,,ii  #aafth ,,congress  #b;d ,session  
,s4 #dfce  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #ba1
 #bjbj,mr4 ,menendez 7for himself and   
,mr4 ,rubio7 introduced the following   
bill2 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     
,cuba1 and for other purposes4  #a4     
,short title2 table of contents  7a7    
,short title ,this ,act may be cited as 
the ,combating ,trafficking of ,cuban   
,doctors ,act of #bjbj4  7b7 ,table of  
contents ,the table of contents for this
 ,act is as follows3 ,sec4 #a4 ,short   
title2 table of contents4,sec4 #b4      
,findings4,sec4 #c4 ,sense of           
,congress4,sec4 #d4 ,annual report and  
determination on international          
trafficking of ,cuban medical           
personnel4,sec4 #e4 ,reestablishing the 
,cuban ,medical ,professionals ,parole  
program4,sec4 #f4 ,role of the ,pan     

,american ,health ,organization4  #b4   
,findings ,congress makes the following 
findings3 7#a7 ,in #bjai1 the           
,government of ,cuba maintained an      
estimated #cd1jjj to #ej1jjj medical    
personnel in more than #fj countries    
under conditions that represent forced  
labor1 according to the ,department of  
,state4  7#b7 ,since the outbreak of the
 ,,covid-#ai pandemic in early #bjbj1   
the ,government of ,cuba has deployed   
approximately #a1ejj medical personnel  
to at least #bj countries4  7#c7 ,the   
,department of ,state's #bjbj           
,trafficking in ,persons report ranked  
,cuba in ,tier #c and included evidence 
regarding ,cuba's foreign medical       
missions and the ,government of ,cuba's 
longstanding failure to criminalize most
 forms of forced labor1 specifically    
noting allegations that ,cuban          
authorities coerced participants to     
remain in foreign medical missions by-- 
7,a7 withholding their passports and    
medical credentials2  7,b7 using minders

 to conduct surveillance of participants
 outside of work2  7,c7 restricting     
their movement2  7,d7 retaliating       
against their family members in ,cuba if
 participants leave the program2 or     
7,e7 imposing criminal penalties1 exile1
 and family separation if participants  
do not return to ,cuba as directed by   
government supervisors4  7#d7 ,on ,july 
#bf1 #bjai1 the ,united ,states imposed 
visa restrictions under section         
#bab7;a77#c77;,c7 of the ,immigration   
and ,nationality ,act 7#h ,u4,s4,c4     
#aahb7;a77#c77;,c77 against certain     
,cuban officials and other individuals  
responsible for the coercive labor      
practices of ,cuba's overseas medical   
missions4  7#e7 ,the ,united ,nations   
,special ,rapporteur on contemporary    
forms of slavery and the ,united        
,nations ,special ,rapporteur on        
trafficking in persons1 especially women
 and children1 in their letter to the   
,government of ,cuba on ,november #f1   
#bjai-- 7,a7 noted reports of coercive  

labor practices through the ,government 
of ,cuba's foreign medical missions2    
7,b7 highlighted reports by ,cuban      
medical professionals that they received
 regular threats from ,cuban officials  
while working overseas1 including sexual
 harassment of women2 and  7,c7         
expressed concern that the practices    
referred to in subparagraphs 7,a7 and   
7,b7 constitute slavery and trafficking 
in persons4  7#f7 ,in ,july #bjac1 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-- 7,a7 required
 the administration of former ,brazilian
 ,president ,dilma ,rousseff to transmit
 a monthly payment through the ,pan     
,american ,health ,organization         
7referred to in this section as ,,paho7 
to the ,cuban ,ministry of ,health for  
the medical services provided by each   
,cuban doctor serving in ,brazil2 and   
7,b7 prevented participating ,cuban     

doctors from seeking employment in      
,brazil outside of the formal structure 
of the agreement4  7#g7 ,in implementing
 the agreement described in paragraph   
7#f71 the ,cuban ,ministry of ,health   
acted through the for-profit ,cuban     
,medical ,services ,trading ,corporation
 7referred to in this section as        
,,cms7-- 7,a7 to pay each ,cuban doctor 
approximately #be percent 7averaging    
#gij7 of the monthly payment received   
from ,,paho 7averaging #c1aeh72 and     
7,b7 to retain approximately #ge percent
 of the monthly payment for each doctor 
received from ,,paho4  7#h7 ,between    
#bjac and #bjai1 according to the       
digital platform ,diario de ,cuba1 the  
,government of ,cuba-- 7,a7 garnished   
the salaries of more than #bj1jjj ,cuban
 medical professionals who served in    
,brazil under the ,mais ,mdicos program2
  7,b7 frequently confiscated their     
passports2 and  7,c7 prohibited family  
members from accompanying them4  7#i7   
,cuban doctors were the only medical    

