Aaradhya Arya

Preliminary Matters
Service
1. Notice of the hearing was served by post to the Registrant’s registered address and by
email to the Registrant’s registered email address on 11 February 2022. There had been no response from the Registrant to the Notice of the hearing.

2. The Panel, having heard and accepted the advice of the Legal Assessor, was satisfied that
this evidence met the requirement which required the Registrant to be notified of the
hearing. Accordingly, the Panel was satisfied that service of the proceedings had been
effected on the Registrant.

Proceeding in absence

3. The Registrant was not in attendance at the hearing, nor was he represented.

4. Mr Mansell made an application to the Panel for the hearing to proceed in the absence of
the Registrant.

5. The last substantive contact which the Registrant had made with the HCPC was in
2019. There had been very limited engagement since then. On 22 January 2019, the Registrant notified the HCPC of a change of his registered details and gave an address in India as his registered address. On 4 March 2020, the Registrant changed his registered address again, this time to an address in New Zealand. It was to that address that the Notice of hearing had been posted. In addition, the Notice of hearing was sent to the Registrant’s registered email address. There had been no contact by him in response. Mr Mansell invited the Panel to conclude that the Registrant had voluntarily absented himself from the hearing. Live witnesses had been scheduled to give evidence in support of the Allegation which the Registrant faced. The Allegation was serious and stretched back to 2016. The public interest was also engaged, in Mr Mansell’s submission.

6. The Panel heard and accepted the Legal Assessor’s advice and had regard to the
HCPTS Practice Note, ‘Proceeding in the Absence of the Registrant’.

7. The Panel was satisfied that it was fair and appropriate to proceed in the Registrant’s
absence. There had been very limited engagement by the Registrant in relation to the proceedings. He had notified the HCPC of changes to his registered address in 2019 and 2020. The HCPC had served the Notice of hearing on the Registrant’s most recently notified registered address and to his registered email address. There had been no response from the Registrant to the Notice of hearing. Thus, the Panel was satisfied that the Registrant had voluntarily absented himself from attending the hearing. Further, there had been no request from the Registrant for an adjournment. The Panel had no basis upon which to suppose that adjourning the hearing to a later date would secure the Registrant’s attendance at the hearing or the attendance of a representative on his behalf.

8. The Panel noted that proceeding in the Registrant’s absence could cause some disadvantage to him. However, the Panel considered that it could attach such weight, as it considered appropriate, as the hearing unfolded, to the Registrant’s written evidence which was contained in the hearing bundle.

9. The Panel also considered the other factors which weighed in favour of the hearing
proceeding in the Registrant’s absence. There were witnesses whom the HCPC wished to
call to give evidence. The Panel considered that it was important to hear evidence from the
witnesses at the hearing while their memories were still relatively fresh. Further, the allegations were serious and stretched back to 2016. As such, the Panel considered that the public interest was engaged in this case.

10. For all the reasons advanced, the Panel considered that it was fair and appropriate to
proceed in the Registrant’s absence. In so deciding, the Panel was careful not to draw any
adverse inference against the Registrant in relation to his absence from the hearing.

Amendment of the Allegation

11. Mr Mansell applied to amend the Allegation.

12. He applied to add ‘2017’, following ’29 November’, in Particular 1(a).

13. He applied to substitute ‘you’ for ‘your’, after ‘Service User A’, in Particular 3(f).

14. Mr Mansell submitted that the proposed amendments were minor and purely technical. The year of the allegation, as set out in Particular 1(a), was always clear on the face of the papers and the Registrant would not be taken by surprise by the proposed amendment. As regards, Particular 3(f), this was to correct a typographical error.

15. Having heard and accepted the Legal Assessor’s advice, the Panel granted the
application. The Panel was satisfied that the proposed amendment did not alter the substance
of the Allegation, nor would the Registrant be caused an injustice if the application was granted.

Background

16. The Registrant is a Physiotherapist.

17. He was employed by Physiobeats Ltd (‘the company’) between December 2016 and
January 2019. The Registrant had a case load of physiotherapy patients who he saw across four to five locations at which the company operated.

18. In August 2018, the company received a complaint concerning the Registrant from one
of its referral agencies. The complaint alleged that the Registrant had attempted to contact
Service User A by phone and through various social media platforms. The company received a further complaint concerning the Registrant in August 2018 from another referral agency. The complaint alleged that the Registrant had sexually assaulted Service User B.

