Malta Dental Technologists Association - Oral hearing at CJEU
To the President and Members of the Court of Justice of the European Union
In the case C-125/16
Malta Dental Technologists Association
John Salomone Reynaud
- the Applicants
Superintendant of Public Health and
The Council for the Professions Complementary to Medicine
- the Defendants
Submissions by the Applicants, the Malta Dental Technologists Association and John Salomone Reynaud.
This hearing was set by Order given by this Court following a request by the Applicants.
When the Applicants instituted domestic civil proceedings against the Superintendent of Public Health and the Council for the Professions Complementary to Medicine, they were fully aware of the fact that, contrary to the situation in Case C-108/96 “Denis Mc Quen and Others v Grandvision Belgium SA” decided on 1st February 2001, the profession of Clinical Dental Technologists and Denturists was a safe profession vis-a-vis clients wishing to procure from them dental appliances.
The case “Mc Quen v Grandvision” concerned charges of unlawful practice of medicine in Belgium brought against the employees of an optician’s firm upon the complaint of the Belgian ophthalmologists’ association. The practices at issue included testing for hypertension of the eye, examining the state of the retina, examining the field of vision and biomicroscopic examinations. These practices that were being carried out by persons who were not qualified ophthalmologists undoubtedly constituted a serious health risk as they could lead to irreversible damage, in this case, blindness.
The profession of Clinical Dental Technologists and Denturists is indubitably a safe profession. Denturists do not perform invasive procedures. Any appliance produced by denturists is removable by the patient himself or herself in case of discomfort.
- Denturists do not diagnose;
- they do not perform invasive procedures in the oral cavity;
- they do not prescribe medical treatment;
- they refer cases of pathology to dentists and the latter refer them to pathologists after a biopsy. That the profession of Denturists is a safe profession is not open to challenge .... though it might be open to scaremongering by the Dentists’ lobby.
Indeed, on the occasion of the 45th Anniversary of the Denturist Association of Canada in 2016, the Chief Dental Officer representing the Public Health Agency of Canada, congratulated the Denturist Association of Canada as follows:
“As Chief Dental Officer of Canada, I would like to formally acknowledge the 45th Anniversary of the Denturist Association of Canada, as an association representing Canada’s Denturists.
Denturists are an important element of Canada’s oral health care community, improving access to care for denture services to Canada’s most vulnerable populations, and to Canadians in general.
Congratulations on your achievement of the 45 year milestone!”
(signed) Dr James Taylor
No less than the Chief Dental Officer, the head of the Public Health Agency of Canada, acknowledged the valid contribution of Canada’s Denturists over a 45-year span, and that is not all. The Prime Minister of Canada Justin Trudeau declared:
“Since it was founded in 1971, the DAC has been the voice of Canadian denturism, diligently representing the best interests of its members while offering valuable opportunities for career development and networking with fellow dental health professionals. ....
I would like to commend the members of the DAC for maintaining high standards of excellence and professionalism in the provision of denture services and patient care.”
Not so in Malta, where dentists have the upper hand, and the profession of denturist is not allowed to exist.
The questions set by the Court
1). To what extent does Article 36(3) of Directive 2005/36/EU of the European Parliament and of the Council of the 7th September 2005, concerning the recognition of professional qualifications (GU 2005, L 255, p. 22), enlisting the activities of the persons who practise in the dentistry profession, provide that certain professional activities of clinical dental technologists that are the subject matter of the dispute in the main proceedings should be considered as being reserved for persons who practise the dentistry profession in the sense of this provision?
Applicants will be the first to acknowledge that the case “Mc Quen v Grandvision” was decided correctly in 2001. In the applicants’ view, the decision remains good law as it was based on sound legal principles. Patient safety should come before anything else. The professional practices encountered in the Mc Quen case were correctly reserved for persons who are qualified ophthalmologists.
Article 36(3) of the Directive was not intended to favour any particular profession in the eventuality that one profession is contesting another, but to ensure that activities that are inherently risky are reserved for qualified persons, only if there is a justification for this. This involves a weighing exercise between the activity or practice under examination and the existence or otherwise of a valid justification to reserve.
