Mr Adeyinka Adeshina

Profession: Physiotherapist

Registration Number: PH102718

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 30/04/2020 End: 17:00 01/05/2020

Location: Health and Care Professions Tribunal Service, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

1. Whilst the subject of an order suspending you from the HCPC Register, in
relation to Patient A you:

a) Undertook an initial physiotherapy assessment on 26 February 2016.

b) On 11 March 2016:

i. Undertook a first physiotherapy treatment session;

ii. Provided physiotherapy treatment over the telephone when it was not clinically appropriate to do so.

2. Whilst registered with the HCPC as a Physiotherapist, in relation to Patient A, you provided physiotherapy treatment over the telephone when it was not clinically appropriate to do so, on the following dates:

a) 25 March 2016;
b) 8 April 2016;
c) 22 April 2016;
d) 29 April 2016;
e) 13 May 2016;
f) 20 May 2016;
g) 27 May 2016;
h) 3 June 2016;
i) 10 June 2016.

3. Your actions as described at paragraph (1)(a) and / or (1)(b)(i) were dishonest.

4. The matters set out at paragraphs 1 and 3 amount to misconduct.

5. The matters set out at paragraph 2 amount to misconduct and / or lack of
competence.

6. By reason of your misconduct and / or lack of competence, your fitness to practise as a Physiotherapist is impaired.

 

Finding

Preliminary Matters

Service of Notice

1. The Panel found that there had been good service of the Notice of Hearing. The Notice of Hearing dated 20 January 2020 was sent to the Registrant’s registered address, informing the Registrant that the hearing was due to begin on 17 February 2020. An amended Notice of Hearing was sent to the Registrant’s registered address on 4 February 2020. This Amended notice did not make any change to the first day listed for the hearing of 17 February 2020.

Proceeding in the absence of the Registrant

2. Mr Millin made an application for the hearing to proceed in the absence of the Registrant and submitted that it was in the public interest to proceed. Mr Millin referred the Panel to the expert report of LM in the HCPC bundle of exhibits. The report refers to the Registrant’s submissions for the Investigating Committee (IC) dated 1 November 2018.

3. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

4. The Panel carefully considered the circumstances of the Registrant’s absence. Although there had been no response from the Registrant to the Notice of Hearing, he was aware of the ongoing HCPC proceedings and had engaged with those proceedings by providing submissions to the IC. The Panel decided that he had waived his right to attend the hearing. He has not applied for an adjournment of the hearing and the Panel considered that an adjournment was unlikely to secure his attendance. The HCPC alleges that the Registrant dishonestly worked as a Physiotherapist whilst suspended from the HCPC Register in 2016. Arrangements were in place for an expert witness and an HCPC witness to attend the hearing. The Panel considered that there was a clear public interest in the expeditious disposal of the Allegation.

5. The Panel decided that the public interest outweighed the Registrant’s interests and that it was appropriate to proceed with the hearing in the absence of the Registrant.

Proceeding in private

6. The Panel accepted the advice of the Legal Assessor and decided that evidence relating to details of the health of the witness QZ should be heard in private in order to protect the private life of the witness.

Application for the evidence of witness QZ to be given by telephone

7. Mr Millin made an application for the evidence of QZ to be given by telephone. The Registrant did not have prior notice of this application. The Hearings Officer contacted QZ, who had not arrived when he was due to give evidence to the Panel. QZ advised that he was unable to attend the hearing for health reasons. Mr Millin submitted that in the circumstances it was appropriate for QZ to give evidence by telephone, and this did not create unfairness for the Registrant. He submitted that this was not a case where the credibility of QZ appeared to be in dispute.

8. The Panel accepted the advice of the Legal Assessor. She advised that the Panel’s case management powers included the option of permitting a witness to give evidence by telephone. The Panel should consider whether this option created unfairness for the Registrant and whether it was appropriate.

9. The Panel decided to exercise its discretion to permit QZ to give evidence by telephone. The Panel was satisfied that this did not create unfairness for the Registrant and that it was the appropriate means of securing the best evidence in the circumstances that had arisen.

