Temperature rises in doctors' dispute.

THE newest president of the Hongkong Medical Association, Dr David Fang Jin-sheng, delivered the message in the most refined of tones.

''A decision will be made about whether the matter will be referred to the Medical Council,'' said the Reader in Orthopaedic Surgery at the University of Hongkong this week.

''No, I can't tell you when that meeting will be, or if the matter will definitely be put to the council. That would be a breach of the rules. I'm afraid I can't comment further on the case.

''But may I add, that it is incorrect to claim, as reported in the media, that we have threatened anyone with disciplinary action.

''Firstly, we never threaten, and secondly, we have no disciplinary power whatsoever. Only the Medical Council has the authority to make such decisions.'' And the question this week was, after the South China Morning Post printed a report that a complaint had been lodged against a Dean of one of the territory's two medical faculties, Professor Arthur Li Kwok-cheung of the Chinese University: will the Medical Council take such a step? It is a matter of consuming interest to those in the profession. An episodic but constant airing of its dirty linen in a dispute that is divided along the usual lines - the traditional versus the new, the practice of conservative medicine counterpoised against the impatient progress of researchers, the politics behind the allocation of public funding for health services and a monumental clash of personalities.

In this case, it is more complicated because one of the principal players, Professor Li, has broken an unspoken rule of medical practice; he has spoken. Many of his peers believe that he has chosen to conduct a debate on the matter related to his faculty via the media.

''I cannot tell you anything,'' Dr Fang repeated. ''I am not the official spokesman for the association.'' What others say is that Dr Fang, as a staff member of HKU, is a progressive in terms of the HKMA, but falls into the camp of the University's Department of Cardiology when the subject of the complaint is brought up - the success and treatment of the patients provided with the ox-valve, and not the metal heart valve for certain types of heart disease.

At the heart of the dispute is the screening of a television documentary last year, which showed patients at the Prince of Wales Hospital, which is staffed by Professor Li's doctors, using an ox-valve, as opposed to a metal valve, in surgery.

The documentary claimed that the surgery was preferred by Chinese University surgeons because it did not require patients to sustain lifelong treatments of anti-coagulant drugs. At the Queen Mary Hospital Cardiology Unit staffed by doctors from the HKU, the surgical team were besieged with enquiries. On average, the HKU team implants about 300 metal valves in patients per year, and follows the accepted post-operative treatment of anti-coagulant drugs.

The surgeons claim that they were more than happy to adopt the new ox-valve technique, if they could be certain of its long-term effects. They suggested that the director of the CU programme, Dr Jonathan Ho, had not complied with the normal practice of submission of the technique to scientific meetings, peer review, and publication of the procedure, before they chose to promote the new surgery via the media.

''A lot of things have been said and a lot of people were unhappy,'' said one medical academic this week. Last March, they became even unhappier. Professor Li, in a lengthy interview in the Chinese-language NEXT magazine, refuted claims that six of the 12 patients had died because the ox-valve implants were faulty and said an internal investigation had proved only one death had resulted from the animal-tissue implant.

Moreover, he chose to say that the issue was being used to attack his faculty because his team were trained overseas, the department was dynamic and advanced and that a lot of doctors in Hongkong were ''collecting rent'' with the present post-operative treatment for metal heart valve implants.

Since then, it has been, in the usual gritted teeth way that medicos conduct their battles, all-out war, although the skirmishes rarely surface in public.

Basically, it concerns control, and to many people in the medical fraternity, Professor Li seems to be winning, and they do not approve of his techniques - personal or otherwise.

He is a member of the Hospital Authority, he has conducted a hearts-and-minds campaign to win salary parity with Hospital Authority staff for all university teaching hospital doctors and he is a colourful, young, energetic and forthright personality.

This year he was involved in another controversy when the widely-respected Professor John Wong, head of the Department of Surgery at HKU, resigned from the College of Surgeons over alleged in-fighting between the two groups.

Professor Wong said four members of the 20-member council are from the Chinese University and he was the only HKU member.

''Well, what is the point of being in the minority,'' another academic explained this week. ''If you are not the majority, you can't have your view put and won. It is that simple, isn't it?'' So should the outspoken Professor Li, whom the HKU camp suggests is publicity-seeking, be even considered worthy of a complaint, let alone the possibility of an investigation? Or is the present rumbling part of a larger scheme to limit the influence and control of the CU Dean who is seen to be getting too big for his surgical rubber boots.

Certainly, he has a battle ahead of him as the investigation proceeds. Unlike the College of Surgeons executive, and the more aggressively-minded management team of the Hospital Authority, the MC and the HKMA has a largely HKU-based membership.

Although it must be added that there is no suggestion the HKU medical staff, in general, are biased against Professor Li, the question remains unanswered as to how the complaint made its journey to the HKMA, and perhaps to the MC. A free press should not operate to the exclusion of the medical profession.

At the office of the Professor Li yesterday, his secretary said he did not want to discuss the matter. He did not think he could provide any new information on the matter. It would not be appropriate at this stage, she said.

She also might have added that it would have been difficult. Although none of the parties involved will confirm the information, if normal practice is followed in the investigation of complaints against doctors, Professor Li will not be informed that an action has been taken against him until the Medical Council believes an investigation is justified.

It is correct to say that when a complaint is lodged with an organisation such as the Hongkong Medical Association that the parties to the complaint are not immediately informed, Dr Fang said.

''But no, I disagree with you that it is more serious for an allegation to be laid against a man of Professor Li's stature,'' he said. ''A professor of medicine is just as culpable as anyone else if a complaint proves to be correct.'' During the last two years, a number of recommendations have been made to update legislation governing the medical profession in Hongkong, and have included amendments to the structure and membership of the Medical Council.

Critical changes concern expansion of the council from its present 14 members to up to 28, and the establishment of two separate sub-committees to examine independently policy and ethics. The changes are expected to be put to the Legislative Council nextyear but in the meantime, the complaints procedure is routine.

Professional peers or members of the public can lodge grievances against Hongkong doctors with a body such as the Hongkong Medical Association. This group represents about 4,500 of the territory's 6,500 registered medical practitioners, and is on a membership drive.

The 21-member HKMA council meets on the first Thursday of each month, and the agenda includes discussion of complaints. A quorum of six is required, and if the council agrees, the allegations are passed on to the three-member Preliminary Investigations Committee of the Medical Council.

They take a closer look at the complaint, and if they believe it has sufficient validity to justify an investigation they recommend the procedure to the Council. When a vote is taken, the parties are informed of the investigation and their right of natural justice to respond.

Information about the case is confusing. The Government has given mixed signals about progress on the matter. Everyone has gone to ground. But this time the medical profession may be forced to account for itself.