WRITTEN QUESTION E-3672/02 by Antonio Di Pietro (ELDR) to the Commission. The practice of stomatology.
Date: 2002-12-18
Institutions: European Parliament, Provisional data
Subjects: Italy, dentist, derogation from EU law, gastrointestinal disease, medical specialisation, physician, professional association, recognition of diplomas, vocational training

12.6.2003

EN

Official Journal of the European Union

C 137 E/237

Apart from these political initiatives, the Commission remains the biggest humanitarian aid donor in the
North Caucasus, which, since the onset of the second conflict, has received over EUR 90 million in aid for
the victims of the fighting. The Commission will also continue to raise the question of access and the
multiple obstacles the Russian authorities put in the path of humanitarian organisations on the ground, an
issue which is at the centre of discussions between the EU and Russia.

(2003/C 137 E/268)

WRITTEN QUESTION E-3672/02

by Antonio Di Pietro (ELDR) to the Commission

(18 December 2002)

Subject: The practice of stomatology

In Italy, access for doctors to the practice of stomatology is subject to inclusion on the register of dental
practitioners, who are not physicians, for the simple reason that the professional associations want to
regulate medical practice in the field of stomatology via the ‘dentist directives’, thereby obliging doctors
who want to practice stomatology to be included on a professional register alien to their actual profession,
in blatant contravention of Community Directive 93/16/EEC (1).

This misguided requirement has been causing serious prejudice, not least in the legal sphere, to those
doctors who have relied on the provisions of Directive 93/16 in order to treat mouths and teeth in their
role as doctors on the medical register, a right recognised by Directive 93/16 for holders of a degree in
medicine.

This attitude, which has already been censured twice in infringement proceedings brought against Italy
(cases C-40/93 and C-202/99), both of which resulted in a guilty verdict on the grounds that Italy had
treated as identical two different professions regulated by different directives which treat them separately
(cf. the Commission’s answers to written questions E-1522/96 (2), E-1649/97 (3), E-2698/98, E-2699/98
and E-2700/98 (4)).

Can the Commission say whether the degree in medicine and surgery awarded in Italy to people who
started their medical
training in the 1980/81 academic year or later have the minimum training
requirements allowing them to practice medicine in Italy in the field of odontostomatology or whether the
exercise of this activity is subject to possession of a specialised qualification or inclusion on the register of
dental practitioners, who are not physicians?

(1) OJ L 165, 7.7.1993, p. 1.
(2) OJ C 356, 25.11.1996, p. 52.
(3) OJ C 391, 23.12.1997, p. 113.
(4) OJ C 135, 14.5.1999, p. 99.

Answer given by Mr Bolkestein on behalf of the Commission

(20 January 2003)

Except where provided for by specific derogations,
the Member States have been prohibited from
authorising non-specialist doctors to practice dentistry or odontostomatology since the entry into force of
Council Directives 78/686/EEC and 78/687/EEC of 25 July 1978 (1) concerning the mutual recognition of
dental practitioners’ diplomas and the coordination of their professional training. This situation was
confirmed by the Court of Justice in its judgment of 1 June 1995 in Case C-40/93 (Commission v Italian
Republic (2)), which stated that Member States may not, under any circumstances, create categories of
dental practitioners that are not provided for by the aforementioned Directives.

The only derogation affecting Italy appears in Article 19 of Directive 78/686/EEC, which expressly allows
Italian doctors who began their university and medical training before 28 January 1980 to continue to
practice dentistry in Italy and to move to any other Member State for that purpose. Because there was no
specific dental training and profession which were separate from those open to medical practitioners in
Italy at the time of the adoption of Directives 78/686/EEC and 78/687/EEC, the rights of the doctors in
question had to be preserved whilst the new profession was being established.

C 137 E/238

Official Journal of the European Union

EN

12.6.2003

Nevertheless, since Italy had unilaterally deferred the Article 19 deadline (28 January 1980) for the start of
medical studies to the 1984-1985 academic year, the Court in its above-mentioned judgment found that it
had failed to fulfil
its obligations under Directives 78/686/EEC and 78/687/EEC. As Italy could not
implement this judgment on its own (except by revoking the authorisation of the roughly 4 000 doctors
concerned to practice the activities in question), Directive 2001/19/EEC (3) introduced specific measures
designed to regularise the status of these practitioners (an aptitude test to be organised by the Italian
authorities).

In conclusion, non-specialist doctors may not practice dentistry or odontostomatology unless the
derogation conditions laid down in Article 19(1) or (2) of Directive 78/686/EEC, as amended by Directive
2001/19/EC, are satisfied. This state of affairs is not contrary to Directive 93/16/EEEC (4).

(1) OJ L 233, 24.7.1978.
(2) ECR 1995 I-1319.
(3) Directive 2001/19/EC of the European Parliament and of the Council of 14 May 2001 amending Council Directives
89/48/EEC and 92/51/EEC on the general system for the recognition of professional qualifications and Council
Directives 77/452/EEC, 77/453/EEC, 78/686/EEC, 78/687/EEC, 78/1026/EEC, 78/1027/EEC, 80/154/EEC, 80/155/
EEC, 85/384/EEC, 85/432/EEC, 85/433/EEC and 93/16/EEC concerning the professions of nurse responsible for
general care, dental practitioner, veterinary surgeon, midwife, architect, pharmacist and doctor (Text with EEA
relevance), OJ L 206, 31.7.2001.

(4) Council Directive 93/16/EEC of 5 April 1993 to facilitate the free movement of doctors and the mutual recognition

of their diplomas, certificates and other evidence of formal qualifications, OJ L 165, 7.7.1993.

(2003/C 137 E/269)

WRITTEN QUESTION E-3677/02

by Bart Staes (Verts/ALE) to the Commission

(18 December 2002)

Subject: Combating leukaemia with stem cells from umbilical cord blood

Bone marrow transplants have been used for years in the treatment of leukaemia, proper patient-donor
compatibility being the greatest problem in this connection. Bone marrow and the peripheral bloodstream
contain hematopoietic stem cells. Placental and umbilical foetal blood is the richest source of stem cells,
however, though it has been known about for only a few years. At the start of 2001, two doctors set up
Europe’s first private umbilical cord blood bank (cid:1) Cryo Cell Europe (www.cryoc.com) (cid:1) which is based in
Mechelen but already contains blood stocks from throughout Europe. Despite the fact that the operation is
thriving, Cryo Cell Europe is not welcomed everywhere with great acclaim. Some university hospitals have
had their own umbilical cord blood banks for a few years. The big difference between Cryo Cell Europe
and the universities is that
the university blood banks make blood available anonymously and,
furthermore, give it to children from poor backgrounds who need a transplant. Cryo Cell Europe is a
private firm, however, which banks blood on a personalised basis, storing it for the owner in return for
payment. Storing blood stocks for a 20-year period will cost a total of EUR 1 000, the likelihood that the
owner’s child will need the umbilical cord blood being negligible. In November 2000, the European Group
on Ethics issued an opinion on the use of human stem cells, albeit without specifically addressing the
ethical aspects of such practices.

How does the Commission propose to provide sufficient stem cells for those in need if, possibly, they are
stored only on a personalised basis and universities consequently have insufficient stocks of umbilical cord
blood to provide a public service? Is this not the start of two-tier medical treatment?

Is the fact that the website mentions only the insurance company Mercator & Noordstar and that, in return
for taking out a hospitalisation policy, that insurer will reimburse laboratory and transport costs not an
instance of improper, bundled selling in Belgium?