Application for the admission of statement of SHA as hearsay evidence

10. Mr Millin made an application for the statement of SHA to be admitted as hearsay evidence. The Registrant did not have prior notice of this application. The statement of SHA was a written witness statement for the HCPC signed by SHA and dated 11 September 2019. The HCPC advised SHA of the date she was expected to attend the hearing to give evidence. SHA contacted the HCPC on 21 January 2020 and explained that she had now received the HCPC correspondence forwarded to her from her previous employer. SHA gave reasons she was unable to attend the hearing at short notice. There was brief mention of the possibility of SHA giving evidence by videolink. Mr Millin referred the Panel to the content of SHA’s statement and submitted that the HCPC primarily relied on the documents exhibited by SHA. The remainder of SHA’s evidence provided background information.

11. The Panel accepted the advice of the Legal Assessor, who advised the Panel of the need to conduct a careful balancing exercise when deciding whether or not to admit hearsay evidence. She referred the Panel to guidance in the cases of El Karout v NMC [2019] EWHC 28 and Thorneycroft v NMC [2014] EWHC 1565.

12. The Panel noted that the statement of SHA was prepared for the purpose of the HCPC proceedings, contained a statement of truth, and was signed and dated. The statement exhibited documents and provided limited information on the circumstances in which SHA contacted the HCPC to alert it to a claim made by a medical agency in respect of physiotherapy services provided by the Registrant.

13. The Registrant did not have prior knowledge that the HCPC would make an application to admit SHA’s statement as hearsay evidence. Further, the Panel noted that the matters alleged were serious and, if proved, might have an impact on the Registrant’s career. Nevertheless, the Panel considered that other relevant factors indicated that it was appropriate and fair to admit the statement of SHA.

14. There was no information to suggest that the Registrant disputed SHA’s credibility or the content of SHA’s statement. He has not suggested that she has a reason for fabricating her evidence. SHA’s evidence is not the sole or decisive evidence in relation to any of the particulars of the Allegation. Her involvement in the matter is that in the autumn of 2017 she carried out an investigation of a claim relating to Patient A and identified concerns arising from the documents she reviewed.

15. The Panel was satisfied that the HCPC had taken reasonable steps to secure the attendance of SHA and that there was a good reason for her non-attendance.

16. Having carefully balanced the relevant factors, the Panel decided to admit the statement of SHA as hearsay evidence.

Background

17. The Registrant is a Physiotherapist who was suspended by the HCPC between 17 April 2015 and 15 March 2016. Following a review hearing on 11 February 2016, a panel of the Conduct and Competence Committee decided that no further action was required and that the Suspension Order would expire at the end of its duration on 15 March 2016.

18. On 10 October 2017, the HCPC received an email from a law firm, Keoghs LLP, who represented a defendant in a civil court case. In that civil court case there were issues between the parties, including whether physiotherapy treatment for Patient A had taken place.

19. SHA stated that Keoghs had seen the press releases relating to the Registrant’s suspension and that the Registrant was the treating physiotherapist to the Claimant, Patient A, in that civil court case. On 8 November 2017, Keoghs provided to the HCPC a signed statement from the Registrant stating that he treated Patient A over the telephone on various occasions. Keoghs also provided a physiotherapy Discharge Report signed by the Registrant which recorded that an initial assessment of Patient A had taken place 26 February 2016 and a first physiotherapy session on 11 March 2016. The HCPC commenced a fitness to practise investigation because the Registrant remained subject to an HCPC Suspension Order on both of these dates.

20. In its investigation the HCPC obtained information from QZ, the director of Concise Medico Ltd (Concise Medico). Concise Medico is a medico-legal agency which receives instructions from solicitors dealing with personal injury claims and allocates medical experts from its database of experts to the case. Concise Medico forwards the Discharge Report from the medical expert to the referring solicitor.

21. The HCPC also received information from AK, a Litigation Executive employed by Accident Injury Solicitors, the solicitors for Patient A. At the time of the events Patient A was a child and AK had some recollection of speaking to Person B, Patient A’s mother, about the physiotherapy treatment provided for Patient A.

