An expert witness for the Medical Council has told an inquiry that it was "unbelievable" that surgical senior house officer Dr Omar Hassan wrongly identified an X-ray of an elbow as being of an ankle.
Prof John McElwain said this raised questions about Dr Hassan's basic knowledge of anatomy and his training, given he had been working as a senior house officer for 14 months.
The incident occurred during a trauma meeting on 17 February 2014 at University Hospital Galway.
Prof McElwain said it was a very serious matter, given medical students would know the difference, as there is no similarity between an X-ray of an elbow and an ankle.
"You would see this a mile away", he told the inquiry.
He said this was poor professional performance.
Prof McElwain also accused him of "sloppy practice" given the evidence that in February 2014 at Galway, Dr Hassan used the same glove to take blood, hold vials and answer a telephone.
He said it was not proper aseptic technique.
He also criticised Dr Hassan for walking into theatre wearing his normal street shoes and failing to scrub up properly, in preparation for theatre.
He said it was poor professional performance.
Prof McElwain said that in another case, Dr Hassan was wrong to give a non-steroidal anti-inflammatory drug to a 90-year-old patient, due to the risk of renal impairment.
Prof McElwain told the inquiry he had every reason to believe the allegations made by doctors and nurses at the three hospitals at the centre of the cases.
He said there were far too many incidents that were not isolated.
He said Dr Hassan was taken off call very quickly at the hospitals and he was given every opportunity to try and rectify matters but had no insight into his own limitations.
Prof McElwain commended the Midland Regional Portlaoise, Mayo General, and Galway hospitals for prompt action.
He said taking Dr Hassan off call minimised the exposure to patients.
An issue with Dr Hassan was that when asked to see certain patients he did not do so, or when he did, he failed to perform in the manner he should have.
"Fortunately others were there to correct any problems that arose," Prof McElwain said.
The professor said he had a "serious problem" that there was no communication between the three HSE hospitals where Dr Hassan worked over the period.
This is the ninth day of the inquiry, which is expected to conclude on Monday.
Olivia Hutchinson, clinical nurse manager on the surgical ward at the Midland Regional Portlaoise, was called by Dr Hassan to give evidence.
She said she vaguely recalled Dr Hassan in 2012.
Nurse Hutchinson said she did not recall any major incidents with Dr Hassan.
She recalled no incidents of a failure to answer bleeps, or poor communication.