A top surgeon and former chairman of the British Medical Association left a surgical clip inside a patient, shouted at junior staff and behaved like a "caricature of surgical arrogance", watchdogs heard today.

James Johnson, a "seasoned surgeon and distinguished doctor" railed against the "incompetence" of theatre staff and was acting so "furiously" during one operation that he accidentally stabbed a colleague in the forehead with a needle, a Fitness to Practise panel of the General Medical Council (GMC) heard.

The 64-year-old, a consultant surgeon at NHS hospitals in Cheshire, had held a number of senior posts representing the medical profession, Andrew Colman, counsel for the GMC, told the hearing in Manchester.

But this led to "conflicting pressures of time" as he was travelling to London as chair of the BMA while working at two hospitals, in Runcorn and Warrington, for North Cheshire Hospitals NHS Trust, Mr Colman said.

It led to his patients "missing out" on his care, his techniques became "outdated" and he began "over-operating", conducting amputations of patients' limbs where less drastic procedures may have been more appropriate, it is alleged.

He also developed a "resentment" of working in Warrington, with his patients caught in the "crossfire", Mr Colman said.

Mr Johnson is accused of misconduct and faces a series of disciplinary charges over alleged flaws in his performance - in pre and post operative work as well as surgery - relating to 14 patients between 2006 and 2008.

Mr Johnson was the public face of the BMA, which represents 140,000 doctors, for almost half of the 19-month period in which the GMC is investigating his conduct.

He became the BMA leader in July 2003 but resigned in May 2007.

In one operation - on a 69-year-old woman on July 3 2007 - he moved from "initial irritation, through increasing exasperation to outright aggression," it is alleged.

Mr Colman told the GMC that Mr Johnson's behaviour "reflected rather a caricature of surgical arrogance that was out of place even decades ago, other than through the lampooning lens of cinema comedies."

During the operation, he struck a house officer in the forehead with a needle and when staff tried to tell the surgeon a 2.5 inch bulldog clip was still in the patient's leg, he was "in no mood to listen", the GMC panel heard.

Instead, Mr Johnson sewed the wound up - and an X-ray later revealed the clip was still in the patient's leg as theatre colleagues had tried to warn him.

Two months later he amputated another patient's leg above the knee. He is accused of failing to consider another procedure, involving the amputation of a toe, as an alternative.

The final charge relates to an abdominal aortic aneurysm repair on a 71-year-old patient on January 17 2008.

Mr Johnson is alleged to have failed to warn the patient of the risk involved in the surgery, to get an assistant to help with the procedure - which had encountered problems - or give a proper handover to nursing staff afterwards.

Twelve days later - after the patient's death, which it is not suggested was due to any error on Mr Johnson's part - he was called by the Coroner's Officer.

He is accused of failing to say during that conversation that there had been problems with the operation. He allegedly told the officer a colleague's operation on the same patient the day after his surgery had not been successful.

The GMC allege the effect of his statements, though not deliberate or dishonest, was misleading.

Mr Johnson is also accused of failing to ensure patients were warned about the possible risks of certain procedures and that some of the operations performed were "not surgically appropriate".

He is also accused of failing to participate in meetings before operating to discuss the patient's case and failing to involve himself properly in patients' post-operative care.

He denies the charges and has publicly said he will "vigorously defend" his position.

Around 30 witnesses will be called and the hearing is scheduled to last into November.