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United States Court of Appeals for the District of Columbia Circuit
November 3, 2021, Argued; March 29, 2022, Decided
Karen [*2] Lecraft Henderson, Circuit Judge: A group of Cuban physicians (physicians) sued the Pan American Health Organization (PAHO) for its role in facilitating Brazil's Mais Médicos (translated, "More Doctors") program, under which Brazil hired foreign physicians to augment its medical services provided to impoverished Brazilians. Cuba supplied physicians to the program, allegedly without their consent and in violation of human trafficking laws. The physicians sued PAHO for, inter alia, acting as a financial intermediary between Brazil and Cuba. PAHO moved to dismiss the suit, asserting immunity under both the International Organizations Immunities Act (IOIA), 22 U.S.C. § 288, and the World Health Organization (WHO) Constitution, Constitution Adopted by the United States of America and Other Governments Respecting a World Health Organization, June 21, 1948, 62 Stat. 2679, T.I.A.S. No. 1808. The district court denied dismissal of the claim that PAHO acted as a financial intermediary and PAHO appeals therefrom. As detailed infra, we affirm.
] On review of a dismissal denial, "we must accept as true all material allegations of the complaint, drawing all reasonable inferences from those allegations in plaintiffs' favor, and presuming that general [*3] allegations embrace those specific facts that are necessary to support the claim." LaRoque v. Holder, 650 F.3d 777, 785, 397 U.S. App. D.C. 93 (D.C. Cir. 2011) (cleaned up). We recite the facts accordingly.
In 2012, Brazilian and Cuban officials discussed Cuba's "export[ing]" medical services to Brazil. Rodriguez v. Pan Am. Health Org., 502 F. Supp. 3d 200, 208 (D.D.C. 2020). According to the United States Department of State, Cuba relies on "medical missions" as a significant source of income and recruits physicians under the threat of "harsh social, economic, political[,] personal, reputational, and legal repercussions." Id. Cuba proposed sending six thousand internal medicine specialists to Brazil. Id. Brazilian officials did not want to enter into an "intergovernmental agreement," which required approval of the Brazilian Congress and thus could "generate controversy." Id. To avoid an intergovernmental agreement, Brazilian officials proposed using PAHO as an intermediary. Id. Accordingly, PAHO entered into an agreement with Brazil and Cuba, the "Technical Cooperation Agreement Between the Ministry of Public Health of the Republic of Cuba and the Pan American Health Organization/World Health Organization for Expanded Access by the Brazilian Population to Primary Health Care" (Agreement).
PAHO's participation in the Mais Médicos [*4] program is somewhat ambiguous, as the complaint alleges two alternative roles that PAHO played. First, the complaint alleges that PAHO directly participated in human trafficking. PAHO "knowingly provided and obtained the labor or services of Plaintiffs by threats of force, physical restraint, threats of physical restraint, serious harm, threats of serious harm, abuse of laws and legal process, threats of abuse of laws and legal process, and by participating in a scheme, plan, or pattern intended to cause Plaintiffs and Class members to believe that if they did not comply with the restrictions and work under the conditions PAHO instituted and enforced, they would suffer serious harm or physical restraint." App. 123. By its alleged conduct, the complaint continues, PAHO violated the Trafficking Victims Protection Act (TVPA), 18 U.S.C. § 1589(a) (prohibiting "provid[ing] or obtain[ing] the labor or services of a person" by force or threat). The complaint also alleges that "PAHO . . . knowingly participated in the recruitment, harboring, and transportation of, and provided and obtained Plaintiffs' labor and services," in violation of § 1590 (prohibiting "transport[ing] . . . any person for labor or services in violation of this chapter"). App. 124.
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2022 U.S. App. LEXIS 8172 *; __ F.4th __; 2022 WL 904850
RAMONA MATOS RODRIGUEZ, ET AL., APPELLEES v. PAN AMERICAN HEALTH ORGANIZATION, APPELLANT, JOAQUIN MOLINA, ET AL., APPELLEES
Prior History: [*1] Appeal from the United States District Court for the District of Columbia. (No. 1:20-cv-00928).
Rodriguez v. Pan Am. Health Org., 502 F. Supp. 3d 200, 2020 U.S. Dist. LEXIS 208904, 2020 WL 6561448 (D.D.C., Nov. 9, 2020)
immunity, gravamen, treaty, commercial activity, self-executing, privileges, district court, cause of action, allegations, trafficking, sovereign, claim-by-claim, courts, plaintiffs', abroad, financial intermediary, medical services, wrongful conduct, organizations, ratified, separate agreement, political branch, forced labor, participated, quotation, violating, asserts, lawsuit, parties, marks
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