The Treaty provisions on freedom of movement for workers are intended to facilitate European Union nationals’ pursuit of occupational activities of all kinds throughout the European Union, and preclude measures which might place such nationals at a disadvantage when they exercise this right conferred on them by the Treaty (C-515/14, 38-39). The attitude adopted by the Maltese health authorities in favour of the Dentists’ lobby to oppose the profession of denturists constitutes a serious obstacle to the freedom of movement for workers, which is, in principle, prohibited by Article 45 of the Treaty (TFEU). Moreover, such a flagrant obstruction cannot be accepted in light of the duty of sincere cooperation and assistance which Member States owe the European Union and which finds expression in the obligation laid down in Article 4(3) TEU to facilitate the achievement of the European Union’s tasks (C-515/14, 43-52). Furthermore, Community Law also protects the freedom to provide services, besides the right to establishment.
The mere fact that a Member State is entitled to make conditions for the exercise of certain practices does not entitle that Member State to seek to impose restrictions and prohibitions without justification. One has to bear in mind that the Articles of the TFEU expressly prohibit national discriminatory measures or lack of proportionality in the way these rights are restricted. In the case Reinhard Gebhard v Consiglio dell’Ordine degli Avvocati e Procuratori di Milano (C-55/94, paragraph 37) the Court of Justice ruled:
“It follows, however, from the Court's case-law that national measures liable to hinder or make less attractive the exercise of fundamental freedoms guaranteed by the Treaty must fulfil four conditions: they must be applied in a non discriminatory manner; they must be justified by imperative requirements in the general interest; they must be suitable for securing the attainment of the objective which they pursue; and they must not go beyond what is necessary in order to attain it (see Case C-19/92 Kraus v Land Baden-Württemberg  ECR I - 1663, paragraph 32).”
In the Applicants’ view, it is wrongly assumed that simply because Article 36(3) of Directive 2005/36/EC concerning recognition of professional qualifications only mentions dentists, then there should be just one oral care profession – that of dentists. This wrong assumption leads to serious prejudice to all European Union nationals in general and to Europe’s “most vulnerable populations”, those who cannot afford a visit to a dentist but can afford visiting a denturist.
The Applicants are in no way contesting the Directive’s guiding principle that “dental practitioners are generally able to gain access to and pursue the activities of prevention, diagnosis and treatment of anomalies and diseases affecting the teeth, mouth, jaws and adjoining tissue” (Article 36 (3) of the Directive). Their contestation is based on the undeniable fact that denturists do not perform any invasive procedures; they simply prepare dental appliances for patients. The appliance is removable by the patient himself or herself if and when he or she experiences any pain or discomfort. This is the easiest course of action. Then, if the appliance is defective, it is either adjusted by the denturist or replaced. Opposing and, worse still, eliminating the profession of denturist from the oral care scene on such flimsy grounds is unacceptable. This is quite the opposite of what has happened in Canada where the Prime Minister and the Chief Dental Officer commended the activities of Denturists in Canada.
Adopting reasonable measures intended to regulate a profession is one thing, but rejecting a profession simply because another profession sees it as an obstacle in its resolve to monopolise all the turf covered by oral health care runs counter to the principles behind the rights guaranteed by the Charter of Fundamental Rights and defeats the essence of these guaranteed fundamental rights. The issue here is not the wide competence pertaining to the Member States under Article 168 (7) TFEU, but the enjoyment of the freedom of establishment and freedom to provide services, without any risk to public health care.
The refusal by the Superintendent of Public Health in Malta to recognise and allow the exercise of the profession of clinical dental technologist in Malta is without any doubt at all a contravention of the Fundamental Freedoms incorporated in the Treaty of the European Union, in particular the freedom of establishment of nationals of other Members States and the freedom of cross-border provision of services between Member States. The conduct of the Maltese Superintendent of Public Health does not allow European Union nationals – including potential Maltese nationals – who possess the appropriate qualifications which they gained in another Member State, to exercise the profession of clinical dental technologists in Malta. There are no two ways about it: this conduct infringes European Union law.
The argument based on public interest is absolutely unfounded because, as stated earlier, the only consequence in the eventuality that a dental appliance turns out to be defective would be that the defective denture would have to be modified or replaced – and this without any risk at all to the patient. This is an incontrovertible truth. The third question posed by the referring Maltese Civil Court readily comes to mind: “Can the prohibition by the Maltese health authorities, which is being contested in the present case, serve to ensure the aim of having a high level of public health protection, when any defective denture can be replaced without any risk to the patient?” The answer is self-evident. There would be no ensuing risk to public health if denturists were to be allowed to practise their profession in Malta as a regulated profession.
