Mr Rumel Rahman

Profession: Physiotherapist

Registration Number: PH109418

Interim Order: Imposed on 03 Nov 2021

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 03/11/2021 End: 17:00 03/11/2021

Location: Virtual via Video Conference

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegation: (as amended)
 
1. On 23 March 2018, you took Patient 1 from Laburnum Lodge Intermediate Care Unit to their home address and to the bank, and;
 
a. It was inappropriate to remove the patient from the care unit.
 
b. You did not complete adequate risk assessments, including:
i) A step assessment;
ii) An outdoor mobility assessment; or
iii) An environmental assessment.
 
c. Did not adequately consider Patient 1’s:
 
i) DNR status;
ii) Medication requirements;
iii) Toileting needs;
iv) Meal times;
v) Mobility requirements;
vi) Capacity.
 
d. Did not follow the lone worker policy in that you did not sign the contact sheet.
 
e. Allowed Patient 1 to walk upstairs without adequate supervision.
 
2. On 23 March 2018, you told your supervisor that a senior colleague had approved taking Patient 1 out, when this was not the case.
 
3. On 18 April 2018, you instructed and/or asked Person A to help mobilise Patient 2 when it was inappropriate for them to do so.
 
4. On 23 April 2018 and/or 3 May 2018, you displayed aggressive behaviour towards your supervisors during a meeting.
 
5. On 3 May 2018, you inappropriately assessed, Patient 13 
6. Between 10 May 2018 & 30 August 2018, you completed private work for Tara Physiotherapy, whilst signed off on sick leave from Bolton NHS Trust on the following dates:
 
a. 10th, 15th, 17th, 22nd, 24th, 29th and 31st of May 2018;
b. 7th, 12th, 14th, 19th, 21st and 26th of June 2018;
c. 5th, 10th, 12th, 17th, 19th, 24th, 26th and 31st of July 2018; and
d. 9th, 21st, 23rd, 28th and 30th August 2018.
 
7. On 17 September 2018, you signed a declaration confirming that you had not undertaken any paid or unpaid work during your absence from Bolton NHS Trust, when this was not the case.
 
8. In around March 2020 you told Person B that the HCPC investigation had been resolved, when this was not the case.
 
9. The matters set out at paragraph 2, 6, 7 and 8 were dishonest.
 
10. Your actions at paragraphs 1 - 9 amount to misconduct.
 
11. By reason of your misconduct your fitness to practise is impaired.
 
 

Finding

Preliminary Matters
 
Application to hear evidence by video link
 
1. Mr Tarbert, on behalf of the HCPC, initially made an application for the evidence of KS to be heard by video link. The basis of the application was that a family member of hers was seriously unwell and that in the circumstances, KS did not wish to travel to London to attend this hearing. He
 
submitted that there would be no unfairness to the Registrant who, through his Counsel, could still ask questions of the witness, as could the Panel members.
 
2. The application was not opposed by Ms Ibbotson on behalf of the Registrant.
 
3. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied that there was a good reason for KS being unable to attend the hearing in person to give live evidence, and that there was no unfairness or injustice to the Registrant in allowing her evidence to be heard by video link.
 
4. The Panel therefore granted the application in relation to KS.
 
5. Mr Tarbert subsequently made an application for LR to give her evidence by video link. He submitted that it was originally intended that this witness give evidence on the first day of the hearing but that it was not possible to receive her evidence then due to time restrictions. She had made arrangements in relation to her professional obligations but because of childcare arrangements, would not be able to attend the hearing in person but would be available to attend by video link.
 
6. He submitted that LR was an important witness who was willing to give live evidence and that the Panel should therefore allow her evidence to be given remotely.
 
7. This application was also not opposed by Ms Ibbotson.
 
8. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied that there was a good reason for LR being unable to attend the hearing in person to give live evidence, and that there was no unfairness or injustice to the Registrant in allowing her evidence to be heard by video link.
 
9. The Panel therefore also granted the application in relation to LR.
 
10. Mr Tarbert then made an application for HB and CR to give their evidence by video link. He submitted that it was originally intended that these witnesses give evidence earlier on in hearing but that it was not possible to receive their evidence then due to time restrictions. They had returned home and were reluctant to travel again to London to give live evidence. However, Mr Tarbert confirmed that they would both be available to attend by video link.
 
11. He submitted that both witnesses were important witness who were willing to give live evidence and that the Panel should therefore allow their evidence to be given remotely.
 
12. This application was also not opposed by Ms Ibbotson.
 
13. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied that there was a good reason for both HB and CR being unable to attend the hearing in person to give live evidence, and that there was no unfairness or injustice to the Registrant in allowing their evidence to be heard by video link.
 
14. The Panel therefore also granted the application in relation to HB and CR. Application to amend the charge
15. Mr Tarbert made an application to amend the Allegation. The Registrant had
been put on notice of the proposed amendments in a letter dated 13 May 2021. In summary, he submitted that the proposed amendments merely added specificity to the charges. He submitted that any new particulars merely developed allegations that the Registrant already faced and did not change the substance of the allegation against the Registrant, but merely ensured that the allegation better reflected the evidence available. Further proposed amendments better identified the individuals involved.
 
16. The proposed amendments are set out above.
 
17. Ms Ibbotson accepted the amendments and raised no objection to the paragraphs being amended as sought.
 
18. The Panel accepted the advice of the Legal Assessor and carefully considered the HCPC’s application to amend the paragraphs. The Panel concluded, after reviewing each of the proposed amendments, that it would agree to the paragraphs being amended for the following reasons:
 
i. the Registrant had been provided with significant notice of the HCPC’s intention to amend the Allegation, having been put on notice in May 2021, approximately four months before the commencement of the substantive hearing;
ii. the Registrant had not objected to the proposed amendments; and
iii. the proposed amendments do not materially widen the scope of the Allegation, but merely seek to better reflect and particularise the evidence.
 
19. The Panel concluded that the proposed amendments of the paragraphs did not materially affect the nature or seriousness of the Allegation. In all the circumstances, there was no likelihood of unfairness or injustice to the Registrant. The Panel therefore agreed to the proposed amendments.
 
Application to hear part of the hearing in private
 
20. The Panel heard that matters relating to the Registrant’s health may be referred to during the course of the hearing. Mr Tarbert submitted that it was appropriate that those parts of the hearing be held in private. Ms Ibbotson did not oppose the application.
 
21. The Panel accepted the Legal Assessor’s advice and it noted Rule 10(1)(a) of the Rules whereby matters relating to the private life of the Registrant, the complainant, any person giving evidence or of any patient or client should be heard in private. The Panel therefore agreed that those parts of the hearing where reference was to be made to the Registrant’s health should be heard in private.
 