Decision on Facts

22. The Panel bore in mind that the burden of proof is on the HCPC to prove every particular to the required standard, which is the balance of probabilities. The Panel considered each particular separately.

23. The Panel carefully read the exhibits in the HCPC bundle of documents.

24. The Registrant did not provide the Panel with documentary evidence or written submissions. The Panel noted that the Registrant had made submissions for the IC. These submissions were not provided to the Panel as a separate document, but they are set out in the expert report of LM. There was no confirmation from the Registrant that he wished the Panel to take his IC submissions into account, but the Panel noted them as part of the expert report relied on by the HCPC.

25. The Panel heard evidence by telephone from QZ. The Panel found that he did his best to assist the Panel and was a credible witness. The Panel noted that he was guarded when answering questions from the Panel about the Concise Medico process for choosing a physiotherapist.

26. The Panel heard evidence from AK. He was not involved in the instruction of Concise Medico and had a limited involvement at a later stage of the civil litigation claim involving Patient A. The Panel found that he was an open, credible witness who answered questions to the best of his ability.

27. The Panel heard evidence from LM, an expert witness, and found her to be a credible witness. LM is an experienced physiotherapist with experience in NHS, private, and sports settings. LM demonstrated a good understanding of the working practice of physiotherapists in the context of insurance claims. When instructed by the HCPC she asked to see the Registrant’s physiotherapy notes, but was advised that they were not available. The Panel noted that LM was willing to make concessions.

Particular 1(a) – Proved

28. The Panel found particular 1(a) proved by the documentary evidence, the hearsay statements of Person B and SHA, and the evidence of QZ and AK.

29. The Panel was provided with three redacted decisions and orders made by a panel of the Conduct and Competence Committee of the HCPC. A Notice of Decision and Order dated 17 April 2015 (the decision is incorrectly dated 2014) included an order that the Registrant should be suspended from the HCPC Register for a period of six months. The Registrant attended this substantive hearing and represented himself. On 16 October 2015, the Suspension Order was reviewed and extended for a period of four months to expire on 15 March 2016. The Registrant again attended this hearing and represented himself. On 11 February 2016, at the second review hearing, the Panel decided that no further order was required and that the Suspension Order would be allowed to expire at the end of its duration. The Registrant did not attend this hearing, but provided documents for the review panel.

30. Therefore, the Panel found that the Registrant was suspended from the HCPC Register on 26 February 2016.

31. QZ confirmed that Concise Medico received a Discharge Report from the Registrant’s company, Physique Rehab. The Discharge Report identifies “Mr Yinka Adeshina” as the treating physiotherapist and includes his qualification and HCPC registration number. The Discharge Report is dated 10 June 2016 and it appears to be signed by the Registrant. The Discharge Report includes the date of the initial assessment as 26 February 2016.

32. The documents exhibited by SHA included a formal witness statement obtained from the Registrant as part of a personal injury claim on behalf of Patient A. The witness statement is signed and dated by the Registrant on 25 January 2017. The Registrant states:

“I completed an initial assessment on 26 February 2016 with Patient A over the telephone from my room at Wednesbury, also present with her was her mother”

33. At the time he wrote the statement the Registrant had access to his physiotherapy notes. He stated:

“I will have to seek permission from Concise Medico Ltd before releasing a copy of my session notes”.

34. The Panel gave weight to this statement because it was in formal form prepared for the purpose of court proceedings and accompanied by a statement of truth. It was also signed by the Registrant and at the time he had access to his physiotherapy records.

35. The Panel noted that the expert report of LM includes direct quotations from the Registrant’s submissions to the IC. In those submissions he appears to retract from his signed statement and states that he was mistaken. He suggests that he subcontracted the work to another physiotherapist. However, he was unable to provide the name of the physiotherapist because “I did not keep good records of the names of the physiotherapists to whom I would subcontract the work”.

