A consultant surgeon who left five women dead after operations was accused of performing botched surgery that was beyond his competence, of lacking clinical judgement and of misleading relatives about the outcome.

Steven Walker, a consultant general surgeon at the Victoria Hospital in Blackpool, was said to have been "over-optimistic" about his skills, to have made "inappropriate" choices of operation and to have showed " an alarming lack of insight" into his clinical skills, the General Medical Council was told.

Mr Walker, 44, is charged with serious professional misconduct in relation to his treatment of 12 female patients during two and a half years from December 1995 to June 1998. The charges are among the most serious to be levelled at a doctor since the case of Rodney Ledward, the self-styled "fastest gynaecologist in the west" who was struck off in 1998.

The case, one of the most complex heard by the GMC, is expected to last eight weeks.

The worst example of Mr Walker's alleged incompetence arose in December 1997 when a patient was treated for a suspected tumour of the lower rectum. The woman, Margaret Wilson, referred to as MW at the hearing, died after he operated on her on 5 January 1998.

Mr Walker is said to have failed to manage the bleeding during the operation and to have failed to communicate the amount of blood loss to the anaesthetist. He failed to refer the patient to a colorectal specialist and the procedure was "beyond the limits of his clinical competence and technical expertise", the GMC was told.

In another operation to remove a cancerous tumour from the liver of a 70-year-old woman, Mr Walker failed to stem the bleeding and the woman lost 17 litres of blood. She died two hours after the operation but, in a letter to her GP, Mr Walker said she had been transferred to the intensive care unit "in a satisfactory state". He told her relatives immediately after the surgery that she had had "a few problems during the operation" and that she had "bled a little".

During another operation in which a patient was rapidly losing blood, colleagues were horrified when he turned his back on the patient "to give a nurse a sample of the tumour he had removed so a picture could be taken of it", the GMC heard.

A 31-year-old woman also died three weeks after a string of operations to remove a cyst on her liver. The GMC was told Mr Walker had left the woman in pain for 20 days after the fourth operation. "This woman had problem upon problem and he failed to send her to a hepatobiliary [specialist liver] unit for treatment. The doctor was inadequately skilled to perform the operation," the GMC heard.

Five women were scarred by his attempts at breast implant operations, for which he had no training, but managers allowed Mr Walker to carry on in a limited capacity despite a number of complaints. When an anaesthetist refused to work with him it was put down to a clash of personalities. A second anaesthetist pulled out after working with him for seven months.

Mr Walker was a general surgeon but often operated on cancer patients. The 12 cases considered by the GMC involve two liver operations, five bowel operations and five breast reconstructions.

He was employed at the hospital from December 1995 until complaints from colleagues led to his suspension in January 1999. He was given an ultimatum about his working practices a year earlier. The hospital conducted a review of 140 cases and referred a number to an external assessor. In August 2000, the case was taken over by the GMC and the trust suspended its internal inquiry. Mr Walker denies serious professional misconduct.

The hearing continues.