19. Following receipt of the complaint from Service User B, the Registrant was placed under
supervision and an internal investigation was commenced. At the time of the
internal investigation, the company collated feedback from patients treated by the
Registrant. During this process Service Users D and E raised concerns about the treatment they had received from the Registrant. The concerns included allegations that the Registrant had requested they remove clothing and that he used techniques which they felt were not
warranted by their injuries.

20. The Registrant resigned from the company on 10 January 2019 which brought the investigation to a halt. MA, one of the company’s directors, made a referral to the HCPC on 13 January 2019.

21. In the course of the hearing, the Panel heard evidence from the following witnesses:

• Service Users A, B and E;

• MA; and

• Mr Tim Edbrooke, a physiotherapy expert instructed by the HCPC.

22. Service User A adopted her witness statement dated 19 June 2020. She attended with the Registrant at treatment sessions, following a car accident, on dates between May and
November 2017. In her oral evidence to the Panel, Service User A stated that, to the
best of her recollection, the Registrant rubbed his groin against her on the second, third and
fourth consultations she had had with him. She stated that he may have acted in a similar fashion in the remaining consultations that she had with him, but she could not be sure at this stage. On the first occasion (the second consultation), Service User A stated that she thought her arms had got in the way of the Registrant. To avoid contact, Service User A attempted to tuck her arms under her body as she lay prone on the treatment table. On subsequent occasions, Service User A kept her arms tucked under her torso in a similar manner. This did not stop the Registrant brushing against her with his groin and making contact with her upper arms.

23. The Registrant’s actions were ‘subtle’ and Service User A, who had not had physiotherapy
before, was unsure as to whether the Registrant’s contact with her was inappropriate or an
innocent consequence of him working on her in the course of his professional duties.

 

24. To allay her concerns, Service User A brought her then six-year-old daughter with
her to the consultations. Her thinking was that, if his actions were inappropriate, the
Registrant would not persist with them in the presence of Service User A’s daughter. The
presence of Service User A’s daughter had no material impact and the Registrant made contact with Service User A in the same manner as before.

25. When questioned by the Panel, Service User A confirmed that the Registrant was
standing to one side of the treatment table. He was reaching over to her shoulder which
was furthest away from where he was standing. Rather than working on the shoulder that was nearest to him, in reaching over Service User A, he came into contact with her arms in the manner which she described.

26. Service User A also gave evidence about the Registrant’s alleged social media contact with her via various means after he had stopped treating her. Service User A told the Panel that she had been affected significantly as a result of the Registrant’s actions. She lived on her own and, in general conversation, Service User A told the Registrant about that. Even though she had since moved address, Service User A remained fearful that the Registrant might turn up at her home unannounced. She had never before experienced such feelings of hyper-vigilance. Service User A directly attributed her anxiety to the Registrant’s concerted efforts to make contact with her, long after his treatment of her had ended.

27. Service User B adopted her witness statement dated 29 June 2020. She had five
physiotherapy sessions with the Registrant between 18 April 2018 and 20 June 2018. She
attended for treatment with the Registrant as she had been in a car accident and had sustained injuries to her back, shoulder and neck. In her oral evidence to the Panel, Service User B explained that the Registrant never explained to her why she was required to remove her bra during treatment sessions. He had forcibly pressed upon her chest, breasts and nipples. The Registrant was so close to her during some sessions that Service User B could feel him breathing on her and, on one occasion, his beard touched her face.

28. In addition to the pain and discomfort which she felt as a result of the Registrant’s
actions, Service User B was left confused and in a state of disbelief at what had happened to
her. She could not take any more sessions with the Registrant and felt physically sick at the
prospect. She said she broke down when, in August 2018, she told a lady at the
physiotherapy centre where she had been treated by the Registrant why she had stopped attending with him. She attended a number of further sessions with another male
Physiotherapist. She could not believe the difference. Service User B was not asked to remove her clothing. The new Physiotherapist explained what he was doing and why he was doing it. He obtained Service User B’s consent to treatment in advance. The door to the treatment room was unlocked, unlike when she went to the Registrant who locked the door during sessions. The door, and whether it was locked or unlocked, had made a significant impression on Service User B. The Registrant’s treating room was at the top of several flights of stairs and was relatively quiet. In contrast, Service User B was treated in a gym by the other male Physiotherapist, which was much busier.