Background
 
22. The Registrant was employed by Bolton NHS Foundation Trust (the Trust) at Royal Bolton Hospital (the Hospital) as a Band 5 Physiotherapist within Laburnum Lodge (the Lodge) between March 2018 and May 2018. On 23 March 2018, the Registrant took a patient (Patient 1) from the Lodge to the bank and her home. Concerns about his actions were raised by his supervisors, KS and HB, to Therapy Team Leader JS. The Registrant was subsequently placed on capability / performance management. On 18 April 2018 KS raised further concerns about the Registrant allegedly asking the wife (Person A) of a patient (Patient 2) to assist in mobilising Patient 2 when it was inappropriate to do so. During a supervision meeting with JS on 23 April 2018, it is alleged that the Registrant reportedly became angry, raising his voice and pointing his finger in JS’s face.
 
23. The performance management process continued. During his meeting on 3 May 2018 with JS and Occupational Therapy Team Lead, LR, the Registrant reportedly became angry again at the feedback being given. He was allegedly pacing angrily and again pointed his finger in JS’s face.
 
24. After their meeting the Registrant was observed by LR taking a patient (Patient 13) to her room. Patient 13 had fallen earlier in the day. The Registrant was seen on his own with Patient 13, which was in contravention
 
of the restrictions placed on him as part of the performance management process. LR also observed him performing an assessment on Patient 13, which was allegedly inappropriate.
 
25. After 3 May 2018 the Registrant went on sick leave and did not return to the Lodge. On 18 May 2018 a referral was made to the HCPC by the Trust. The Registrant returned from sick leave on 17 September 2018 to another department in the Hospital. The Trust discovered that the Registrant had been working at Tara Physiotherapy whilst he had been on sick leave. Local Counter Fraud Specialist with Wrightington, Wigan and Leigh NHS Foundation Trust, CR, was asked to conduct an investigation into the matter which concluded that the Registrant had been working for Tara Physiotherapy whilst on sick leave from the Trust and that his conduct in relation to that had been dishonest.
 
26. At its meeting on 27 May 2020, an Investigating Committee Panel of the HCPC determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise which included a number of allegations of dishonesty as set out in the above charges.
 
Decision on Facts
 
Live evidence heard
 
27. The Panel heard live evidence from six witnesses, all of whom gave evidence by video link:
 
• JS: Former Therapy Team Leader within Bed-based Intermediate Care (“the Lodge”) and former line manager of the Registrant;
• LR: Former Occupational Therapy Team Lead within the Lodge;
• KS: Band 6 Specialist Physiotherapy within the Lodge and former day-to- day supervisor of the Registrant;
• HB: Former Band 6 Occupational Therapist within the Lodge and former day-to-day supervisor of the Registrant;
• CR: Local Counter Fraud Specialist employed by Wrightington, Wigan and Leigh NHS Foundation Trust with additional oversight for Bolton NHS Foundation Trust;
• PC: Director and manager of Tara Physiotherapy Sports Clinic.
 
28. The Panel has also had sight of a number of documentary exhibits which included, but was not limited to:
 
• Minutes of the meeting with the Registrant on 23 March 2018;
 
• A statement of the Registrant’s reflections regarding the incident with Patient 1;
• Minutes of a meeting to discuss the Registrant dated 6 April 2018;
• Minutes of a meeting with the Registrant on 24 April 2018;
• Minutes of the meeting between JS and the Registrant dated 1 May 2018;
• Emails between CR and the HCPC regarding the fraud investigation;
• Witness statement of the Registrant dated 26 April 2019 in relation to the fraud investigation;
• Various sick notes;
• Home Visit Policy;
• Screenshots of invoices relating to private work at Tara Physiotherapy;
• Screenshot of text messages.
 
29. The Panel also heard from the Registrant and considered the documentation provided by him which included, but was not limited to:
 
• An undated statement containing 107 paragraphs;
• The Registrant’s reflections;
• A copy of the Trust’s Post Fall Protocol;
• A Post Fall Physiotherapy Assessment Form;
• A bundle of testimonials and references.
 
Panel’s Approach
 
30. The Panel was mindful that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual paragraphs of the Allegation could only be found proved if the Panel was satisfied that that was the case on the balance of probabilities.
 
31. In reaching its decision, the Panel took into account the oral evidence of the HCPC witnesses and the Registrant, together with all the documentary evidence, as well as the oral submissions made by Mr Tarbert and those of Ms Ibbotson. The Panel also accepted the advice of the Legal Assessor which is a matter of record.
 
Paragraph 1
 
Paragraph 1a
 
32. The Panel found the facts of paragraph 1a proved for the following reasons.
 
33. It is not disputed by the Registrant that on 23 March 2018, he took Patient 1 from the Lodge to her home address and to the bank. HB gave evidence that
 
Patient 1 was an anxious arthritic woman in her 80s. Her home had access steps and internal stairs that Patient 1 was unable to navigate.
 
34. In considering whether the Registrant’s conduct was appropriate, the Panel noted that HB stated that she had a conversation with the Registrant on the morning of 23 March 2018 in which she stated that she explained to the Registrant that Patient 1 was not strong enough, and required a stairs assessment prior to her being taken on a home visit.
 
35. JS stated that by failing to undertake the required assessments prior to taking Patient 1 to her home, Patient 1 had been placed at risk from injury from a fall. She stated that Patient 1 was cognitively impaired. The Registrant accepted that Patient 1 was anxious but did not agree she was cognitively impaired.
 
36. The Panel has also had sight of the notes of the meeting KS and HB had with the Registrant on 23 March 2018. Those notes were signed by the Registrant on 28 March 2018. The Panel noted that the Registrant had been given the opportunity to make any amendments to those notes and had chosen to make some alterations. However, no amendments were made to the entries stating: “No appropriate prior assessment – O.T input, step assessment, outdoor mobility assessment, practice with 4 wheeled walker; No reasoning or justification for visit”.
 
37. The Registrant in his statement stated that he had no specific recollections of his discussion with HB on the morning of 23 March 2018, but conceded that “based on the evidence in the bundle it is possible that their recollections are correct”. Furthermore, in his live oral evidence, the Registrant conceded that it was inappropriate in all the circumstances to have taken Patient 1 out of the Lodge and that he had not undertaken the appropriate planning. In his written reflections on the home visit, the Registrant accepted that he “…therefore did not follow the advice given by my seniors….I did not communicate my plans clearly to my seniors and therefore did not follow the correct policies and procedures as I was not familiar with them. I did not risk assess the patient on stairs and therefore placing the patient at an unnecessary risk.”
 
38. In addition, in the Registrant’s statement prepared for this hearing, he stated that “while I had the best intentions when removing Patient 1 from Laburnum Lodge I admit that it was not appropriate to do so because I cannot be sure with the passage of time whether I (or one of the Laburnum Lodge team) had completed adequate risk assessments including a step assessment, outdoor mobility assessment or an environmental assessment in relation to Patient 1”.
 
