Quantum of Solace
He has made a deal with Dominic Greene to overthrow the current Bolivian government; in return, Greene is given ownership of a seemingly barren piece of Bolivian land. He is first seen at Dominic's port when he is introduced to Camille (years ago, he had killed her father, raped her mother and sister, and burnt the house down while Camille was in it).
In the climax, Medrano attempts to finalize his deal with Quantum in a hotel for his coup. After the signing, Greene forces Medrano to sign a new contract that will give Quantum to use Bolivia's sole water utility company to sell at higher rates, threatening to have him replaced if he doesn't comply. Medrano reluctantly accepts this, and to vent his frustration, he tries to rape his maid. However, Camille gets in the way, and he tries to rape her, but she shoots him in the head, killing him and ending her quest for vengeance.
- He is one of the two villains in the reboot series who are Complete Monsters alongside Franz Oberhauser.