29. Service User B had felt angry for allowing herself to be treated by the Registrant in the
manner which she described to the Panel. She was also angry, after she had reported her
experiences in an email, at the company’s decision to take the matter no further. The company had sent her complaint about him to the Registrant who had replied in writing denying her claims. The company’s handling of her complaint left Service User B feeling that she was not being listened to or believed about what she said had happened to her.

30. Service User E adopted her witness statement dated 11 September 2020. In December
2017, she had a motor vehicle accident. She sustained whiplash injuries to her neck and
right shoulder. Service User E attended 11 physiotherapy sessions, which had been arranged for her by her insurance company. These took place between 10 January 2018 and 30 May 2018. Service User E was seen by the Registrant on the first two sessions which took place on 10 January 2018 and 17 January 2018. In these sessions, Service User E stated that the sites of her injuries were assessed by the Registrant and, in her view, nothing untoward occurred. On the following two occasions, 24 January 2018 and 31 January 2018, Service User E was treated by another Physiotherapist as the Registrant was on holiday. Service User E saw the Registrant again on 7 February 2018, and on a further six occasions, with the last treatment session being on 30 May 2018. It was what happened during these sessions which was the subject of Service User E’s complaint.

31. Service User E set out how she considered the Registrant’s treatment of her was
inappropriate and left her feeling uncomfortable. The Registrant briefly explained what the
Lymphatic Drainage (‘LD’) technique was but did not explain it in any detail or why he considered that it was a clinically appropriate treatment for Service User E. Service User E was never asked to sign any consent paperwork by the Registrant. Service User E gave evidence regarding an incident, during treatment, when the Registrant was alleged to have touched her labia. Service User E felt violated and uncomfortable by the Registrant’s actions.

32. In reflecting about her interactions with the Registrant, and from having engaged with the
HCPC investigation into the regulatory concerns which the Registrant faced, Service User E stated that she now considered that the Registrant’s actions were deliberate. As the sessions progressed, he spent less and less time treating the site of Service User E’s injuries and instead concentrated on her thighs and buttock areas. Service User E felt that the Registrant was ‘building up’ to the incident during which he touched her labia, which she now considered was a deliberate act on the Registrant’s part.

33. Service User E also told the Panel about several WhatsApp messages which she received
from the Registrant on 24 July 2018, some two months after her treatment had ended.
She did not respond to the messages. Service User E found the Registrant’s unsolicited contact with her by WhatsApp to be ‘creepy’ and ‘intrusive.’ As a healthcare professional
herself, she also considered the Registrant’s actions in contacting her, without any
professional or clinical justification, to be entirely inappropriate.

34. Service User E told the Panel about the ongoing impact which the Registrant’s
alleged actions had upon her. Service User E stated: ‘it angers me’ that it was not
reported to the police and, had a report been made, it could have prevented anger and insecurity on her part. As a nurse, she felt it was a privilege to look after people in a position of trust and this trust should not be abused.

35. MA adopted his witness statement dated 3 June 2020. He is one of two directors at the
company. Amongst other things, he was responsible for investigating any complaints that had been made about the company. MA confirmed that the Registrant had been employed by the company as a Physiotherapist from 15 December 2016 until his resignation on 10 January 2019.

36. MA told the Panel that he first received a complaint about the Registrant by way of an
email, dated 23 August 2018, from one of the company’s referral agencies. The complaint
concerned the alleged inappropriate contact which the Registrant had made with Service User A. While in the process of investigating Service User A’s complaint, MA received another email about the Registrant, dated 29 August 2018, from another referral agency. The complaint was made by Service User B. In light of the complaints that had been made by two separate service users, the company collected feedback over the telephone from other patients who had been treated by the Registrant. As a result of these enquiries, Service User D and Service User E made complaints to the company concerning the Registrant’s practice. In general terms, the Service Users B, D and E complained that the Registrant had requested that they remove their clothing during treatment sessions and that he had used techniques which they considered to be inappropriate and not warranted by the injuries which they had presented for treatment.

37. On 5 and 6 October 2018, SP, another director at the company and the Lead Physiotherapist, supervised the Registrant’s clinical practice.