39. The Panel therefore accepted that it was more likely than not that the evidence of KS and HB was reliable and that it was inappropriate to remove Patient 1 from the Lodge. In all the circumstances, the Panel therefore found the facts of paragraph 1a proved.
 
Paragraphs 1bi), 1bii) and 1biii)
 
40. The Panel found the facts of paragraphs 1bi), 1bii) and 1biii) proved for the following reasons.
 
41. The Panel has noted the evidence of HB and KS who both stated that the Registrant had not undertaken the necessary assessments. In addition, JS stated that by failing to conduct the appropriate assessments, Patient 1 had been placed at risk of injury from a fall.
 
42. Their evidence was consistent with the contents of the meeting notes of 23 March 2018 confirming that the Registrant had not undertaken a step assessment or an outdoor mobility assessment. It has also taken account of the Registrant’s reflective piece in which he accepted that he had not followed the correct policies and procedures. It has also taken into account that, as set out in paragraph 37 above, the Registrant admitted not having undertaken a step assessment or an outdoor mobility assessment and admitted the facts of Paragraphs 1bi), 1bii) and 1biii). The Panel noted that the Registrant, despite his admissions, in response to questions put to him by Mr Tarbert in cross-examination, sought to suggest that he had completed a step assessment with Patient 1, but that he was unable to remember whether this was before or after 23 March 2018. This inconsistency in the Registrant’s evidence led the Panel to conclude that his explanation given in response to Mr Tarbert’s questions, was unreliable given the consistency of HB and KS’s evidence.
 
43. The Panel has also borne in mind the evidence of HB who stated that whilst an environmental assessment had previously been done, this had not been done by the Registrant.
 
44. The Panel therefore finds the facts of paragraphs 1bi), 1bii) and 1biii) proved.
 
Paragraph 1ci) -1cv)
 
45. The Panel found the facts of paragraph 1ci), 1cii), 1ciii), 1civ) and 1cv) proved for the following reasons.
 
46. The Panel has had regard to the signed minutes of the meeting on 23 March 2018 recording the fact that the Registrant had failed to consider the matters alleged. In addition, the Registrant in his reflections accepted that he had not followed all relevant protocols and procedures. In his statement produced for this hearing, the Registrant conceded that “Whilst I ensured that Patient 1 had used the toilet before we left the Lodge and I believe she had an adult pad in situ (and we were only out of the Lodge for around 90 minutes) Patient 1’s toilet was upstairs so I admit that I had not adequately considered her toileting needs. I also admit that I had not adequately considered Patient 1’s meal times. DNR status and medication requirements…”. These admissions were consistent with the Registrant’s admissions to the fact of these sub- paragraphs at the outset of the hearing.
 
47. The Panel therefore finds the facts of paragraph 1ci), 1cii), 1ciii), 1civ) and 1cv) proved.
 
Paragraph 1cvi)
 
48. The Panel found the facts of paragraph 1cvi) not proved for the following reasons.
 
49. The Panel had regard to the Registrant’s evidence in respect of this sub- paragraph. The Registrant stated that, even though there had not been a formal capacity assessment, he had adequately considered Patient 1’s capacity and that having done so, he had no reason to doubt it. He stated that: ”I admitted patient 1 into the lodge, I did the initial assessment, I interacted with the patient over 11 days prior to the visit, once or twice a day, I knew her really well, and I interacted with her at different times of day… there was nothing that made me feel that she lacked capacity from all of my interactions with her, and the social worker assigned to the patient did not feel that she had capacity issues”.
 
50. KS stated that an informal capacity assessment was required before taking Patient 1 out of the Lodge. However, the Panel recognised that the assessment of capacity is decision specific as conceded by HB and confirmed by KS, and that capacity is to be assumed unless otherwise indicated. The Panel noted that the notes of the meeting of 23 March 2018 made no reference to Patient 1 lacking capacity and that there was an absence of evidence to indicate that Patient 1 lacked capacity, noting that JS could not recall the source of her assertion that Patient 1 lacked capacity.
 
51. In the circumstances, the Panel accepted that the Registrant had adequately considered Patient 1’s capacity given his knowledge of her over an 11 day period. As such, the Panel therefore found the facts of Paragraph 1cvi) not proved.
 
Paragraph 1d
 
52. The Panel found the facts of Paragraph 1d not proved for the following reasons.
 
53. The Panel has had sight of a template contact sheet. It has not had sight of the specific contact sheet that the HCPC allege the Registrant should have signed and as such, has not adduced evidence that the Registrant had not signed that sheet. In any event, the Panel noted that the template contact sheet provided does not itself require a signature. HB in her evidence confirmed, albeit by way of hearsay evidence, that she had been informed that the relevant sheet had not been signed but that she had not seen the form itself.
 
54. In addition, the HCPC has not produced in evidence the lone worker policy document and as such, has not adduced sufficient evidence to indicate that the policy required the contact sheet to be signed. Whilst the Panel recognises that the evidence before it suggests that the contact sheet was not adequately completed, it has nevertheless concluded that there is insufficient evidence before it to conclude that the specific facts alleged are made out.
 
55. The Panel therefore finds the facts of paragraph 1d not proved.
 
Paragraph 1e)
 
56. The Panel found the facts of Paragraph 1e not proved for the following reasons.
 
57. Whilst accepting that the Registrant took Patient 1 to her home address, the Registrant denied that he allowed Patient to walk upstairs or that she did in fact do so. The Panel noted the absence of direct evidence that the Registrant allowed Patient 1 to walk upstairs without adequate supervision. The Registrant stated he and Patient 1 were accompanied by a Social 
Worker who has not provided evidence as to what took place. The Panel has also noted that the notes of the meeting of 23 March 2018 made no reference to the Registrant having allowed Patient 1 to go upstairs.
 
58. In the circumstances the Panel therefore found the facts of Paragraph 1e not proved.
 
Paragraph 2
 
59. The Panel found the facts of paragraph 2 proved for the following reasons.
 
60. It is alleged that the Registrant told KS, his Supervisor, that HB had approved taking Patient 1 out when this was not the case. The Panel has had regard to their respective evidence and the entry times at 11.08 on the minutes of the meeting of 23 March 2018 where it was stated that “[K] informed [H] Rumel had taken the patient to her home and to the shop and that he had been informed [K] that [H] was ok with this”.
 
61. HB stated that on the morning of 23 March 2018, she had spoken to the Registrant and discussed taking Patient 1 out and she had said that Patient 1 was not sufficiently strong and told him that it was not appropriate. KS stated that the Registrant had said that “ it had all been arranged with [HB’s] approval and he would be with the social worker”.
 