The argument put forward by the Superintendent of Public Health for not allowing a Single Market micro player (the denturist) to function and flourish in Malta, namely, that Chapter 464 of the Laws of Malta does not include clinical dental technologists in the list of professions, is a feeble one. Such a lame argument cannot be relied on before the Court of Justice of the European Union. When this Court ruled in the Mc Quen case that certain activities should be reserved for qualified professionals, it was dealing with eye treatment not dentures.
Denturists do not perform invasive procedures and they do not make diagnosis. Canadian denturists shine like a beacon and irk the Dentists’ lobby because denturists are also capable of referring cases regarding treatment by dentists to the dentists. Patients manifesting pathology are not diagnosed by dentists because dentists are bound to refer such patients with pathological problems to pathologists.
The true reason why dentists oppose denturists is one related to turf: they do not like anyone entering their preserve and engaging in the sphere of activities which they regard as their personal territory. Their lobby is highly influential. Their aim is to prevent direct access of patients to denturists by putting pressure to have regulations that make it compulsory for the patient to visit the dentist before going to a denturist for a dental appliance.
The Rector of the University of Malta has been pushed by the Dentists’ lobby into declaring that there is no scope for a Masters Degree in Dental Technology. Indeed, only last Thursday, the Rector of the University of Malta announced the introduction of a Masters Degree in Responsible Gaming, which is fine. But what about the Masters Degree in Dental Technology? No, definitely not in Malta. There is no room for respect towards the key principle of proportionality; certainly not in Malta.
The fact that according to the Database on the Regulated Professions certain European Union countries notified the EU that in their country the profession of clinical dental technologists or denturists is a regulated profession serves to underline the fact that denturists are not what dentists are trying to make them out to be and that in these countries the profession of denturists is a story of remarkable success. Why should there be such a discriminatory attitude towards denturists? This is not what Community Law is all about.
In the domestic civil proceedings, the Applicants presented the testimony of Philip Tucker, a clinical dental technologist who has practised for many years as a registered denturist in England. When he applied to the Council for the Professions Complementary to Medicine for permission to establish his services in Malta, the Council replied with an outright refusal. Incidentally, the Council for the Professions Complementary to Medicine takes the easy way out and systematically shies away from shouldering its responsibilities. It says that it has no executive powers. The Maltese Judge acknowledged that the Council for the Professions Complementary to Medicine has an important role. They guide the Minister through their recommendations. The Council is not represented by any of its agents or lawyers at this oral hearing being held today.
If the referring Civil Court did not provide sufficient information regarding public interest considerations it is because neither the Council for the Professions Complementary to Medicine nor the Superintendent of Public Health had any valid points to present concerning considerations of public interest before the Maltese Civil Court. The refusal decision by the Maltese authorities resembles a dilapidated structure. There is no rhyme or reason; only arbitrariness.
Considering that it is a proven fact that denturists are qualified and trained to exercise their profession autonomously from the dental profession, there is no risk to public health. Dentures that prove to be defective can be removed instantly by the patient and will be adjusted or replaced without any risk at all to the patient. No serious or irreversible damage can result. There is no scientific evidence that removable partial dentures ‘per se’ cause serious damage.
The Maltese health authorities, like those of any other EU Member State, ought not to be allowed by this Court to base their refusal on flimsy grounds. There have to be valid reasons for refusing to abide by the Member State’s obligations of allowing freedom of establishment and cross-border provision of services. Patients have the right to access the Single Market.
The Third Schedule of Chapter 464 of the Laws of Malta contains a list of “Professions Complementary to Medicine”. Is the exclusion of the profession of denturists from this list without valid reasons to be tolerated by this Court? Is Maltese law in this regard compatible with the Articles of the TFEU and the Charter? It is up to the Maltese health authorities to prove the alleged risk; the ‘onus probandi’ lies on the party alleging that there exists a risk to public health.
Denturists undergo training and are highly qualified. In a letter sent by the Vice President of the European Committee of the International Federation of Denturists, representing Transparency Register 362696619240-92, to Commissioner Vytenis Andriukaitis on 2 October 2016, it was stated:
“A Denturist / CDT is allowed to work independently and can directly hear the expectations or medical concerns of patients. He manufactures the prosthesis, makes adaptations to the device (if necessary) and ultimately delivers and fits the appliance to the end-user / patient.”