38. On 8 October 2018, the Registrant sent an email to MA in which he denied acting
inappropriately towards patients in his care. On 13 October 2018, at MA’s request, the Registrant sent a list of patients whom he was treating. For each patient, the Registrant confirmed which patients he had asked to remove clothing during treatment, together with the clinical reasoning for his request.

39. On 25 October 2018, the Registrant emailed MA to confirm that he agreed to the
following measures being put in place in respect of his practice:

• To display the company’s chaperone policy posters in the Registrant’s clinics and to advise all female patients that they had the choice of being accompanied by a friend or family member during their sessions with the Registrant;

• Not to offer the LD technique to any female patients; and

• To discuss any case, where the Registrant considered that the patient was required to remove any of their clothes together with the clinical reasoning for same, with the Team Leader or Clinical Director of the company and to obtain the patient’s written permission before proceeding.

40. On 10 January 2018, the Registrant resigned from the company before the investigation into the concerns in respect of his practice had been completed. MA made a referral to the HCPC on 13 January 2019.

41. MA told the Panel that the Registrant, at the time, had given issues with his health as the
reason for leaving the company. On 22 January 2019, the Registrant emailed the HCPC to advise that he had lodged a formal grievance with the company, in which he alleged that he had been underpaid wages and had not been paid fees by the company which were owing to him. MA stated that, in his view, there was no substance to the Registrant’s grievance. MA stated that it had been initiated after the Registrant had left the company and that the motive for the grievance was that the Registrant was unhappy about the investigation which the company had undertaken in relation to the service users’ complaints about the Registrant’s practice and the subsequent HCPC referral.

42. The Panel also heard evidence from Mr Tim Edbrooke. Mr Edbrooke is a Chartered
Physiotherapist. He was provided with the witness statements of the service users, their clinical notes and other relevant materials and was asked by the HCPC to prepare an expert
report for these proceedings. In his written report, dated 29 October 2020, and in his oral
evidence to the Panel, Mr Edbrooke provided his expert opinion on the following:

• The presenting symptoms of each service user;

• What diagnostic assessment and/or treatment did the Registrant provide to each service user and were his actions clinically appropriate;

• The LD technique and whether such technique was clinically indicated and/or appropriate;

• The appropriateness of the Registrant's course of action in treating each service
user;

• Consent and whether the Registrant obtained appropriate consent in relation to his treatment of service users; and

• Whether any failings could be identified in the Registrant's practice and, if so, the extent to which the Registrant's actions fell below the standard to be expected of a registered
Physiotherapist.

Application to admit the Witness Statement of Service User D as Hearsay:

43. Having heard from the above witnesses, Mr Mansell applied to have the witness statement of Service User D admitted as hearsay. Service User D had provided a witness statement and had engaged in the regulatory proceedings. She had been advised by the HCPC that she would be required to give evidence to the Panel on the afternoon of Wednesday 20 April 2022. Service User D was called by the Hearings Officer on the
morning of 20 April 2022. The purpose of the call was to ensure Service User D’s remote attendance as arranged. Service User D answered the phone and asked the Hearings Officer to call her back in an hour. When she did so, the call was not answered by Service User D and it went to voicemail. The Hearings Officer left a message for Service User D to call her and that if she had a difficulty in attending on the day, she could give evidence later in the week or at the start of the week following. Mr Mansell told the Panel that subsequent and repeated efforts made by the HCPC and his instructing solicitors to make contact with Service User D had been unsuccessful.

44. Mr Mansell stated that he could not second guess why she had not been reachable at the very last minute.

45. Mr Mansell invited the Panel to admit Service User D’s witness statement as hearsay. The
regulatory concerns which underpinned the Allegation were very serious. With the exception of allegation 4, there was support for Service User D’s evidence in the statements provided by other service users and in the documentary material in the Exhibits which were contained in the hearing bundle. Mr Mansell submitted that, even if the statement was admitted, the Panel would still need to assess what weight, if any, to place on it in the course of the proceedings.

46. The Panel heard and accepted the advice of the Legal Assessor. In the course of that advice, the Legal Assessor made reference to the cases of R (Bonhoeffer) v GMC [2011] EWHC 1585 (Admin) and Ogbonna v NMC [2013] EWHC 1595 (Admin). He also referred the Panel to the case of Thorneycroft v NMC [2014] EWHC 1565 (Admin), which distilled the principles to be derived from those two authorities.