62. In response, the Registrant stated that he did not recall these conversations, but “based on the evidence in the bundle it is possible that their recollections are correct”. That position, the Panel concluded was consistent with the Registrant’s admission of the facts at the start of the hearing. Whilst the Registrant sought to go back on his admission in giving his live evidence, stating that there must have been a misunderstanding, the Panel concluded that the inconsistency in his position, when contrasted with the clear and consistent recollections of KS and HB, led the Panel to conclude that the HCPC’s witnesses position was to be preferred.
 
63. The Panel therefore finds the facts of Paragraph 2 proved.
 
Paragraph 3
 
64. The Panel found the facts of paragraph 3 not proved for the following reasons.
 
65. Patient 2 was an elderly man with Parkinson’s disease. KS explained that Patient 2’s wife, Person A, was not able to cope with her husband at home and wanted him to go into long term care. KS stated that, as she approached the room she heard the Registrant “telling Person A that she needs to come and stand by him and assist because this would be what she needed to do at home”. Seeing that Person A seemed upset, KS stated that she intervened at that point as she could not allow Person A to assist in moving Patient 2. She stated that Patient 2 was going to be sent home with mobility equipment, which for safety reasons would require two members of staff to operate.
 
66. KS accepted that she could not be sure that the Registrant had in fact used the word “assist” but that he told Person A to come and stand by him indicating that she would be involved in mobilising Patient 2 at home. This, she stated, gave her the impression that the Registrant was asking Person A to assist.
 
67. The Registrant stated that he told Person A to stand next to him so that she could see how difficult it was to mobilise Patient 2 and that both Person A and KS had formed the wrong impression that he was asking Person A to assist in mobilising Patient 2. This evidence was consistent with the Registrant’s position as expressed in his written reflection, the supervision notes and KS’s repeated acceptance that she formed an impression about what the Registrant had intended.
 
68. The Panel has balanced the weight to be attached to these two conflicting accounts and having done so, has concluded that the HCPC has not discharged the burden of proof in establishing the facts on the balance of probabilities.
 
69. The Panel therefore found the facts of Paragraph 3 not proved.
 
Paragraph 4
 
70. The Panel found the facts of paragraph 4 not proved in relation to the meeting on 23 April 2018, but proved in relation to the meeting on 3 May 2018 for the following reasons.
 
71. JS and LR were present at both meetings. JS stated that at the meeting on 23 April 2018. She stated that in relation to the Registrant, “his body language appeared tense, his pupils dilated, he was on the edge of his chair and he became sweaty and agitated, his hand movements became more animated and his voice was louder”. She stated that the Registrant “stood up over me and pointed his finger at my face […] …”.
 
72. The Panel has had regard to the notes of the meeting on 23 April 2018 and noted that no reference is made within them of aggressive behaviour by the Registrant. JS also accepted that the alleged behaviour only happened once and that she might have been getting mixed up. The Panel further noted that LR made no reference in her statement dated 11 February 2021 of aggressive behaviour by the Registrant at the meeting on 23 April 2018.
 
73. In the circumstances the Panel finds the facts not proved in relation to the meeting of 23 April 2018.
 
74. In relation to the meeting on 3 May 2018, both JS and LR were consistent in that they perceived the Registrant’s behaviour as aggressive, irrespective of the Registrant’s intentions. Both witnesses stated that the Registrant entered JS’s personal space and was aggressive in his manner, body language and tone.
 
75. LR stated that at the meeting on 3 May 2018, the Registrant “became extremely upset. He was visibly angry, his voice was raised and his speech quickened. He was pacing up and down the room and squashed a plastic cup in anger”. She described how “he had been towering over me and pointing his finger in my face, …”. His behaviour, she stated made her feel threatened and frightened and she recalled having to ask her husband to collect her from work as a result.
 
76. The Panel accepts that the Registrant was stressed. However, the Panel rejected the submissions on his behalf that the conduct, even if found proved, was not aggressive. It was satisfied that JS and LR felt threatened by the Registrant’s conduct and that his language, tone and body language could properly be considered to be threatening and intimidating, and therefore aggressive.
 
77. The Panel therefore found the Registrant’s behaviour at the meeting on 3 May 2018 towards his supervisors to be aggressive.
 
78. The Panel therefore found the facts of Paragraph 4 proved only in relation to the incident on 3 May 2018.
 
Paragraph 5
 
79. The Panel found the facts of paragraph 5 not proved for the following reasons.
 
80. Following the meeting, the subject of Paragraph 4, LR stated that she subsequently saw the Registrant attending to Patient 13 alone in the corridor. Patient 13 had had knee surgery and she stated that she had a wound from the surgery. She stated that the Registrant should not have been attending to Patient 13 alone as he was on a performance management and had to be supervised. She stated that she accompanied Patient 13 and the Registrant to Patient 13’s room where the Registrant began to test Patient 13’s range of knee movement by bending and straightening the knee that had been operated on. Whilst doing so, she stated that Patient 13 cried out in pain which the Registrant failed to acknowledge. She then stepped in and told the Registrant to stop. She stated that in her view, the testing of Patient 13’s range of movement was inappropriate. It was suggested that Patient 13’s movement could have been tested functionally, rather than through formal movement exercises.
 
81. The Panel noted that LR accepted that she was not present when the Registrant undertook his initial post fall assessment. The Registrant stated that, having been called by another member of staff to attend to Patient 13, he had assessed her pain and that he had not observed any injuries. He transferred Patient 13 to a wheelchair to her room. It was at this stage that LR started to observe him. He said that he undertook a further assessment when Patient 13 was on her bed. He accepted that Patient 13 expressed having some pain whilst he performed the movement tests. However, he stated that his actions were appropriate and in line with the Trust’s post fall assessment document.
 
82. The Panel accepted that the Registrant had properly undertaken tests that could more appropriately carried out on the Patient’s bed. It recognised that pain can occur when assessing range of movement after surgery. However, it was satisfied that the Registrant had followed the applicable procedures as set out in the Trust’s Post Fall Protocol. In the circumstances, the Panel did not conclude that the Registrant inappropriately assessed Patient 13.
 
83. The Panel therefore found the facts of Paragraph 5 not proved.
 
Paragraph 6
 
Paragraphs 6a, 6b, 6c and 6d
 
84. The Panel found the facts of paragraphs 6a proved save for the 10 May 2018. The Panel also found the facts of paragraphs 6b proved. The Panel found the facts of Paragraphs 6c proved save for the 31 July 2018. The Panel also found the facts of Paragraph 6d proved.
 
85. The Panel has taken into account the evidence of PC and CR who exhibited the Registrant’s invoices and sick notes respectively, for the dates in question. Initially, on 17 May 2018, the Registrant was signed off work due to an abscess which had to be drained. Subsequently, on 17 June 2018 and 25 July 2018, the Registrant was signed off work as unfit. On 14 September 2018, the Registrant was signed off work due to work-related stress and that this was “location specific”. PC confirmed the dates when the Registrant worked for Tara Physiotherapy whilst signed off work whilst unfit.
 