Regarding the Dentists’ lobby, the Vice President warned:
“Lobbyists have recommended setting the minimum qualifications to practise Dentistry, in the EU, as that of a Dentist. This ignores the independent practice of Denturists / CDTs, already recognised in EU Member States (MS). It will restrict the PARTIAL ACCESS covered within the scope of practice for Denturists in the provision of Custom-Made Dental Devices (CMDD), directly to the Public. Denturists / CDTs have practised safely in Europe and internationally for many years, without any threat to Public Health.
Our European Committee recommends that, Partial Access to be included in any revision of Directive 2005/36/EC for the provision of dentures, by qualified Denturists / CDTs and that the profession is recognised separately from Dentists.”
Denturists provide less costly oral care for patients who cannot afford to pay for services offered by dentists. The poor are entitled to a high level of health protection in all European Union countries as much as the wealthy. The EU strives for health to be included in all policy areas, and when it comes to disease prevention and health promotion there should be an ‘all hands on deck’ attitude, and not a turf war. Early access to disease prevention is to be encouraged not shackled. In reality, denturists can also serve as an early warning signal.
Another warning signal given by the Vice President in the said letter concerns Article 4 and the free movement of devices:
“Providing the CMD (dentures) satisfies the requirements of the MDD 93/42/EC, Members States cannot obstruct the supply to European consumers. This is quoted in Article 4 (2) of the Directive, as the device and conformity statement fulfils all legal requirements.
Although Denturists are not regulated in all MS, it is clear the Directive on Professional Qualifications and the MDD allow these professionals to provide goods and services in all Member States.
Allowing Dentists and Dental laboratories to retain this monopoly is not in the interest of EU citizens and Single Market policies.”
The second question
2). If the answer is in the affirmative, is the proposed request that clinical dental technologists who originate from other Member States should be entitled to exercise their profession in Malta without it being necessary that patients are referred to them by a person who exercises the dentistry profession, compatible with Directive 2005/36, and in particular with Article 36 thereof in so far as the qualification of clinical dental technologist is not included among the qualifications for training mentioned in point 5.3.2 of Annex V of this Directive ?
The rules concerning the coordination of the profession of dentists are to be found in Articles 34 et sequitur of the TFEU (Chapter 3) and in Annex V (point V.3) of Directive 2005/36/EC. Annex V only refers to Dentists who have harmonisation (that is, standardisation) in their training and education. Clinical dental technology is listed in the General system.
Denturists or clinical dental technicians / technologists / special technicians [according to the nomenclature applicable in the particular Member State] are listed within the General system, where professions do not possess harmonisation in their education and training from one Member State to another. The International Federation of Denturists, however, has stipulated the Baseline Competencies which the EU Member States having regulation of clinical dental technologists acknowledge but do not implement. The International Federation of Denturists registered with the EU Transparency Register is presently formulating an international accreditation status for educational institutions. In the Selective or Sectoral system this refers to all professions with harmonisation of education in which the dental practitioner (dentist) is included.
The adoption of harmonisation laws has made it possible to remove obstacles created by national provisions by making them inapplicable and to establish common rules aimed at guaranteeing both free circulation of goods and products and respect for other EC Treaty objectives, such as protection of the environment and of consumers, competition, etc.
If an applicant’s qualification is not listed in Annex V, point 5.3.2 because it does not meet the basic criteria, it may still be recognised under an acquired rights regime. To this end, one of the persons who applied to the Council to be able to establish his profession in Malta, Philip Tucker, certainly possessed at least 3 years of professional experience within the last 5 years (Art. 23) – in fact he has many more years of experience – nevertheless his application was still rejected by the Maltese Council for the Professions Complementary to Medicine. There were other applicants and each one of them was rejected. All this occurred while one of the European Union’s ‘desiderata’ is the progressive abolition of restrictions in order to implement Single Market policies.