47. The Panel, at the outset, had regard to rule 10 of The Health and Care Professions Council
(Conduct and Competence Committee) (Procedure) Rules 2003, as amended (‘the Rules’). In material part, rule 10 provides as follows:

(b) subject to sub-paragraph (c) the rules on the admissibility of evidence that apply in civil
proceedings in the appropriate court in that part of the United Kingdom in which the hearing takes place shall apply;

(c) the Committee may hear or receive evidence which would not be admissible in such
proceedings if it is satisfied that admission of their evidence is necessary in order to protect
members of the public.

48. The Panel noted that the allegations faced by the Registrant were serious. The
Panel considered the nature of the evidence contained in Service User D’s statement. In the main, the complaints raised by her were closely in keeping with the other witness statements and evidence given to the Panel by the other service users and, in particular, Service Users B and E.

49. The Panel also had regard to the fact that, by his absence, the Registrant would not have
had advance notice of Service User D’s non-attendance at the hearing. The reason for Service
User D’s non-attendance was unknown. This was a development which had been unforeseen by the HCPC and had occurred as the hearing was unfolding.

50. On balance, the Panel decided to admit Service User D’s witness statement. The
allegations faced by the Registrant were of a very serious nature. With the exception of
allegation 4, the allegations made by Service User D bore a striking similarity to other
elements of the evidence presented. The Panel determined that the evidence contained in
the witness statement was relevant to those matters which it had to consider and that it was fair to admit the statement as hearsay. The Panel would approach the consideration of Service User D’s statement with care and when assessing what, if any, weight to attach to the statement, would exercise particular care with regard to those elements of Service User D's witness statement which addressed allegation 4.

Decision

Decision on Facts

51. Before retiring to consider its decision on the facts, the Panel carefully considered all
the oral and documentary evidence which had been presented at the Hearing. The Panel
heard and accepted the Legal Assessor’s advice in relation to the proper approach to adopt at
the fact- finding stage. In the course of that advice, on the question of sexual motivation, the Legal Assessor referred the Panel to the Practice Note entitled, ‘Making decisions on a registrant’s state of mind’, published by the HCPTS. He also referred the Panel to Basson v
GMC [2008] EWHC 505 (Admin) and Haris v GMC [2021] EWHC Civ 763.

52. The Panel was reminded that the burden of proof required the HCPC to prove each element of the Allegation on the balance of probabilities. The Panel could only be satisfied that a fact was proved if it was satisfied that it was more likely than not to have occurred.

53. At the outset of its deliberations on facts, the Panel undertook an assessment of
the evidence which it had heard at the hearing.

54. Service User A, to the Panel’s mind, was a reliable and credible witness. Service User A
gave her evidence in a careful and thoughtful manner. Her oral evidence was consistent with her witness statement.

55. Service User B was a credible witness whose evidence, both written and oral, was consistent and reliable.

56. Service User E gave her evidence in a straightforward manner. The Panel was of the
view that she was reliable and credible as a witness.

57. Mr Edbrooke, as an expert witness, was credible and reliable. Properly, he gave evidence in accordance with his knowledge and expertise.

58. The Panel then turned to consider the Allegation.

Service User A:
Allegations 1a); 1 b); 1 c); 1 d); 3 f) and 7

59. Service User A started seeing the Registrant for physiotherapy appointments
following a car accident in May 2017. She saw the Registrant at appointments between May
and November 2017.

As a registered Physiotherapist (PH109213) your fitness to practise is impaired by reason of
misconduct and/or lack of competence.

In that:
1. Between November 2017 and August 2018, you breached professional boundaries in that you contacted and/or attempted to contact Service User A via a number of social media platforms in that you:
a) On or around 29 November 2017 sent Service User A a friend request on Facebook;

60. In her witness statement, Service User A explained that, on 29 November 2017, she received a friend request from the Registrant via Facebook. She exhibited to her statement a screenshot of the request. Service User A said she ‘found it weird’ that the Registrant was trying to contact her in this way.

61. In her oral evidence, Service User A confirmed the contents of her witness statement and that she had received the dated screenshot of the friend request from the Registrant. Although she did not think at the time that the Registrant was ‘coming on to me’, the Registrant’s subsequent contact via Facebook, and other social media platforms, made her question what had happened during her sessions with the Registrant and his intentions. In her oral evidence, Service User A described the Registrant’s actions in making contact with her in this manner as ‘strange’ and ‘creepy’.