86. PC however conceded in evidence that there could have been a mistake in relation to the 10 May 2018 and 31 July 2018 dates.
 
87. The Registrant accepted that he had been working for Tara Physiotherapy on the dates in question, when he had been signed off on sick leave, save for 10 May 2018 and 31 July 2018. The Panel has also taken into account the Registrant’s admissions made at the outset of the hearing to the facts alleged (save for the disputed dates).
 
88. The Panel therefore found the facts of Paragraph 6a, 6b, 6c and 6d proved to the extent as set out in Paragraph 87 above.
 
Paragraph 7
 
89. The Panel found the facts of Paragraph 7 proved for the following reasons.
 
90. The Panel has had sight of the relevant declaration made by the Registrant on the Trust’s Return to Work form and has considered it in light of its findings in relation to Paragraph 6. It has also taken into account the Registrant’s admission to the facts of this Paragraph.
 
91. In the circumstances, the Panel therefore found the facts of Paragraph 7 proved.
 
Paragraph 8
 
92. The Panel found the facts of Paragraph 8 proved for the following reasons.
 
93. The Panel has had sight of the exchange of texts exhibited by PC. Those texts show that PC texted the Registrant to ask: “What is the latest regarding your HCPC investigation?”. In response, the Registrant replied: “The HCPC thing was sorted no action to be taken”. The Registrant conceded that the statement was untrue.
 
94. The Panel has also taken into account the Registrant’s admission to the facts alleged which is consistent with the exhibited texts.
 
95. In the circumstances, the Panel therefore found the facts of Paragraph 8 proved.
 
Paragraph 9
 
96. The Panel finds the facts of Paragraph 9 proved in respect of Paragraphs 2, 6, 7 and 8 for the following reasons.
 
97. In considering whether the Registrant acted dishonestly, the Panel has applied the test for dishonesty as set out in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67.
 
“When dishonesty is in question the fact-finding tribunal must first ascertain subjectively the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the objective standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.”
 
Dishonesty in relation to Paragraph 2
 
98. The Panel having found the facts of Paragraph 2 proved, then considered whether the Registrant’s conduct was dishonest.
 
99. The Panel concluded in respect of this Paragraph, that the Registrant told his supervisor that a senior colleague had approved taking Patient 1 out, when this was not the case. The Panel has taken into account that the Registrant initially admitted that he acted dishonestly as alleged. The Panel considered that the fact that the Registrant now offered a subsequent,
 
different explanation in that he sought to suggest that there had simply been a misunderstanding, undermined the reliability of that further explanation. The Panel is therefore satisfied that the Registrant knew at the time that that what he told his senior colleague was not true. The Panel considered that ordinary members of the public would consider that telling his supervisor that a senior colleague had approved taking Patient 1 out when this was not the case in these circumstances would be considered dishonest.
 
100. The Panel therefore concluded that in relation to this Paragraph, the Registrant acted dishonestly. The Panel therefore finds this Paragraph proved in respect of Paragraph 2.
 
Dishonesty in relation to Paragraph 6
 
101. The Panel having found the facts of Paragraph 6 proved, (to the extent as set out in this determination) then considered whether the Registrant’s conduct was dishonest.
 
102. The Panel concluded in respect of this Paragraph, that the Registrant completed private work for Tara Physiotherapy whilst signed off sick from the Trust on the dates as set out earlier in this determination. The Registrant conceded, and the Panel finds, that the Registrant knew at the time that he should not have been undertaking private work whilst signed off sick and that it was wrong for him to have done so. The Panel noted that the Registrant admits that he acted dishonestly as alleged. The Panel considered that ordinary members of the public would consider that working for Tara Physiotherapy in the circumstances found proved, would be considered dishonest.
 
103. The Panel therefore concluded that in relation to this Paragraph, the Registrant acted dishonestly. The Panel therefore finds this Paragraph proved in respect of Paragraph 6.
 
Dishonesty in relation to Paragraph 7
 
104. The Panel having found the facts of Paragraph 7 proved, then considered whether the Registrant’s conduct was dishonest.
 
105. The Panel concluded in respect of this Paragraph, that the Registrant signed the relevant declaration that he had not undertaken any paid or unpaid work during his absence from the Trust when that was not the case. The Registrant conceded, and the Panel finds, that the Registrant knew at the time that the declaration was untrue, yet nevertheless signed the declaration. The Panel notes that the Registrant admits that he acted dishonestly as alleged. The Panel considered that ordinary members of the public would consider that signing the declaration in these circumstances would be considered dishonest.
 
106. The Panel therefore concluded that in relation to this Paragraph, the Registrant acted dishonestly. The Panel therefore finds this Paragraph proved in respect of Paragraph 7.
 
 
Dishonesty in relation to Paragraph 8
 
107. The Panel having found the facts of Paragraph 8, proved, the Panel then considered whether the Registrant’s conduct was dishonest.
 
108. The Panel concluded in respect of this Paragraph, that the Registrant told Person B that the HCPC investigation had been resolved when that was not the case. The Registrant conceded, and the Panel finds, that the Registrant knew at the time that what he said was untrue. The Panel notes that the Registrant admits that he acted dishonestly as alleged. The Panel considered that ordinary members of the public would consider that the statement he made to Person B in these circumstances would be considered dishonest.
 
109. The Panel therefore concluded that in relation to this Paragraph, the Registrant acted dishonestly. The Panel therefore finds this Paragraph proved in respect of paragraph 8.
 
110. In summary, the Panel therefore finds the facts of Paragraph 9 proved in relation to Paragraphs 2, 6, 7 and 8.
 
Decision on Grounds
 
111. On the basis of the facts found proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct or a lack of competence. It took into account the submissions made by Mr Tarbert and Ms Ibbotson.
 
112. In considering this matter, the Panel exercised its own judgement. The Panel also took into account the public interest, which includes protection of the
 
public, maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.
 
113. When considering whether the facts found proved amounted to misconduct, the Panel noted that not all breaches of the HCPC’s Standards of Performance, Conduct and Ethics need amount to a finding of misconduct.
 
HCPC’s submissions
 
114. Mr Tarbert invited the Panel to bear in mind the explanation of that term given by the Privy Council in the case of Roylance v GMC (No.2) [2000] 1 AC 311, where it was stated that:
 
“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 misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”
 
115. Mr Tarbert submitted that the Registrant’s conduct marked a serious departure from the standards expected of a registered Physiotherapist and was sufficiently serious to amount to misconduct. He submitted that the Registrant’s actions in relation to Paragraph 1 placed Patient 1 at risk of significant harm. His behaviour in respect of Paragraph 4 represented threatening and intimidating behaviour towards colleagues. In addition, the Registrant’s dishonesty represented behaviour falling substantially below the standard expected of him.
 