professionals participating in the ,mais
 ,mdicos program to have their salaries 
directly garnished by their government1 
while doctors of other nationalities    
serving in ,brazil received the full    
amount of the payments made for their   
medical services under the program4     
7#aj7 ,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 #h years4  7#aa7 ,in ,february     
#bjai1 ,brazil's ,ministry of ,health   
announced the termination of the ,mais  
,mdicos program4  7#ab7 ,the ,government
 of ,cuba realized profits in excess of 
#f1cjj1jjj1jjj during #bjah from        
exporting the services of ,cuban        
professionals1 of which foreign medical 
missions represent the majority of the  
services and income4  7#ac7 ,countries  
in which similar abuses to those        
suffered by ,cuban medical professionals
 in ,brazil have been reported to have  

occurred include ,angola1 ,guatemala1   
,mexico1 ,qatar1 and ,venezuela4  7#ad7 
,in ,venezuela1 a group of ,cuban       
doctors reported in #bjai that they had 
been directed1 and often coerced1 to use
 their medical services to influence    
votes in favor of the ,maduro regime1   
including-- 7,a7 by denying medical     
treatment to opposition supporters2 and 
7,b7 by giving precise voting           
instructions to elderly patients4  7#ae7
 ,the term severe forms of trafficking  
in persons is defined under section     
#ajc7aa77;,b7 of the ,trafficking       
,victims ,protection ,act of #bjjj 7#bb 
,u4,s4,c4 #gajb7aa77;,b77 as the        
recruitment1 harboring1 transportation1 
provision1 or obtaining of a person for 
labor or services1 through the use of   
force1 fraud1 or coercion for the       
purpose of subjection to involuntary    
servitude1 peonage1 debt bondage1 or    
slavery4  #c4 ,sense of ,congress ,it is
 the sense of ,congress that-- 7#a7 the 
,government of ,cuba subjects ,cuban    

doctors and other medical professionals 
to state-sponsored human trafficking2   
7#b7 the ,government of ,cuba should    
fully compensate ,cuban medical         
professionals who have participated in1 
or who are currently participating in   
foreign medical mission programs in     
other countries1 including ,brazil's    
,mais ,mdicos program1 for the full     
amount of wages paid to the ,government 
of ,cuba2  7#c7 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  
persons1 especially women and children2 
and  7#d7 foreign governments that sign 
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     
arrangements4  #d4 ,annual report and   
determination on international          
trafficking of ,cuban medical personnel 
7a7 ,annual report ,not later than #ahj 
days after the date of the enactment of 
this ,act and annually thereafter until 
the date specified in subsection 7c71   
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-- 7#a7  
identifies the countries that are       
hosting ,cuban medical personnel who are
 participating in foreign medical       
missions for the ,government of ,cuba2  
7#b7 to the extent feasible1 includes an
 estimate of-- 7,a7 the number of ,cuban
 medical personnel in each country2 and 
7,b7 the value of the financial         
arrangement between the ,government of  
,cuba and the host country government2  
and  7#c7 describes the conditions in   

each country under which ,cuban medical 
personnel live and work4  7b7           
,determination on human trafficking ,in 
each report submitted pursuant to       
subsection 7a71 the ,secretary of ,state
 shall determine whether-- 7#a7 the     
,cuban medical personnel in each country
 identified in the report are subjected 
to conditions that qualify as severe    
forms of trafficking in persons 7as     
defined in section #ajc7aa7 of the      
,trafficking ,victims ,protection ,act  
of #bjjj 7#bb ,u4,s4,c4 #gajb7aa7772 and
  7#b7 ,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   
7as determined under section #ajh of the
 ,trafficking ,victims ,protection ,act 
of #bjjj 7#bb ,u4,s4,c4 #gajf774  7c7   
,sunset ,the ,secretary of ,state is not
 required to submit the report otherwise
 required under subsection 7a7 after the

 date on which the ,secretary submits a 
second consecutive annual report under  
such subsection that includes a         
determination under subsection 7b7 that 
,cuban medical personnel are no longer  
subjected to trafficking in persons4    
#e4 ,reestablishing the ,cuban ,medical 
,professional ,parole program  7a7 ,in  
general ,the ,secretary of ,homeland    
,security1 in coordination with the     
,secretary of ,state1 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     
,cuba4  7b7 ,authority ,the ,director of
 ,u4,s4 ,citizenship and ,immigration   
,services may exercise its discretionary
 parole authority under section         
#bab7;d77#e77;,a7 of the ,immigration   
and ,nationality ,act 7#h ,u4,s4,c4     
#aahb7;d77#e77;,a77 and subsections 7c7 
and 7d7 of section #bab4e of title #h1  