62. The Registrant did not deny Service User A’s allegation. When asked by MA to give an account of his alleged contact with Service User A, after treatment had ended, the Registrant, in an email dated 24 August 2018, stated:

‘Facebook's *people you may know* also listed patients profile and looking at a familiar
face, friend request was sent…. Probably a friendly gesture might have misunderstood post discharge (sic).’

63. The Panel was satisfied that the evidence considered was sufficient to find allegation 1 a)
proved.

64. Accordingly, the Panel found allegation 1 a) proved.

b) On an unknown date prior to 11 August 2018 you sent a message to Service User A via WhatsApp;

65. The Registrant neither accepted nor denied sending Service User A a WhatsApp message.

66. In her witness statement, Service User A explained that the Registrant sent her a message on WhatsApp. She could not recall the exact date when the message was sent but stated that it was prior to 11 August 2018. She no longer had the message but recalled that it was a ‘generic “how are you?” message’. Service User A did not respond to the message and blocked the Registrant’s number on her phone and WhatsApp.

67. In relation to the date of the message being prior to 11 August 2018, Service User A
confirmed that she had emailed her legal representative, on 11 August 2018, to advise as follows:

‘On a separate note I would also like to make you aware that the Physio you referred me to has (outside of the Physio appointments) tried me message me (sic), add me on Facebook and on Instagram. I have had to block him on my social media accounts and his number on my phone as I feel it is inappropriate and unprofessional and made me feel uneasy.’

68. Service User A’s oral evidence was consistent with the account given in her witness
statement.

69. Accordingly, the Panel found allegation 1 b) proved.

c) On or around 23 August 2018 sent Service User A a friend request on Snapchat;

70. The Registrant, in an email to MA, dated 24 August 2018, initially denied making contact
with Service User A on Snapchat as he stated that he did not use that platform. In a further email to MA, dated 25 August 2018, the Registrant’s position had changed. He stated: ‘May be when I installed SnapChat, it has a option of adding people who are using Snapchat and I might have added all. Like I said, I don't know how to use it so I don't use it (sic).’

71. In her witness statement, Service User A stated that, on 23 August 2018, she received a
notification that the Registrant had added her as a friend on Snapchat. She exhibited a screenshot of the notification to her witness statement.

72. The Panel found Service User A’s oral evidence credible and consistent with the account
given in her witness statement. The Panel preferred her evidence over the accounts given by
the Registrant which the Panel found were inconsistent.

73. Accordingly, the Panel found allegation 1 c) proved.

d) On an unknown date prior to 11 August 2018 sent a ‘Follow’ request to Service User A on
Instagram.

74. In an email to MA, dated 25 August 2018, the Registrant stated: ‘Friend requests on
InstaGram could be possible but I don't even remember as this is an year old issue (sic).’

75. In her witness statement, Service User A explained that the Registrant sent her a request to follow her on Instagram. She could not recall when this happened but knew it was prior to 11 August 2018. Upon receiving the request, Service User A blocked the Registrant’s account. She exhibited a screenshot of her blocked Instagram account list, which showed the
Registrant’s Instagram name and profile picture.

76. In relation to the date of the message being prior to 11 August 2018, Service User A
confirmed that she had emailed her legal representative, on 11 August 2018, to advise as follows:

‘On a separate note I would also like to make you aware that the Physio you referred me to has (outside of the Physio appointments) tried me message me (sic), add me on Facebook and on Instagram. I have had to block him on my social media accounts and his number on my phone as I feel it is inappropriate and unprofessional and made me feel uneasy.’

77. Service User A’s oral evidence was credible and consistent with the account given
in her witness statement. The Panel preferred her evidence over the inconsistent accounts
given by the Registrant.

78. Accordingly, the Panel found allegation 1 d) proved.

79. Having found 1a); 1 b); 1 c) and 1 d) proved, the Panel considered the stem of Allegation 1, which alleged that the Registrant’s actions breached professional boundaries. The Panel recalled Service User A’s evidence as to the impact which the Registrant’s actions had upon her. Service User A described the Registrant’s actions as ‘strange’ and ‘creepy’. During treatment sessions, in passing conversation, she had mentioned to the Registrant that she was separated from her partner and lived alone with her child. Service User A had become ‘paranoid’ in case the Registrant would turn up, unannounced, at her door. She had taken measures to make her home secure to guard against that risk. Whatever might have been the initial professional justification for the Registrant having Service User A’s contact details on his phone, over a prolonged period after he had ceased treating her, the Registrant had accessed Service User A’s information, which he had retained on his phone, to make contact with Service User A via a number of social media platforms. There was no clinical or professional justification for his actions.