36. The Panel did not give weight to the Registrant’s submissions to the IC as quoted in LC’s expert report. They are inconsistent with the statement prepared for civil court proceedings and with the contemporaneous record of the Discharge Report. The Panel did not accept that the Registrant’s record-keeping was so poor that he was unable to provide the name of the physiotherapist who he asserted had carried out any subcontracted work. If the Registrant had engaged another physiotherapist there would be a record of payment to that physiotherapist, and a record in Patient A’s clinical notes. The Registrant earlier confirmed in his statement dated 25 January 2017 that session notes were in his possession.

37. The documentary evidence was further corroborated by the hearsay statement of Person B dated 15 November 2017. Person B confirmed that a physiotherapy assessment by telephone took place on 26 February 2016.

38. Therefore, the Registrant undertook a physiotherapy assessment of Patient A on 26 February 2016 when he was subject to an Order suspending him from the HCPC Register.

Particular 1(b)((i) – Proved

39. The Panel found particular 1(b)(i) proved by the documentary evidence, the hearsay statements of Person B and SHA, and the evidence of QZ and AK.

40. The Panel found this particular proved for the same reasons it found Particular 1(a) proved. On 11 March 2016 the Registrant was still suspended from the HCPC Register. The treatment session for Patient A on 11 March 2016 is confirmed by the Discharge Report and by the Registrant’s statement in the personal injury claim dated 25 January 2017.

Particular 1(b)(ii) – Not Proved

41. The Panel found particular 1(b)(ii) not proved.

42. The Panel found that the physiotherapy treatment session on 11 March 2016 was conducted by telephone. QZ understood that Patient A’s solicitor had requested that the consultation should take place by telephone, which was an option permitted by Concise Medico at that time. In the Registrant’s statement in the personal injury claim dated 25 January 2017, he confirmed that the sessions were all conducted by telephone and this is further corroborated by the hearsay statement of Person B dated 15 November 2017.

43. In her oral evidence LM expanded on her opinion as summarised in her expert report. She accepted that, although it was not “gold standard”, it may be acceptable practice for a physiotherapist to conduct up to a maximum of two physiotherapy sessions (including the initial assessment) by telephone. She acknowledged that there is a process, described by the Registrant as “triage”, where clinicians make an initial assessment of a patient by telephone and rule out the possibility that another form of medical intervention is required. If symptoms are minor and resolve quickly, the assessment and advice process can be completed entirely through telephone triage. Although she did not consider that telephone triage assessment was suitable for Patient A for a range of reasons, LM would not describe a maximum of two sessions as “clinically inappropriate”.

44. The treatment session for Patient A on 11 March 2016 was the first treatment session after the initial assessment on 26 February 2016. The Panel accepted the opinion evidence of LM and found particular 1(b)(ii) not proved.

Particular 2 – Proved

45. The Panel found particular 2(a)-(i) proved by the documentary evidence, the hearsay statements of Person B and SHA, the evidence of QZ and AK, and the expert evidence of LM.

46. The discharge summary for Patient A dated 10 June 2016 confirmed that the Registrant provided physiotherapy treatment for Patient A on 25 March 2016, 8 April 2016, 22 April 2016, 29 April 2016, 13 May 2016, 20 May 2016, 27 May 2016, 3 June 2016, and 10 June 2016. In his statement dated 25 January 2017 in the personal injury claim on behalf of Patient A, the Registrant confirmed that this treatment was provided over the telephone. This was corroborated by the statement of Person B dated 15 November 2017.

47. The Panel accepted the opinion evidence of LM that providing these sessions of physiotherapy treatment for Patient A by telephone was not clinically appropriate. LM’s opinion was that for any patient it would not be clinically appropriate to provide physiotherapy treatment by telephone beyond the initial triage session, which might require up to two sessions. By the conclusion of the second session, at the latest, the physiotherapist would identify the need for physiotherapy treatment, which would require face to face contact, or the patient’s symptoms would be mild and resolve without requiring physiotherapy intervention.

