Giving evidence on the 10th day of the inquiry at Edinburgh Sheriff Court, Registered Nurse Anne Stokes spoke of her concerns about Dr John Evans-Appiah.

"He seemed to have a casual approach to his work," she said.

"He just didn't seem to have, in my opinion, the right attitude in his interaction with patients and staff."

Work was 'messy'

Ms Stokes was employed as a recovery nurse at the Peffermill Dental Clinic in Edinburgh from 1994 until the end of last year.

Darren never regained consciousness from the anaesthetic given before the treatment began.

Asked by Anne Smith, QC, representing the boy's family, how she rated Dr Evans-Appiah with other anaesthetists with whom she had worked, Ms Stokes replied: "Not favourably."

"There seemed to be difficulties with patients. He would not always put monitors on patients and his method of working was quite messy."

Aware of difficulty

Ms Stokes said she expressed her concerns to the owner of the clinic, Maurice Beckett, and asked him to supervise the anaesthetist.

He did this but, said the nurse: "He didn't seem to share my concerns."

Ms Stokes then contacted the Poggo Group in London, the company which placed Dr Evans-Appiah at the clinic and expressed her worries.

"The inclination I got was there seemed to be an awareness they had a difficulty. I was left with the impression they were going to speak to him."

Finlay Scott, Chief Executive of the General Medical Council, which licenses doctors to practise medicine in the UK, was examined at length about legislation related to foreign doctors and the GMC's procedures for ensuring their continuing competence.

Doctor Evans-Appiah was, he said, fully registered at the time of Darren's death.

The inquiry continues.