,code of ,federal ,regulations1 to      
permit eligible ,cuban nationals to come
 to the ,united ,states1 including for  
urgent humanitarian reasons or          
significant public benefit4  7c7        
,eligibility criteria  7#a7 ,in general 
,a ,cuban medical professional is       
eligible for consideration of parole    
under the ,cuban ,medical ,professional 
,program if he or she-- 7,a7 is a ,cuban
 national1 citizen1 or person habitually
 residing in ,cuba2  7,b7 is a medical  
professional who1 at the time he or she 
seeks such parole1 is conscripted by the
 ,government of ,cuba to study or work  
in a third country2 and  7,c7 is not    
inadmissible under section #bab7;a7 of  
the ,immigration and ,nationality ,act  
7#h ,u4,s4,c4 #aahb7;a774  7#b7         
,admission of family members  7,a7 ,in  
general ,the spouse and unmarried       
children accompanying the primary       
applicant in the third country referred 
to in paragraph 7#a77;,b7 shall be      
eligible for parole under the ,cuban    

,medical ,professional ,program in      
conjunction with an application from an 
individual described in paragraph 7#a74 
7,b7 ,applications ,a ,cuban medical    
professional granted discretionary      
parole under section #bab7;d77#e77;,a7  
of the ,immigration and ,nationality    
,act 7#h ,u4,s4,c4 #aahb7;d77#e77;,a77  
pursuant to this section may submit an  
application to ,u4,s4 ,citizenship and  
,immigration ,services seeking admission
 to the ,united ,states of his or her   
spouse and unmarried children4  #f4     
,role of the ,pan ,american ,health     
,organization  7a7 ,findings ,congress  
finds that the ,pan ,american ,health   
,organization 7referred to in this      
section as ,,paho7-- 7#a7 has           
contributed to the health and well-being
 of the people in the ,western          
,hemisphere for longer than a century1  
with the ,united ,states serving as a   
member state since #aibe2  7#b7 engages 
in technical cooperation with its member
 countries-- 7,a7 to fight communicable 

and noncommunicable diseases and their  
causes2  7,b7 to strengthen health      
systems2 and  7,c7 to respond to        
emergencies and disasters2  7#c7 as of  
,august #bd1 #bjbj1 had assisted dozens 
of countries in the ,western ,hemisphere
 region with their response to the      
,,covid-#ai pandemic1 including-- 7,a7  
the provision of #f1bjj1jjj ,,covid-#ai 
tests to #cf countries and territories2 
7,b7 #hd shipments of personal          
protective equipment to #bi countries2  
and  7,c7 other technical support and   
training to its member states2  7#d7 has
 commissioned a third party review of   
its role in the ,mais ,mdicos program2  
and  7#e7 has committed to undertake    
reforms to strengthen its internal      
oversight and risk management for all   
future programs4  7b7 ,sense of         
,congress ,it is the sense of ,congress 
that-- 7#a7 ,,paho is the preeminent    
multilateral organization dedicated to  
public health issues in the ,americas2  
7#b7 ,,paho-- 7,a7 has played a vital   

role in strengthening health systems in 
,latin ,america to address the          
,,covid-#ai pandemic2 and  7,b7         
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 region2  7#c7 the      
,united ,states should continue to      
support ,,paho1 including through       
payment of assessed contributions 7in   
full and on time7 and voluntary         
contributions1 to ensure ,,paho's       
continued operations2  7#d7 ,,paho's    
role in the ,mais ,mdicos program1 as   
described in section #b1 was deeply     
concerning2 and  7#e7 ,,paho should     
provide greater transparency about its  
role in the ,mais ,mdicos program and   
strengthen its internal oversight and   
risk management4  7c7 ,report ,not later
 than #ij days after the date of the    
enactment of this ,act1 the ,secretary  
of ,state and the ,secretary of ,health 

and ,human ,services 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         
includes-- 7#a7 a review of and findings
 on ,,paho's role in the ,mais ,mdicos  
program between #bjac and #bjai2  7#b7 a
 summary of corrective actions to be    
taken by ,,paho2 and  7#c7              
recommendations for further corrective  
actions1 as necessary4  7d7             
,accountability measures ,the ,secretary
 of ,state and the ,secretary of ,health
 and ,human ,services shall jointly--   
7#a7 take all necessary steps to ensure 
that ,,paho undertakes governance       
reforms that strengthen internal        
oversight and risk management for all   
future programs2 and  7#b7 not later    
than #cj days after the receipt of the  
results of the independent1 third-party 
review of ,,paho's role in the ,mais    
,mdicos program1 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  
management4