General Medrano made a deal with Quantum representative, Dominic Greene, to overthrow the current Bolivian government and become their new president; in return, Greene is given ownership of a seemingly barren piece of land. He is first seen in Port-au-Prince, Haiti meeting with Greene. Here he is introduced to Camille Montes. (Years ago, he had killed her father, raped her mother and sister, and burnt the house down while Camille was in it.)
Later, Medrano meets with one of his henchmen, Carlos, in the Atacama Desert to finalize the coup. At the hotel, Greene arrives and Medrano negotiate their terms. Greene then finally reveals his true plans: now that he controls the majority of Bolivia's water supply, Greene forces Medrano to accept a new contract that makes Greene Planet Bolivia's sole water utility company at significantly higher rates.
At first, Medrano resists to this new contract, but Greene silently threatens to have him replaced if he doesn't comply, daring Medrano to shoot him if he wishes to. Medrano reluctantly accepts this and receives his loan as promised. Despite getting his share, Medrano is frustrated by this turn of events. He tries to vent his frustration off by attempting to rape his maid in his suite. However, Bond and Camille lead a full assault in the hotel, killing many all of Greene and Medrano's men in the process. As Bond fights against Greene, Camille makes her way to Medrano' suite, where she frees the maid and lets her escape. However, Medrano attacks Camille, gloating of the time when he raped her mother. Medrano then tries to rape and kill Camille, but she fights back and grabs a gun, aiming at the general. Swearing that she will burn, Medrano (with an evil smile) foolishly attempts to charge at Camille, who forcibly shoots the general in the head, killing him and ending her quest for vengeance.