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.
When the General shows resistance to Greene's terms, Greene notes that to Quantum, Medrano is completely expendable and if he refuses to sign he will "wake up... with [his] balls in [his] mouth... and [his] willing replacement standing over [him]." Threatened into submission by Greene, he signs. To vent his frustration he tries to rape his maid, but Camille - who managed to infiltrate the building along with Bond - gets in the way and after a violent struggle shoots him in the chest, killing him and ending her quest for vengeance.
Henchmen and Associates
He is arguably the most evil James Bond Villain ever.