In some Member States of the European Union with regulation of clinical dental technologists, the full scope of practice of denturists, that is to say, access to the public for full and partial dentures, is still an ongoing issue. For instance, in the United Kingdom, clinical dental technologists can only provide full dentures (prostheses) directly to patients, while partial dentures can only be provided through a referral by a dentist. These Member States therefore have limited partial access to patients due to the strong Dentists’ lobby to monopolise all dental services to the public including the provision of removable prostheses. One strategic way of achieving this opposition is the removal of radiographic credits from the denturists’ programme. So strong is the opposition from the Dentists’ lobby that notwithstanding that independent bodies, such as the Nuffield Report and the Office of Fair Trading in the United Kingdom, were recommending full access, the Dentists’ lobby continues to oppose full access. However, what happened in Malta is very hard to emulate: The course of studies for dental technologists at the University of Malta, a Degree course, was a four-year course of studies, with 240 credits. In 2014, in order to satisfy the Dentists’ lobby, the course of studies was curtailed to three years of study, with 180 credits. Important components of the course were chopped off. The Dean of the Faculty, himself a dentist, was only too pleased to deal such a blow to the dental technologists’ aspirations in order to please the Dentists’ lobby.
Several of the written pleadings submitted before this Court made reference to the risk to public health should denturists be allowed direct access to patients. This allegation is pure fiction as denturists do not perform invasive procedures and they neither make any diagnosis, nor do they prescribe medical treatment. Removing a denture instantly removes pain or discomfort. With a headache, you have to lump it, but with a denture you only have to remove it. Where is the risk? People would wish that all problems were as easy to solve as eliminating pain or discomfort by removing a denture from one’s oral cavity.
Does the provision of false limbs constitute a risk to public health? If a lower limb is causing discomfort or pain, the patient has only to withdraw from public view and remove the false limb; the pain is gone and the risk is nil.
Tattooists shoot ink with a powerful needle into the epidermis. That is surely an invasive procedure and it exposes the client to a high risk of infection. Yet there are scores of tattooists working in Malta, and they are a regulated profession and they are licensed to do just so. Chapter 270 of the Laws of Malta, “Control of Tattooing Act” provides that “tattoo” – “means the insertion into the skin of any colouring material designed to leave a permanent mark”; “licence” means “a licence issued under section 6 of this Act”. Subsidiary Legislation 350.23 lays down the “Requirements as to Advertisements, Methods of Advertising and Directions applicable to Tattoo Advertising”. According to requirement 2.5 – “In order to know whether a person is in possession of a valid licence to act as a tattooist, broadcasters should get in touch with the Director of Public Health”. In Malta, tattooists, such as the “Mad Tatter”, “Skin Label Tattoo Parlour”, “Naughty Needles” and “Source of Pleasure”, have been luckier in finding favour with the Maltese Public Health Authorities than Denturists! It is astonishing that the Superintendent of Public Health appears not to know that in the case of qualified denturists there is no risk to public health.
As proved in the main proceedings, when Philip Tucker, a Registered Dental Technician (RDT) and Clinical Dental Technician (CDT) who qualified from the Royal College of Surgeons in England in 2007, applied to the Council for the Professions Complementary to Medicine for registration as a Clinical Dental Technician in Malta, the Registrar of the Council answered as follows:
“You are to be informed that in accordance to the Health Care Professions Act (Cap. 464) the Council for the Professions Complementary to Medicine regulates 19 health care professions which do not include the clinical dental technician. However, the Council regulates the profession of dental technology.”
It has recently been reported that after a long difficult battle that has been going on for 41 years, the Belgian government has officially announced today that denturism is now to be recognized as a profession in the dental health field along with dentistry and dental hygiene!
A denturist is a qualified dental technologist with an extended clinical programme making him eligible to qualify as a denturist. A qualified denturist studies a programme with a curriculum which reflects dental competencies related to the direct provision of removable oral appliances, lost teeth and oral structures. Denturists provide a more feasible service, both with regard to efficiency and cost, for the provision of custom-made removable dental devices. Many patients turn to denturists after being let down by the service they experienced at the hands of an irresponsible or negligent dentist.
Denturism or Clinical Dental Technology should be perceived and understood as a specialised section of Dental Technology. The most valuable asset of a denturist remains the person to person contact between the denturist – as manufacturer and clinician – and the patient.
