A consultant respiratory physician who worked at Roscommon County Hospital is facing four allegations of poor professional performance at a Medical Council inquiry.
The allegations against Dr Sardar Ali involve a 78-year-old man who attended the hospital from 14 March 2011 until his death on 6 April 2011.
It is alleged that Dr Ali failed to carry out timely investigations, appreciate the gravity of Patient A's low platelet count, or have a timely treatment plan after his admission.
Dr Ali, who qualified in Pakistan in 1985, told the fitness to practise inquiry he is representing himself as he cannot afford the €40,000-€50,000 legal cost of the three-day hearing.
He said he was confident that he can defend himself against all of the allegations.
Three of the allegations were withdrawn at the start of today's inquiry.
Dr Ali told the inquiry that Patient A had a range of illnesses, including type 2 diabetes and haemochromatosis, and had been admitted to the hospital on several occasions.
Dr Ali said he had appreciated the gravity of Patient A's condition and had dealt with the clinical issues in March and April 2011 after Patient A was admitted through the emergency department.
He said the patient had been ill for some weeks complaining of coughing, breathlessness, weakness and loss of appetite.
An application by Dr Ali to have the inquiry held in private was not successful.
Dr Ali said he was currently working at a private hospital.
Dr Ali told the inquiry that Patient A did not die from a significant bleed or low platelet count.
He said the patient had a list of life threatening conditions, but his presenting clinical problem was not low platelet count.
Patient A had received the best clinical treatment.
Dr Ali said Roscommon County Hospital was a very busy but poorly resourced hospital.
He asked the inquiry to recognise the pressure it physicians are under.
Dr Ali said patients were often on trolleys and there was huge pressure on doctors to clear beds on wards.
Neasa Bird, barrister for the Medical Council's CEO, told the inquiry that Patient A was admitted with a chest infection. This was treated with antibiotics and he responded.
She said his platelet count on admission was 27 and never went higher than 32.
Ms Bird said the low platelet count only came to the forefront of his treatment on 29 March and that he suffered a significant nose bleed on the same day.
The inquiry heard Patient A deteriorated over the following days.
Ms Bird said she was not suggesting that earlier treatment for the low platelet count would have altered his ultimate outcome.
The complaint about Patient A's care was made by his daughter.
Patient A's daughter told the inquiry she understood her father was being treated for a chest infection.
She was told he was getting better and would be discharged and so she was trying to organise care in a home for him.
But on a visit to the hospital, she found him in a very bad state, after a massive nose bleed.
She said he later became comatose and needed palliative care.
On 4 April, when she asked Dr Ali what had happened to her father, he told her it was a chest infection.
She said that to this day, no one had explained what happened.
The inquiry has adjourned until tomorrow.