116. He further submitted that the Registrant’s conduct had the potential to impact adversely on the reputation of the profession.
 
117. He invited the Panel to conclude that the Registrant had breached standards 1, 2, 3, 6, 8, and 9 of the HCPC Standards of Conduct, Performance and Ethics (2016):
 
“Standard 1: Promote and protect the interests of service users and carers;
1.1 - You must treat service users and carers as individuals, respecting their privacy and dignity.
 
1.2 - You must work in partnership with service users and carers, involving them, where appropriate, in decisions about the care, treatment or other services to be provided.
1.4 - You must make sure that you have consent from service users or other appropriate authority before you provide care, treatment or other services.
 
Standard 2: Communicate appropriately and effectively;
2.5 - You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
2.6 - You must share relevant information, where appropriate, with colleagues involved in the care, treatment or other services provided to a service user.
 
Standard 3 – Keep within your scope of practice
3.1 - You must keep within your scope of practice by only practising in the areas you have appropriate knowledge, skills and experience for.
3.2 - You must refer a service user to another practitioner if the care, treatment or other services they need are beyond your scope of practice.
 
Standard 6 – Manage risk
6.1 - You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 - You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
 
Standard 9: Be honest and trustworthy;
Standard 9.1: You must make sure that your conduct justifies the public’s trust and confidence in you and your profession;”
 
The Registrant’s submissions
 
118. Ms Ibbotson conceded that except for Paragraphs 1bii) and 1biii) the facts admitted by the Registrant amounted to misconduct. She submitted that in relation to Paragraph 1bii), that although the Registrant did not complete an outdoor mobility assessment, this did not amount to misconduct. She stated that this was because based on his own clinical experience, such an assessment was not required in the circumstances in that the patient was merely walking from a car into a building and back.
 
119. In relation to Paragraph 1biii), she submitted that although the Registrant did not complete an environmental assessment, this did not amount to misconduct because such an assessment had already been completed by an OT whilst Patient 1 had been in hospital immediately prior to transferring to Laburnum Lodge and that there would be no need to re-do one in those circumstances.
 
120. HB confirmed that an environmental assessment had already been completed by OTs and the Registrant disputed that a further environmental assessment would therefore need to be carried within 6 months unless there was a significant change to the property.
 
121. In relation to Paragraph 4, Ms Ibbotson submitted that the alleged conduct does not amount to misconduct for the following reasons:
 
122. It is not alleged that he shouted or became physically abusive, but rather that he raised his voice, squashed a cup, pointed his finger in JS’s face.
 
123. She submitted that it was the Registrant’s case that the Registrant did not do or say anything aggressively and that the alleged conduct could reasonably be interpreted as being displays of frustration/agitation/upset rather than aggression. She submitted that it was JS’s and LR’s perception of his actions/words that caused them to feel that the Registrant was behaving aggressively rather than the Registrant intending to be aggressive towards them. As a result, the Registrant’s actions should be seen in context as not amounting to misconduct.
 
Decision on misconduct
 
124. The Panel heard and accepted the advice of the Legal Assessor, which included reference to the cases of: Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, Remedy UK v GMC [2010] EWHC 1245 and Nandi v GMC [2004] EWHC 2317 (Admin), Chaudhary v GMC [2017] EWHC 2561 (Admin) and Watters v NMC [2017] EWHC 1888 (Admin).
 
125. In Nandi v GMC [2004] EWHC 2317 (Admin), the Court referred to Roylance v GMC [1999], where the Court described misconduct as “a falling short by
 
omission or commission of the standards of conduct expected among medical practitioners, and such falling short must be serious” such that it would be “regarded as deplorable by fellow practitioners”.
 
126. The Panel adopted a two-step process in its consideration. Firstly, the Panel considered whether the facts found proved amount to misconduct. Secondly, and only if the facts proved were found to amount to misconduct, would the Panel then go on to consider whether the Registrant’s fitness to practise is currently impaired as a result of that misconduct.
 
127. The Panel carefully considered all the evidence and submissions presented to it and considered the facts of the case in the round.
 
128. Given the Panel’s findings in relation to the facts found proved, it concluded that the Registrant breached the following standards of the HCPC’s Standards of Conduct, Performance and Ethics: 2.5, 2.6, 3.1, 3.2, 6.1, 6.2,
6.3 (in relation to Particular 6) and 9.1. Standard 6.3 states:
 
“Manage your health
You must make changes to how you practise, or stop practising, if your physical or mental health may affect your performance or judgement, or put others at risk for any other reason.”
 
129. However, the Panel was mindful that a finding of misconduct does not necessarily follow as a result.
 
130. The Panel carefully considered the seriousness of the Registrant’s failings. in doing so, it identified the following:
 
• The Registrant failed to follow the Trust’s procedures, guidance and protocols. In reaching that conclusion, the Panel has nevertheless taken into account that in respect of Paragraph 1biii), whilst as a matter of fact the Registrant had not completed an environmental assessment, the evidence suggested that, as one had been prepared within the previous six months, there was no obligation on the Registrant to complete a further assessment in the absence of a material change of circumstances;
• The Registrant’s actions put a patient at risk of harm;
• The Registrant, behaved aggressively towards colleagues;
• The Registrant was repeatedly dishonest over a 2 year period and, in relation of Paragraph 7, sought to conceal his dishonest conduct. The Panel is mindful that honesty is a core quality of any professional and that the public should rightly be able to expect that registered
 
Physiotherapists adhere to high standards of honesty and probity. Failure to adhere to those standards undermines the trust and confidence the public should justifiably have in the profession.
 
131. The Panel therefore concluded that the Registrant’s conduct and subsequent breaches of the HCPC’s Standards of Conduct, Performance and Ethics, both individually and collectively, marked serious departures from the standards expected of a Physiotherapist.
 
132. In all the circumstances, and having carefully considered the advice received from the Legal Assessor, the Panel therefore found that the Registrant’s behaviour fell sufficiently far short of the standard expect of him such that it amounted to misconduct.
 
Decision on Impairment
 
133. The Panel went on to decide whether, as a result of his misconduct, the Registrant’s fitness to practise is currently impaired. 
 
HCPC submissions
 
135. Mr Tarbert recognised that the Registrant had accepted that he had placed Patient 1 at risk of unnecessary harm and that he had, on reflection, appreciated in part, the importance of completing appropriate assessments to ensure patient safety. He also reminded the Panel that the Registrant had made a number of admissions at the start of this hearing. In addition, in considering the extent of the Registrant’s insight, the Registrant had shown some ability to consider the impact of his conduct on patients, the public, the profession and his fellow colleagues. 
 
