Ramona Matos Rodriguez v. Pan American Health Organization, 29f4th706

Background

Brazil’s Mais Médicos program recruited foreign (primarily Cuban) physicians; Cuba allegedly coerced physicians and treated medical missions as a revenue source.
To avoid a formal intergovernmental agreement, Brazil, Cuba, and PAHO executed a Technical Cooperation Agreement under which PAHO allegedly acted as an intermediary and "triangulated" payments.
Plaintiffs (escaped Cuban physicians) allege PAHO transmitted Brazil’s payments through a Washington, D.C. Citibank account, forwarding ~85% to Cuba, ~10% to physicians, and retaining ~5%, and thereby knowingly financially benefitted from forced labor in violation of 18 U.S.C. § 1589(b).
PAHO moved to dismiss, asserting IOIA immunity (as applied through the FSIA commercial-activity exception) and immunity under the WHO Constitution; the district court transferred venue to D.C., denied dismissal of the § 1589(b) claim, and rejected WHO-constitution immunity as non-self-executing.
On interlocutory appeal the D.C. Circuit affirmed: (1) plaintiffs sufficiently alleged PAHO’s U.S.-based commercial activity (financial intermediation) lifting IOIA immunity under the FSIA exception for § 1589(b); and (2) WHO Constitution Article 67(a) is not self-executing, so it does not bar the suit.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether IOIA/FSIA commercial-activity exception permits suit on §1589(b) claim	Rodriguez: PAHO acted as a U.S.-based financial intermediary, received and forwarded payments through its D.C. account, so the action is "based upon" commercial activity in the U.S.	PAHO: the gravamen is trafficking/forced-labor abroad; any U.S. financial acts are incidental and cannot defeat immunity.	Held: Claim-by-claim gravamen analysis applies; plaintiffs plausibly allege wrongful financial activity in the U.S. that forms the gravamen of the §1589(b) claim, so the commercial-activity exception may apply.
Whether gravamen should be assessed claim-by-claim or by the entire suit	Rodriguez: gravamen assessed by claim; the financial-benefit element is the core of §1589(b) claim.	PAHO: "action" refers to the whole suit; gravamen is trafficking abroad, so exception doesn't apply.	Held: Court applies claim-by-claim gravamen analysis (Sachs/Nelson framework) and focuses on the core elements of the §1589(b) claim.
Whether the gravamen of the §1589(b) claim occurred in the U.S.	Rodriguez: the alleged wrongful financial benefit occurred in D.C. (PAHO’s bank account and transfers).	PAHO: the financial transfers are only wrongful because of trafficking abroad; the real injury occurred abroad.	Held: The alleged U.S. financial conduct is itself wrongful under §1589(b) and constitutes the gravamen for that claim, so it occurred in the U.S. for jurisdictional purposes.
Whether WHO Constitution Article 67(a) provides PAHO immunity (is self-executing)	PAHO: Article 67(a) mandates privileges and immunities necessary to WHO functions, yielding immunity.	Rodriguez: Article 68 contemplates a separate agreement to define privileges; Article 67(a) is not a self-executing grant of immunity.	Held: Article 67(a) is not self-executing; privileges must be defined by a separate agreement and the U.S. has not adopted such an agreement (CPISA not ratified), so WHO Constitution does not immunize PAHO here.

Key Cases Cited

Jam v. International Finance Corp., 139 S. Ct. 759 (2019) (FSIA/IOIA immunity governed by gravamen analysis; tortious conduct abroad can preclude commercial-activity exception)
OBB Personenverkehr AG v. Sachs, 577 U.S. 27 (2015) (instructs courts to identify the gravamen of the claim when applying FSIA commercial-activity exception)
Saudi Arabia v. Nelson, 507 U.S. 349 (1993) (earlier formulation that commercial-activity exception looks to elements that, if proven, entitle relief)
Medellin v. Texas, 552 U.S. 491 (2008) (framework for determining whether a treaty is self-executing)
Zicherman v. Korean Air Lines Co., 516 U.S. 217 (1996) (treaty interpretation may consider preparatory history and postratification understanding)
Kirkham v. Société Air France, 429 F.3d 288 (D.C. Cir. 2005) (FSIA gravamen/element analysis: commercial activity must be essential to the claim)