The Malta Dental Technologists Association is the only professional organisation in Malta representing the interests of Dental Technology as well as its specialisations (vide Legal Notice 20 0f 2017). The request had been made in 2009! The Association has submitted on more than one occasion representations to the Maltese health authorities, through the Council for the Professions Complementary to Medicine, so that the applicable subsidiary legislation is reviewed allowing the introduction of the profession of Denturists. However, the Council of Health (now the Medical Council of Malta) has adopted a negative attitude as a result of the Dentists’ lobby. First the Council of Health, then the Superintendent of Public Health overruled the Association’s recommendations. The reason is that they will only consider the case if and when “trends improve” (their own words), as if the admission of denturists as one of the oral allied health professions should be decided on the basis of “trends”! The restriction has been shown to be arbitrary.
After examining the written submissions made jointly by the Republic of Malta and the Superintendent of Public Health, the Malta Dental Technologists Association states that denturists are qualified to assess the oral cavity and to identify abnormalities and to detect pathological lesions. All these are included in the curriculum followed in their course of studies. The Republic of Malta and the Superintendent of Public Health are not even aware of the fact that denturists take a history of the patient, and therefore if the patient is taking biphosphonates (a medicine for the treatment of osteoporosis), the denturist would know about it. If denturists encounter osteonecrosis of the jaw or tempomandibular joint dysfunction, they would know what they are looking at because such conditions are included in their curriculum of studies. They are trained to refer cases of pathological abnormalities to dentists. Moreover, neither dentists nor denturists are competent to diagnose and treat cancers; both are expected to refer them to pathologists.
The International Federation of Denturists lays down standards of good practice such as: “Students will learn to recognise those pathological conditions which necessitate referral to other professionals for further treatment.”
Futhermore, the Rules of Professional Conduct and Code of Ethics issued by the IFD provide that denturists are under a professional obligation to refer patients to a dentist when they detect a condition which they are not qualified to treat.
The key feature of denturism is that denturists have a combination of clinical and technical skills, which enable them to decide with the patient what dentures are required and then make those dentures themselves. Put simply, denturists offer a ‘one stop shop’ form of service. By contrast, dentists almost invariably subcontract the work of manufacturing the dentures, which they prescribe to dental technicians. This is often because dentists are not trained to do this work.
One of the advantages of having the denturists’ services is that they see the patient ‘one to one’ before carrying out the technical side of the work.
It is astonishing that the Republic of Malta and the Superintendent of Public Health base some of their submissions on information found on “Wikipedia”!
Almost invariably, dentists are not the ones to manufacture the denture. It often happens that from the clinical prescription issued by the dentist, some patients’ needs, such as the psychological attitude of the patient, are not reflected and indicated to the dental technologist / manufacturer in the laboratory. If the patient is less tolerant, a thinner or smaller denture is fitted. The fact that patients are never likely to meet the manufacturer is a serious shortcoming. Patients are being denied all these benefits.
The illogicality of this scenario in Malta is brought into greater focus when considering the ethos of professionalism which is taught to trainees. The profession has its regulatory framework. If the quality of work is below the required standard the remedy is a professional negligence claim.
The Council and the Superintendent are failing in many ways:
- failure to provide any evidence that there is a risk to public health,
- failure to consult,
- failure to listen to constructive criticism of the present scenario,
- failure to understand the advantages of reform,
- failure to understand the context of the work provided,
- failure to demonstrate flexibility and openness to reasoned arguments.
But, above all else, denturists have to fight against the die-hard attitude of the Dentists’ lobby. A document published by the FDI World Dental Federation unashamedly states:
“.... the FDI World Dental Federation: ....
Opposes any kind of undergraduate and post-graduate education which gives the dental laboratory technician the status of a healthcare provider.”
The Department of Dentistry at the National Hospital “Mater Dei Hospital” has issued the following consent form to be signed by patients, entitled “General Consent Form for Dentistry”:
“I realize that full or partial dentures are artificial, constructed of plastic and may have metal wire. Multiple visits are required for the construction of dentures. I realize the final opportunity to make changes in my new dentures will be the “teeth in wax” try-in visit.
“I understand the wearing of dentures is difficult, especially in the initial period after insertion. Sore spots, altered speech and difficulty in eating are common early problems. Other problems may arise with time including looseness, soreness and possible breakage. I(n) these cases, modification of the existing dentures (easing, repair, reline, rebase) or provision of new dentures is at the discretion of the dentists working within the Dental Department.”
This is the truth. The rest is a dangerous cocktail of fiction and bad faith.
Advocate Tonio Azzopardi
2 March 2017