A former general manager at Cavan General, Bridget Clarke, has told a Medical Council inquiry that Dr Salah Aziz opposed an external review into the case of Patient 1, whose baby died after emergency delivery at the hospital in November 2012.

On the second day of an inquiry, Ms Clarke said it was decided to have an internal review and thereafter commission an external review of the case.

Baby 1 was delivered on 22 November 2012 by emergency caesarean section and was transferred to the Rotunda for care.

It is alleged that Dr Aziz, a consultant obstetrician, engaged in a prolonged attempt at an instrument delivery at Cavan and failed to do a caesarean section in good time.

Ms Clarke told the inquiry she had an 'up and down' professional relationship with Dr Aziz.

Sometimes they agreed on service configuration and sometimes vehemently disagreed.

Ms Clarke supported GP and midwifery-led services and Dr Aziz and some of his colleagues had significantly different views.

She said she also had concerns about the high level of C-sections at Cavan, which had a rate of almost 30%.

Ms Clarke said she was very concerned about the number of planned C-sections being performed out of hours.

She said she was first made aware of the case of Patient 1 and Baby 1 on 24 November 2012, after the emergency C-section.

A staff meeting was held to discuss the serious incident.

She believed there was enough evidence for an external review but Dr Aziz disagreed.

The inquiry has heard that the theatres were very busy at the time and three of four theatres were working.

Ms Clarke insisted there had never been an issue about opening another theatre, where an emergency C-section needed to be performed.

The inquiry has been told Dr Aziz will claim there was a delay in getting a second theatre open, for an emergency C-section on Patient 1, when he was involved in efforts for an instrument delivery in the case.

The inquiry is in Module One, dealing with one of three cases relating to women and childbirth at Cavan between 2012-2014.

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The inquiry has heard that four consultants, including Dr Aziz, wrote to Cavan general management on 30 November 2012, expressing serious concern about not being able to get staff in quickly enough to open a theatre for an emergency.

The letter said delays in dealing with cases affected outcomes.

It said that after a number of recent events, involving emergency cases, there was serious concern over the timely availability of operating theatre staff.

Ms Clarke told the inquiry that emergency time was "misused" by elective operations being performed out of hours by doctors.

Bernie Fitzpatrick, who was assistant director of nursing at the hospital, told the inquiry she did not recall any delay in opening a second theatre for Patient 1.

She said any extra staff needed were living just five to ten minutes away.

Ms Fitzpatrick said that having to open an extra theatre for an emergency C-Section at the hospital was a rare event, occurring at most two to four times a year.

The inquiry has adjourned until Monday.