48. LM also identified further factors relevant to Patient A which indicated that providing physiotherapy by telephone was inappropriate. She highlighted that there was a significant geographical distance of approximately ninety miles between Patient A and the Registrant’s clinic address. In LM’s opinion this is not an acceptable distance because the option of “hands on treatment” was not available. LM also highlighted that Patient A’s symptoms had been present for eleven weeks and involved multiple areas (right arm, neck, lower back, and knees).

49. LM also considered that telephone consultation was inappropriate because an interpreter was required for Person B. The language barrier raised a concern about the accuracy of the communication between the parties.

50. In her evidence LM also highlighted that the treatment described by the Registrant in the Discharge Report of massage release and spinal posture correction required the physiotherapist to see the patient and to have physical contact. This treatment could not have been conducted by the Registrant by telephone.

51. For these reasons, the Panel concluded that all physiotherapy treatment sessions listed at 2(a)-2(i) were conducted by telephone and were not clinically appropriate.

Particular 3 – Proved

52. The Panel accepted the advice of the Legal Assessor. Applying the guidance from the Supreme Court decision in Ivey v Genting Casinos, it first considered the Registrant’s state of mind. Having considered the Registrant’s understanding and beliefs, it applied an objective test, and considered whether the Registrant’s conduct was honest or dishonest by the standards of ordinary decent people.

53. Throughout his suspension the Registrant knew that he was suspended from the Register and not permitted to practice as a physiotherapist. The Registrant attended the substantive hearing on 17 April 2015 and the review hearing on 16 October 2015. He did not attend the review hearing on 11 February 2016, but he was engaged in the HCPC process and he provided written submissions for that review.

54. The Panel also noted that in his IC submissions the Registrant stated that, “on the dates of the allegations I was therefore two weeks from the expiry of my suspension and aware of the seriousness of practising when I was suspended from the register”.

55. The Registrant knowingly chose to practise as a physiotherapist while he was subject to a Suspension Order. He represented to Concise Medico, Patient A, Person B, and others that he was a registered physiotherapist. This is dishonest behaviour by the standards of ordinary decent people.

56. The Panel found particular 3 proved.

Decision on Grounds

57. The Panel first considered whether the Registrant’s conduct in Particulars 1(a), 1(b)(i), and 3 amounts to misconduct. The question of whether the facts constitute misconduct is for the judgment of the Panel and there is no burden of proof.

58. There is no statutory definition of misconduct, but the Panel had regard to the guidance of Lord Clyde in Roylance v GMC (No 2) 1 AC 311: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances…”. The conduct must be serious, in that it falls well below the standards.

59. The Panel considered the HCPC Standards of Conduct, Performance and Ethics (2016) and considered that the Registrant’s conduct was a breach of standards 1, 6, and 9.

60. The Registrant chose to accept work from Concise Medico when he should not have done so. The Registrant exposed Patient A, who was vulnerable due to her age, to the risk of harm because he undertook work when he was not a registered physiotherapist. There was a risk that the Registrant’s insurance cover may not have been valid for Patient A’s treatment sessions while he was suspended.

61. The Registrant’s actions also made dishonest false representations to Concise Medico, Patient A, and others that he was a registered physiotherapist. In doing so he seriously damaged public confidence in himself as a physiotherapist. His conduct also had the potential to damage public confidence in the integrity of the HCPC Register.

62. The dishonesty was directly relevant to the Registrant’s professional role and involved a breach of trust placed in him by Concise Medico and Patient A.

63. The Panel had no doubt that the Registrant’s behaviour fell well below the required standards and was sufficiently serious to constitute misconduct.

64. The Panel next considered whether Particular 2 amounted to misconduct or a lack of competence.

65. In the Panel’s judgment, the treatment of one individual patient is not a fair sample of the Registrant’s work. Further, the Panel considered that the Registrant did not lack knowledge, understanding, or skills. He had experience of physiotherapy so as to judge whether the appropriateness and limits of telephone assessment was inappropriate. The Panel noted that the Registrant described treatment of Patient A of massage release and spinal posture correction, which could not have been carried out by him over the telephone. In the Panel’s judgment, the Registrant’s conduct is more appropriately characterised as misconduct.

