Consultant surgeon Dr Syed Naqvi has begun giving evidence at the Medical Council inquiry into 11 allegations against him.
The case surrounds the death of Martina Sherlock, who died in December 2008 after three operations at the Mid-Western Regional Hospital, Ennis.
Dr Naqvi said he started working at the hospital in 2005 and before then had worked in many other Irish hospitals.
He has been a consultant surgeon at Mid-Western Regional Hospital, Dooradoyle, since 2009.
Dr Naqvi said there was no CT scanner at Ennis and it did not have enough consultants.
He told the inquiry that he came into Ennis hospital on 21 November 2008 to do keyhole surgery on Mrs Sherlock for gallstones.
But he learned that a CT scan done at the Limerick hospital suggested she had appendicitis and an abscess, which was a more urgent condition.
He spoke to Mrs Sherlock and her husband James and got consent for a change of surgery.
Dr Naqvi told the inquiry that he could not do what was planned during the first operation on 21 November.
He had to remove a large part of Mrs Sherlock's large and small bowel and do a repair.
The surgeon accepted that he did not put down the extent of the operation in the medical notes after the operation.
Dr Naqvi said that Mrs Sherlock was well and stable the day after the operation.
But she later developed what he believed was a wound infection, which was treated with antibiotics.
He did a second operation on 3 December to explore and treat a wound infection that was not improving.
On the allegation that it was professional misconduct not to have sent Mrs Sherlock to Limerick at this stage for a CT scan, Dr Naqvi said that organising it would have been difficult.
He also said the patient would not be monitored in the ambulance to and from Limerick or in the CT scanner, which was dangerous.
He said that Mrs Sherlock deteriorated after the second operation and over the weekend of 6/7 December, 2008.
Dr Naqvi was off that weekend and a locum consultant was on, but no-one contacted Dr Naqvi about her deterioration.
On his return on 8 December, Dr Naqvi did a third and final operation on Mrs Sherlock due to the risk of a septic wound.
Mrs Sherlock died two days later after being transferred to Limerick regional hospital.
Today, Mr Sherlock said he and their 13 children were devastated at the events.
Letter sent to Mary Harney
Details of a letter sent to former health minister Mary Harney in April 2005 have also been given to the inquiry.
The letter from consultants at Ennis warned that patients' lives were being put at risk due to the shortage of consultants, the lack of a CT scanner and the transfer of patients elsewhere.
Senior counsel for Dr Naqvi, Eileen Barrington, said that when there was no response to this letter from the minister or the HSE, the consultants wrote to the Medical Council President in April expressing the concerns for patients.
Dr Naqvi said that following a HIQA inquiry report into Ennis in April 2009, all acute surgery was ended at the hospital and he later moved to work at the Limerick hospital.
