meet the needs of Venezuelans affected by
the ongoing humanitarian crisis in their country and
displaced individuals in other countries in the region;
(3) the United States should continue to support PAHO,
including through payment of assessed contributions (in full
and on time) and voluntary contributions, to ensure PAHO's
continued operations;
(4) according to the Department of State, the Brazilian
Court of Accounts, and PAHO's official independent external
auditor, the Tribunal de Cuentas de Espana, PAHO's role in the
Mais Medicos program, as described in section 2, raises serious
questions; and
(5) PAHO should provide greater transparency about its role
in the Mais Medicos program and strengthen its internal
oversight and risk management to require that its external
auditor reports be distributed to PAHO board members and
discussed at PAHO board meetings.
(c) Report.--Not later than 90 days after the date of the enactment
of this Act, the Secretary of State and the Secretary of Health and
Human Services shall jointly submit a report to the Committee on
Foreign Relations of the Senate and the Committee on Foreign Affairs of
the House of Representatives that includes--
(1) a review of and findings on PAHO's role in the Mais
Medicos program between 2013 and 2019;
(2) a summary of corrective actions to be taken by PAHO;
and
(3) recommendations for further corrective actions, as
necessary.
(d) Accountability Measures.--The Secretary of State and the
Secretary of Health and Human Services shall jointly--
(1) take all necessary steps to ensure that PAHO undertakes
governance reforms that strengthen internal oversight and risk
management for all future programs; and
(2) not later than 30 days after the receipt of the results
of the independent, third-party review of PAHO's role in the
Mais Medicos program, provide a briefing to the Committee on
Foreign Relations of the Senate and the Committee on Foreign
Affairs of the House of Representatives that includes a
detailed summary of such results and the progress made in
PAHO's efforts to strengthen internal oversight and risk
management.
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