136. Mr Tarbert submitted that the Registrant’s conduct placed Patient 1 at significant risk of harm and that service users are entitled to expect that any physiotherapist will follow the required procedures and act in a way so as to minimise that risk. Whilst the Registrant may have felt that he was acting in a way that was best for Patient 1, he submitted that the Registrant’s conduct was far from being in Patient 1’s best interests.
 
137. He further submitted that it is a fundamental tenet of the Physiotherapy profession that healthcare professionals will work together and treat one another with respect and dignity. The way in which the Registrant treated both JS and LR in their meeting on 3 May 2018, he submitted, was a significant departure from this requirement, with both describing feeling threatened and intimidated by the Registrant. Such conduct would, he submitted, undoubtedly be of concern to the public.  
 
138. In relation to the Registrant’s dishonesty, he submitted that the public is entitled to expect that Registrants act with honesty and integrity in all aspects of their professional life.  
 
The Registrant’s submissions
 
139. Ms Ibbotson made detailed written submissions. In summary, she submitted that the Registrant’s fitness to practise is not currently impaired because:
 
• The Registrant has continued to work at Laburnum lodge without there being concerns about his clinical practice;
• He has provided positive testimonials attesting to his competence and professionalism;
• The Registrant was only subject to an informal capability process;
• The Registrant has shown remorse and insight into his failings;
• He has reflected on his failings;
• That no harm was caused to Patient 1 and his actions were well intended;
• That if the public were fully aware of the context of events, a finding of impairment would not be required for confidence in the profession to be maintained.
 
140. In all the circumstances, she submitted that the Registrant’s fitness to practise is not currently impaired. 
 
Decision on impairment
 
141. The Panel had regard to all the evidence presented in this case, including the submissions of Mr Tarbert and Ms Ibbotson. The Panel heard and accepted the advice of the Legal Assessor and took into account the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’”.
 
142. Physiotherapists are expected at all times to act in a professional manner. They must make sure that their conduct at all times justifies both service users’ and the public’s trust in the profession. In this regard, the Panel considered the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) in reaching its decision. In paragraph 74, she said:
 
“In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”
 
143. Mrs Justice Cox went on to say in Paragraph 76:
 
“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:
 
a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or 
b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or
c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or
d. has in the past acted dishonestly and/or is liable to act dishonestly in the future”.
 
144. Given its findings regarding ‘seriousness’, the Panel considered that limbs a, b, c and d were all engaged by the Registrant’s past actions. The Panel had regard to the fact that honesty is a core value of the physiotherapy profession which the Registrant had repeatedly breached as set out in its determination on facts. 
 
145. However, in assessing future risk, the Panel noted that the Registrant had developed some insight into his failings. He had appreciated that his actions principally in relation to Paragraph 1, were unacceptable and he has apologised for them. It has also had regard to the fact that his misconduct has not been repeated. 
 
146. In relation to the circumstances in relation to Patient 1, the Panel accepts that the Registrant’s failings were isolated and that they arose early on in his rotation. The Registrant had recognised his failings, identifying the risk to which Patient 1 had been put, and the impact of his actions on public confidence in the profession. 
 
147. In all the circumstances, the Panel did not consider that the failings identified in relation to Paragraph 1 were likely to be repeated. 
 
148. The Panel remained concerned about the extent of the Registrant’s insight into his aggressive behaviour and bore in mind that limited insight lends itself to the risk of repetition. The Panel recognised that at the time of the events of 3 May 2018, the Registrant was under considerable stress. However, in the Panel’s view, he has insufficiently demonstrated that he appreciated how his behaviour during the meeting of 3 May 2018 would have been perceived by his supervisors as aggressive. Whilst the Panel considered that this failing was capable of remediation, the Panel considered that, given his limited insight and lack of demonstrable remediation, there remained an ongoing risk of that behaviour being repeated in similar circumstances.
 
149. Similarly, in relation to the proven incidents of dishonesty, the Panel recognises that dishonesty, while not impossible to remediate, is difficult to do so and evidence. The Panel was concerned that the Registrant had behaved dishonestly over a 2 year period. His dishonest behaviour as identified in Paragraph 2 had placed a patient at risk. The dishonesty identified at Paragraphs 6 and 7 had been pursued against his employer for financial gain and the Registrant had similarly behaved dishonestly in relation to the HCPC investigation. The Panel was further concerned at the Registrant’s lack of candour in these proceedings in promoting his good character when he was aware that further concerns had been raised in connection with his conduct, albeit that no action has been taken by the HCPC in relation to one of those concerns. In the circumstances, the Panel concluded that he was likely to repeat his dishonest behaviour. 
 
150. The Panel therefore determined that a finding of impairment was required on the personal component of impairment.
 
151. The Panel also took into account the overarching objectives of the HCPC to protect, promote and maintain the health, safety, and wellbeing of the public and patients, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Physiotherapist profession and upholding proper professional standards for members of the profession. The Panel considered that, given the nature and breadth of the misconduct, and the serious and repeated nature of the dishonesty found proved, public confidence in the profession would be undermined if a finding of impairment were not made. 
 
152. Having regard to all of the above, the Panel finds that Registrant’s fitness to practise is currently impaired on both the personal and public components of Impairment. 
 
 
Sanction
 
153. Ms Woolfson, who replaced Mr Tarbert in representing the HCPC, for the last day of the hearing, submitted that the matter of what sanction, if any, is for the Panel to determine.  She made reference to the Sanctions Policy (“SP”) published by the HCPC in detailing some of the considerations that the Panel might address its mind to and factors drawn from case law. She provided written submissions.
 
154. Ms Ibbotson submitted that the Panel must consider a proportionate response. She reminded the Panel of key parts of her written submissions in relation to impairment and she stressed that the Registrant has continued working in the interim period without issue. She submitted that a Caution Order in relation to paragraphs 102 and 114 of the SP, in particular, is one that the Panel should consider. She indicated that a Suspension Order was disproportionate, and in fact that wrongdoing in respect of Patient 1 was isolated and occurred in 2018 without repetition. The dishonesty took place one and a half year ago and no questions about any dishonesty have since arisen while the Registrant has worked. She reminded the Panel that the Registrant had undertaken remediation and that ill health had impacted his decision making previously, but that this has improved, with numerous testimonials before the Panel to evidence support for the Registrant.
 
155. The Panel has considered this case very carefully and has decided to impose a Striking Off Order.
 
156. In reaching this decision, the Panel has had regard to all the evidence that has been adduced in this case, including the submissions of both parties.
 
157. The panel heard and accepted the advice of the Legal Assessor which included reference to the SP and principles drawn from case law.
 
158. The panel has borne in mind that any sanction imposed must be appropriate and proportionate, and its purpose is not one of punishment, albeit any sanction may have punitive consequences. The Panel had careful regard to the SP, and recognised that the decision on sanction is a matter for the Panel, exercising its own independent judgement.
 
