A locum consultant radiologist who worked at Bantry General Hospital is facing allegations of poor professional performance in relation to serious errors in up to 22 CT scans he reported on.
The allegations involve Dr Dawar Siddiqi who worked at the hospital from May 2013 to September 2013.
It is alleged that Dr Siddiqi's rate of error was unacceptably high.
The Medical Council inquiry has heard that it follows a selected review of 62 CT scans by an independent radiologist for the inquiry.
Dr Siddiqi qualified in Lahore in Pakistan in 1979.
He previously worked in the Limerick Regional in 1994, Our Lady of Lourdes in Drogheda in 2013 and also in London and Saudi Arabia.
The inquiry is scheduled to last five days and Dr Siddiqi is representing himself.
Solicitor JP McDowell for the Medical Council said that Dr Siddiqi has claimed the hospital was so busy, the workload so heavy and the system in flux, that it impacted on his reporting on CTs.
He also had complained about the physical working environment.
During his time at Bantry, clinicians raised concerns about the quality of his CT scan reporting.
In September 2013, the hospital wrote to the agency that had introduced him saying they wanted to end the arrangement.
The hospital decided to order a review of the imaging reported on by Dr Siddiqi during his term.
The Faculty of Radiologists were asked to organise a review of 10% of the scans.
No major problems were found with his plain film and ultrasound reports but concerns about patient care were found in relation to CT scan reporting.
The review expressed concern in relation to five cases where major discrepancies were found and it recommended that all of the CT scans be reviewed.
The inquiry has heard that the hospital decided that all of the imaging be reviewed - plain film, ultrasound and CT scans. That review report is close to completion.
The hospital reported the matter to the Medical Council.
Dr Siddiqi told the inquiry that when he arrived at Bantry, as the sole consultant radiologist, there was a significant backlog of patient scans not reported on.
He said the scans were stored "haphazardly" and he described the facilities as inadequate and primitive.
He said he had to manage the backlog and maintain a service and suggested to the hospital to reduce the workload because of this.
Dr Siddiqi said he was promised that the new digital system would be in place within weeks.
Dr Siddiqi has told the inquiry that no-one at Bantry General Hospital ever contacted him to say they had found problems with his performance.
He also said he was not informed that an external audit was being ordered from the Faculty of Radiology.
Dr Siddiqi said that since his time at Bantry, he was unemployed until May 2014, after which he worked at Connolly and Wexford General Hospitals.
He insisted he had not harmed any patient and that any errors were within accepted limits.
Inquiry hears from expert witness
Dr Peter Ellis, consultant radiologist, Blackrock Clinic, an expert witness for the inquiry, has said the conditions at Bantry were almost a text-book of where poor governance can occur.
He said Dr Siddiqi was single-handed, was not subject to peer review, worked with hard-copy images and a dictaphone reporting system.
He also said he had a heavy workload.
Dr Ellis said he agreed with Dr Siddiqi's findings on 40 scans but had concerns with 22 other scans.
The inquiry is now going through each of those 22 scans of concern.
In relation to scan A, Dr Ellis said the scan showed clearly that the patient's prostate cancer may have spread.
Dr Ellis said that Scan B was not a haemorrhage or abscess, as suggested by Dr Siddiqi, but was an aggressive brain tumour.
Scan C showed possible bowel lymphoma recurrence and was not "unremarkable" as described by Dr Siddiqi.
Dr Ellis said these three cases amounted to serious errors.
He said Scan D showed a tumour spread not spotted by Dr Siddiqi.
In the case of Scan E, there was no reference to an old stroke which should have been identified as a cause of balance problems.
With Scan F, signs of lung disease were not identified, instead Dr Siddiqi suggested emphysema for which Dr Ellis said there was no evidence.