66. The Registrant’s conduct put Patient A at potential risk of harm because the treatment he had identified as required could not be carried out. There was a risk that the Registrant’s diagnosis of Patient A was incorrect because of the limited assessment that was possible without face to face contact.

67. In the Panel’s judgment the Registrant’s conduct was a breach of the HCPC Standards of Conduct, Performance and Ethics (2016) standards 1, 3.2 (the Registrant should have referred to another physiotherapist because of the geographical distance), and 6. The Registrant’s conduct was also a breach of the Standards of Proficiency for Physiotherapists (2013) standard 2.1.

68. In the Panel’s judgment, the Registrant’s conduct in particular 2 fell well below the required standards and was sufficiently serious to amount to misconduct.

Decision on Impairment 

69. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Finding that Fitness to Practice is ‘Impaired’”. The Panel considered the Registrant’s fitness to practise at today’s date.

70. The Panel first considered the personal component, which is the Registrant’s current behaviour. The Registrant has not attended the hearing and has not provided the Panel with any evidence to demonstrate that he has any insight into the seriousness of the matters the Panel has found proved. The Panel found no evidence that the Registrant currently has insight into his misconduct.

71. Dishonesty by its nature is difficult to remediate, and there is no evidence that the Registrant has taken any remedial action.

72. In the circumstances the Panel found that there is a real risk that the Registrant may repeat dishonest behaviour. There is therefore an ongoing risk of harm to members of the public.

73. In the Panel’s judgment, the Registrant’s conduct put Patient A at risk of harm, brought the physiotherapy profession into disrepute, was a breach of a fundamental tenet of the physiotherapy profession, and was dishonest conduct. The Panel has found that the Registrant is liable to repeat this behaviour in the future. Therefore, all the four reasons suggested by Dame Janet Smith in her Fifth Shipman Report as to why a decision maker might conclude that a Registrant is unfit to practise are satisfied.

74. The Panel next considered the public component and considered whether a finding of current impairment is required to uphold standards of conduct and behaviour and to maintain confidence in the physiotherapy profession.

75. The Registrant’s conduct put Patient A, who was a child at the time of the events, at risk of harm because he treated her when he knew he was suspended from the Register. This behaviour had the potential to undermine public confidence in the integrity of the HCPC Register and the physiotherapy profession. Members of the public trust physiotherapists to comply fully with orders made by the regulator and that trust is undermined by the Registrant’s actions. The Registrant’s behaviour was dishonest, which is entirely unacceptable for members of the public.

76. The Panel decided that it was necessary to mark the Registrant’s serious departure from the required standards of conduct in relation to particulars 1, 2, and 3 by finding that his fitness to practise is currently impaired.

77. For these reasons, the Panel decided that the Registrant’s fitness to practise is currently impaired on the basis of the personal component and the public component.

Reconvened Hearing 30 April – 1 May 2020

Service of Notice for hearing on 30 April - 1 May 2020

1. The Panel previously found good service of the Notice of Hearing by a letter dated 20 January 2020 and the amended Notice dated 4 February 2020. The Registrant was then advised in an email dated 20 March 2020 that that the hearing due to continue on 30 April and 1 May and 20-21 May 2020 would be converted to a virtual hearing. The Panel was satisfied that good service had been effected in accordance with the Rules.

Proceeding with the hearing on 30 April - 1 May 2020

2. Mr Millin submitted that the hearing should proceed in the absence of the Registrant. He submitted that the position had not changed from 17 February 2020 and that reasonable steps had been taken to inform the Registrant of the change of venue to enable him to participate in the virtual hearing if he wished to do so.

3. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

4. The Panel decided that it was appropriate to proceed in the absence of the Registrant. The Registrant’s last engagement with the HCPC was that he responded by email on 29 February 2020 to the amended Notice of Hearing. The Registrant has not responded or objected to the conversion of the hearing of 30 April-1 May 2020 and 20-21 May 2020 to a virtual hearing. The Panel decided that in these circumstances that there had been no change in the balance of relevant factors and that it was appropriate to continue with the hearing in the absence of the Registrant.