 159. The Panel considered whether there was any aggravating or mitigating factors in this case. It identified the following facts:
 
Aggravating factors
 
• A vulnerable patient was put at risk.
• The dishonesty was persistent, and repeated over a two-year period.
• Efforts were made to cover up the dishonesty.
• The dishonesty occurred in different ways, in respect of multiple declarations made to different people.
• There was a lack of candour even in the oral evidence before this Panel.
• This was a breach of trust in respect of deceiving his employer.
• There was a lack of insight into the dishonest conduct, (albeit more insight into his aggression).
 
Mitigating factors
 
• There were some admissions to dishonesty once this was discovered.
• He has undertaken some remediation.
• He has shown some insight in his reflections.
• Positive testimonials have been supplied on his behalf.
• His ill health impacted his behaviour in acting aggressively.
 
160. The Panel then turned to the question of which sanction, if any, it should impose. It considered each course of action in turn, starting with the least restrictive sanction before moving upwards.
 
161. In view of the seriousness of the case, to take no further action, would not be appropriate.  This is because a number of failures have been found proved, where incomplete insight and some continuing risks have been identified. Taking no action would not address the concerns that have arisen in this case.
 
162. Imposition of a Caution Order was considered but discounted as this is not a case where a caution would be sufficient or appropriate to maintain confidence in the profession and the regulatory process. The Panel carefully considered the submissions of Ms Ibbotson in relation to a Caution Order which focused on the context in which the Registrant’s wrongdoing occurred, linked his ill-health to his poor decision making, and what the public would make of this if they knew of these circumstances. 
 
163. The Panel did not find a nexus between the Registrant’s health conditions and his wrongdoing in respect of dishonesty. It noted that he was considered to be fit on his return to work following a period of extended sick-leave, but the dishonesty persisted.  Accordingly, the Panel did not consider that a Caution Order was a suitable disposal to this case. This is because the criteria set out at paragraph 101 of the SP is not met. Issues of aggression and dishonesty have featured, which are not relatively minor in nature. There is a risk of repetition that is not low. The Registrant’s insight is incomplete and the Panel  has not seen remediation for dishonesty, acknowledging that this is difficult to evidence.
 
164. The Panel went on to consider the imposition of a Conditions of Practice Order in terms of addressing the concerns identified in reaching its decision on Impairment.  It recognised that there are multiple concerns, involving both the risk of patient harm and dishonesty. It considered where a Conditions of Practice Order is likely to be appropriate in examining the criteria as set out in paragraph 106 of the SP. While the Registrant has some insight it is incomplete. 
 
165. There are different failures that have been identified in relation to the Registrant and a Conditions of Practice Order does not lend itself to addressing dishonesty. Paragraph 108 of the SP indicates that conditions are less likely to be appropriate in serious case, for example, those involving dishonesty. Nonetheless, the Panel considered whether this was a suitable disposal of this case. The Panel could formulate no appropriate, proportionate, realistic and verifiable conditions which addressed dishonesty, and noted that the risk of harm in being able to practise was not one that could be met by the imposition of a Conditions of Practice Order.
 
166. The Panel next considered whether a Suspension Order was appropriate. It was assisted in this task by looking at the criteria set out at paragraph 121 of the SP.  It did find that the concerns represented a serious breach of the required standards of conduct, performance and ethics, and that there was evidence that at least some of the conduct was remediable and that the Registrant has taken steps to remedy some of his failings, particularly in relation to managing his stress within meetings, in terms of ending a meeting that is stressful or practising mindfulness.  However, the Panel did not find that the issues were unlikely to be repeated and had indicated that it considered that the Registrant’s insight remains incomplete some years after the index events.
 
167. In these circumstances, there is an on-going risk of harm, and further action is required to safeguard the public and the public interest.
 
168. The Panel next considered a Striking Off Order. It recognised that it may be a long term sanction unless new evidence comes to light, because restoration to the register cannot occur before a five year period. It was at particular pains to consider afresh whether health was an issue in this case. It noted that the allegation was not one relating to health.
 
169. The Panel looked at when a Striking Off Order is appropriate. It was assisted by the criteria set out at paragraph 130 of the SP. It did find that this sanction of last resort was suitable for serious, persistent and deliberate acts which the Registrant tried to cover up and was not candid about even in the hearing, suggesting that his dishonesty was limited. It considered the guidance available on dishonesty as set out in the SP at paragraph 56-58.
 
170. The Panel has found that the Registrant had repeated opportunities to admit his dishonesty but did not take these. This dishonesty was related to his professional life and could have a significant impact on the trust that the public hold in the profession, as well as potentially on public safety. Untruthful information was provided by the Registrant on different occasions and aspects of his dishonesty were for financial gain.
 
171. The Panel did consider the nuances in this particular case, in looking at the form, degree and type of dishonesty. It bore in mind that:
 
a) the dishonest behaviour was not confined to a single act, but occurred on multiple occasions and was covered up;
b) that the dishonest behaviour persisted for 2 years;
c) that the Registrant took an active role in the dishonesty.
It weighed these against the mitigating facts that:
d) there were admissions of dishonesty on the Registrant’s behalf; and
e) the mitigating factors outlined above at paragraph 158.
 
172. The Panel took into account that the Registrant had not been found to be dishonest in the last year and a half while he was working. However, the lack of facts alluding to further dishonesty was set against the issues of a lack of candour that were apparent in the evidence he gave before the Panel. This only became apparent when the Registrant was challenged.
 
173. The nature and gravity of the concerns of the Panel, the lack of complete insight even now, and the length of time over which the wrongdoing was repeated, means that even applying the principle of proportionality, and recognising that this decision deprives the Registrant of working in his chosen profession, the Panel was not persuaded that any lesser sanction than a Striking Off order could protect the public, public confidence in the profession, and public confidence in the regulatory process.

 

Order

That the Registrar is directed to strike the name of Rumel Rahman from the Register on the date this order comes into effect.

Notes

Right of Appeal
 
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.
 
Interim Order 
 
1. Having determined on a Striking Off Order, the Panel has the power to impose an interim order under Article 31.                                   
2. The HCPC applied for such an interim suspension order to be imposed for a period of 18 months to cover any appeal. There were no representations made on behalf of the Registrant despite the Panel providing an opportunity for this. 
3. The Panel considered that having made the substantive order it had that it was necessary for the Registrant to be subject to an immediate interim order of suspension to protect the public and the public interest. Given the substantive order made, and the rationale and basis for that, an interim order of conditions would be insufficient, an interim order of suspension for 18 months was the appropriate order to cover any appeal period.
 

Hearing History

History of Hearings for Mr Rumel Rahman

Date Panel Hearing type Outcomes / Status
03/11/2021 Conduct and Competence Committee Final Hearing Struck off
20/09/2021 Conduct and Competence Committee Final Hearing Adjourned part heard