80. Accordingly, the Panel was satisfied that the Registrant’s actions at 1a); 1 b); 1 c) and 1
d) breached professional boundaries.

3. Between 15 December 2016 and 10 January 2019, during treatments, you inappropriately touched and/or treated service users, without clinical justification, in that you:

[…]
f) During treatment of Service User A your brushed your groin against Service User A’s arm.

81. In her witness statement, Service User A stated that she felt uncomfortable ‘during some of the sessions’ she had with the Registrant. She further stated:

‘I recall that I would be lying on my front and sometimes when he would lean across me, I could feel his nether regions rubbing against my arm.’

82. In her oral evidence, Service User A stated that she could definitely recall the
Registrant’s groin making contact with her on the second, third and fourth treatment sessions, although there may have been other sessions when this happened as well. On the first occasion, Service User A stated that the Registrant’s groin made contact with her forearms as she was lying face down on the treatment table. This happened when the Registrant was leaning over Service User A on the treatment table to work on the opposite side of her body. In subsequent sessions, Service User A consciously tucked her arms under her body when she was lying on the treatment table. She did this to prevent the Registrant brushing her arms with his groin area. Her efforts in preventing this occurring by repositioning her arms were unsuccessful. Service User A stated that during these subsequent sessions, the Registrant continued to make contact with her arms with his groin area. When her arms were partially tucked under her body, the Registrant’s groin made contact with her upper arms rather than her forearms.

83. Service User A stated that, at the time, she did not know whether the Registrant’s actions
were deliberate. She had never needed to attend a Physiotherapist before. Service User A thought that the ‘subtle’ contact that the Registrant was making with her body was as a result of the positioning of her arms. It was when the Registrant began making contact with her via social media platforms, some months after treatment had ended, that she became concerned and began to consider that the Registrant’s actions were deliberate and not accidental.

84. Mr Edbrooke, in his expert report, noted that such contact as described by Service User A
was ‘usually avoidable’ and, if not deliberate, was ‘the result of carelessness on the part
of the physiotherapist…’ In his oral evidence, Mr Edbrooke stated that it was not unusual for a Physiotherapist to stand beside a patient, who was lying on a bench, to treat the opposite side of the patient’s body. However, it was possible to work in that manner without making contact with the patient’s body. This objective could be achieved, for example, by moving
the treatment bench up or down. Despite stating in his report that contact might have been
inadvertent, in his oral evidence, Mr Edbrooke revised his opinion after hearing the evidence of Service User A. He thought the touching was likely to have been deliberate in this instance.

85. Having considered Service User A’s written and oral evidence, which was credible and
consistent, and the evidence of Mr Edbrooke, the Panel was satisfied that, during the treatment of Service User A, the Registrant brushed his groin against Service User A's arm and that his actions, during those treatment sessions, were without clinical justification.

86. Accordingly, the Panel found allegation 3 f) proved.

7. Your conduct in allegation 3 […] was sexually motivated.

87. The Panel had found that the Registrant had inappropriately touched Service User
A’s arms with his groin area during a number of treatment sessions. The Panel was satisfied that the Registrant could have acted so as to prevent such contact. He had not done so. He had, deliberately and repeatedly, brushed his groin against Service User A’s arms during several treatment sessions, even when the service user had taken measures to prevent her coming into contact with him. The Registrant’s actions were not clinically justified. In these
circumstances, the Panel concluded that the only reasonable inference which could be drawn from the facts found proved was that the Registrant’s actions were sexually motivated.

Service User B:

Allegations 3 a)i; 3 b)i; 3 e); 7 and 5i

88. Service User B was involved in a car accident in March 2018 and sustained injuries to her back, shoulder and neck. Between April and June 2018, she attended five appointments with the Registrant.

3. Between 15 December 2016 and 10 January 2019, during treatments, you inappropriately touched and/or treated service users, without clinical justification, in that you:
a) Touched the chest and/or breast area and/or nipples of: i. Service User B;
b) Requested to be removed and/or removed the bra of: i. Service User B.