Decision on Sanction

5. In considering which, if any, sanction to impose, the Panel had regard to the HCPC Sanctions Policy (SP) and the advice of the Legal Assessor.

6. The Panel reminded itself that the purpose of imposing a sanction is not to punish the Registrant, but to protect the public and the wider public interest. The Panel ensured that it acted proportionately and, in particular, it sought to balance the interests of the public with those of the Registrant and imposed the sanction which was the least restrictive in the circumstances, commensurate with its duty of protection.

7. At the sanction stage of its decision, the Panel was provided with an unredacted copy of the decision of the Conduct and Competence Committee dated 17 April 2015. In that decision, the substantive panel decided that the Registrant’s fitness to practise was impaired by reason of a Conviction (control of a thing knowing it was a counterfeit currency with intent; and making off without payment). The circumstances of the conviction were that the Registrant drove his car into the forecourt of a Shell Garage and filled the tank of his car with diesel. He produced a £20 note to the cashier which was obviously counterfeit. The Registrant then handed over a bank card, which was declined. Having asked where the nearest cash point to the Shell Garage was, he nevertheless returned to his car and made off without payment. The matter was reported to the police, and on 22 October 2013, the police attended the Registrant’s premises and discovered counterfeit currency to the face value of £320. The Registrant was sentenced to 12 months’ imprisonment suspended for 18 months.

8. The Panel noted that the Registrant is not of previous good character and that the previous fitness to practise history involved dishonesty and a criminal conviction.

9. The Panel considered that the aggravating features included:

• a breach of trust involving Patient A, Concise Medico, and the HCPC;
• the absence of any evidence of the Registrant’s insight, remorse, or apology;
• the lack of any remediation;
• the potential risk of harm to Patient A, who was vulnerable due to her age and due to the language barrier in communicating with Person B;
• the pattern of dishonest behaviour; the Registrant was previously subject to a regulatory sanction due to dishonesty and, while still subject to that sanction, he repeated dishonest behaviour.

10. The Panel carefully considered whether there were any mitigating features, but it was not able to identify any in this case.

11. In its deliberations the Panel noted the guidance in the SP on dishonesty at paragraphs 56-58. Dishonesty is identified as a serious case which is likely to lead to more serious sanctions. The SP highlights that dishonesty undermines public confidence in the profession and that it can have a significant impact on the trust placed in those who have been dishonest. The Panel’s assessment of the dishonesty in this case is that it was at the higher end of the spectrum of seriousness. It took place against the background that the Registrant was subject to a Suspension Order imposed in relation to a conviction for a criminal offence involving dishonesty. The Registrant took an active role in the dishonesty, in that he knew that he was suspended and should not be practising. There has been no admission of dishonesty by the Registrant either at an early stage or within the HCPC process.

12. Following the end of his Suspension, the Registrant then went on to deliver, or attempt to deliver, a course of treatment by telephone that was clinically inappropriate and potentially harmful to a vulnerable patient.

13. The Panel had no information about the Registrant’s current circumstances to enable it to assess the impact of any restriction on his practice. The Panel took into account the Registrant’s interest in continuing to practise the profession of physiotherapy and had in mind that any restriction on the Registrant’s practice had the potential to have a significant negative impact on the Registrant both financially and personally.

14. The Panel considered the option of taking no action, but decided that the misconduct was too serious; this option would not address the risk of repetition the Panel has identified and it would not be sufficient to maintain public confidence in the profession.

15. The Panel next considered a Caution Order. The Panel did not consider that the guidance in the SP for Caution Orders applied. The conduct was not isolated or minor and there was a risk of repetition. A Caution Order would also not be sufficient to address the wider public interest considerations because of the gravity of the misconduct.

16. The Panel next considered a Conditions of Practice Order. The Panel considered that conditions could not be formulated to address the Registrant’s dishonest behaviour. A Conditions of Practice Order would also be insufficient to mark the gravity of the Registrant’s conviction and misconduct.

17. The Panel next considered the option of a Suspension Order. The Panel considered that the guidance in the SP for a Suspension Order did not apply. The Registrant has not demonstrated insight into his misconduct. The Panel previously concluded that there remains a risk of repetition of dishonest behaviour and this concern was reinforced by the information the Panel received at sanction stage about the Registrant’s fitness to practise history, which demonstrates a pattern of dishonest behaviour. There was also no evidence before the Panel that the Registrant was likely to be able to resolve or remedy the matters. The Panel also noted that there was a risk of repetition of clinically inappropriate behaviour.

18. The Panel also considered whether a Suspension Order was a sufficiently severe sanction to act as a deterrent effect to other registrants and to maintain public confidence in the profession and the regulatory process. The Panel reviewed the aggravating features. The dishonesty involved a significant breach of trust. While suspended from the Register, the Registrant deliberately misled others as to his professional status. In these circumstances, the Panel considered that a Suspension Order would not be a sufficient sanction to maintain public confidence in the profession and to uphold the required standards of conduct.

19. The Panel considered the more restrictive sanction of a Striking Off Order. The Panel considered that the criteria in the SP for a Striking Off Order applied. The case involved clinically inappropriate behaviour, dishonesty, and the Registrant abused his professional position by misleading others as to his professional status. The Registrant has not attended the hearing to give reassurances to the Panel that the dishonesty will not be repeated or his clinical failings remedied. The Registrant lacks insight and has previous fitness to practise history which involves dishonesty. The Panel considered that in all the circumstances, anything less than a Striking Off Order would not be sufficient to maintain confidence in the profession and the regulatory process.

20. In these circumstances, the Panel decided that a Striking Off Order was the appropriate and proportionate order. A Striking Off Order would mark the seriousness of the Registrant’s misconduct, act as a deterrent to other registrants, and maintain the reputation of the profession.

21. In reaching its decision the Panel took into account the Registrant’s financial and reputational interests, but decided that they were outweighed by the need to protect the public and by the wider public interest considerations. The Panel decided that the appropriate and proportionate Order was a Striking Off Order.

Order

The Registrar is directed to strike the name of Mr Adeyinka Adeshina from the Register from the date this Order takes effect.

Notes

Interim Order

Proceeding in absence

1. Mr Millin invited the Panel to consider an application for an interim order in the absence of the Registrant. He submitted that the Panel should proceed in the absence of the Registrant in the light of the guidance in Sanusi v GMC [2019] EWHC Civ 1172. The Registrant was also advised that an interim order application might be made at the conclusion of the case in the Notice of Hearing dated 4 February 2020.

2. The Panel received and accepted legal advice on proceeding in the absence of the Registrant.

3. The Panel agreed that it was appropriate to proceed in the absence of the Registrant. The Registrant was advised that an interim order application might be made in the Notice of Hearing. The Registrant has waived his right to attend the hearing and it is in the public interest for this matter to be concluded expeditiously.

Application

4. Mr Millin made an application for an Interim Suspension Order for a maximum period of 18 months on the ground that it was necessary for the protection of the public and it was otherwise in the public interest.

5. The Panel accepted the advice of the Legal Assessor.

6. The Panel decided that an interim order was necessary for the protection of the public. The Panel has identified a risk of repetition of dishonesty and of the clinically inappropriate treatment and there is therefore a potential risk to the public which is ongoing. The Panel also considered that an interim order was otherwise in the public interest to maintain public confidence in the profession and the regulatory process. Given the conclusions of the Panel, an informed member of the public would be shocked and troubled if no restriction was in place.

7. The Panel considered whether an Interim Conditions of Practice Order would be sufficient, but decided that it would not. Conditions cannot be formulated to address the issues of dishonesty and, in respect of the clinical concerns, are not realistic.

8. The Panel decided to make an Interim Suspension Order for a period of 18 months, the maximum duration, to allow sufficient time for any appeal to be concluded.

9. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

Hearing History

History of Hearings for Mr Adeyinka Adeshina

Date Panel Hearing type Outcomes / Status
30/04/2020 Conduct and Competence Committee Final Hearing Struck off