89. On 15 September 2018, MA sent, by email to the Registrant, a complaint from Service User B. In response, in an email dated 16 September 2018, the Registrant said he had, among other things, conducted a Lymphatic Drainage (‘LD’) technique on Service User B. He denied that the front of the chest and breasts of the service user were treated or accessed. He accepted that he locked the door during his appointments. He claimed this was to stop people walking in.

90. In her witness statement, during the first session, Service User B stated that the
Registrant asked her to remove her t-shirt. The Registrant undid Service User B’s bra from the back and removed the bra so her breasts were exposed. Service User B stated:

‘He [the Registrant] did not explain why he was doing this or ask me whether it was
okay I was not given a choice as to whether he removed my bra or not. [The Registrant] started applying a lot of pressure on my back and then did the same on my front. He pressed into my chest and around my breasts which physically hurt me. He came up from under my armpits and rubbed his hands across my breasts into the middle of my chest many times. He also used his hands to rub down from my neck area to the top of my nipples leaving me very sore. It seemed to me that he worked on my chest area for the whole session, which I think was about half an hour.’

91. Despite feeling uncomfortable, Service User B decided to attend the second session
to see if it would be better. However, she felt even more uncomfortable afterwards. At the second session, Service User B said the Registrant lowered her bra, exposing her breasts. She stated:

‘Again, during the session, I was sitting in a chair and [the Registrant] worked on my chest and breasts, pushing and applying a lot of pressure. This session felt a lot more intense; his hands touched all over my breasts and he pushed lot harder. He touched my nipples by pressing his whole hand down onto them. He also came up from under my armpits and rubbed his hands across my breasts as he had done in the first session.’

92. Service User B explained that she continued to attend sessions with the Registrant because she was ‘in denial.’ She wore a sports bra to the third session in the hope that the Registrant would work over the top of it rather than taking it off. However, Service User B’s evidence was that the Registrant did take it off and her breasts were exposed. Service User B stated:

‘[The Registrant] put his knee up on the table so that it was on my right side. He then began
pressing on my chest and breasts like he had done before. His hands touched all over my breasts and he touched my nipples many times. I felt him breathing on the side of my face and on my neck as he pressed into me, and the stubble on his beard connected with my face as he leaned in to me.’

93. The next two sessions were similar to the first three; during each session, Service User B
stated the Registrant removed her bra and pressed on her chest and breast area. Service User B stated that ‘Every week the treatment felt more intense.’

94. At the fourth session, Service User B stated that, by way of an excuse, she asked the
Registrant not to work on her chest area as her asthma was playing up because of the hot weather. She also pointed out to the Registrant that she didn’t have any pain in her chest
anyway. Nevertheless, Service User B stated that the Registrant continued to work on her
front area.

95. In her oral evidence, Service User B gave an account of the sessions which was consistent
with the explanation of the sessions which she had set out in her witness statement. In her
mind, Service User B kept questioning the appropriateness of the Registrant’s actions. Service
User B felt uncomfortable during each session but did not want to complain about the Registrant’s treatment of her. However, after the fifth session,

Service User B could not take anymore. She felt ‘suffocated’ and ‘sick’ by the Registrant’s
actions.

96. In August 2018, Service User B was called by the physiotherapy centre to ask why she did not attend her last appointment. She explained that she did not want to continue because of what had happened during her previous sessions with the Registrant. Having told the physiotherapy centre what had happened and why she had stopped attending sessions with the Registrant, it was arranged by the physiotherapy centre that she would have treatment sessions with a different Physiotherapist. Although the treatment room was in a more public place, being attached to a gym, Service User B stated that the new Physiotherapist did not lock the door during sessions as the Registrant had done. The new Physiotherapist, unlike the Registrant, did not ask her to remove her clothes and, again unlike the Registrant, he explained what treatments he was undertaking and the reasons for the treatments before he undertook them. Her subsequent experience with the new Physiotherapist brought home to Service User B how inappropriate her sessions with the Registrant had been.

97. On 22 August 2018, Service User B wrote an email to the physiotherapy centre in which she set out the Registrant’s actions towards her during treatment. She stated that, ‘…I realised that I had been putting up with very inappropriate behaviour. I became very ashamed and withdrawn, I blamed myself for being so stupid for allowing him to do what he did and not realising sooner that it wasn't right and that I did not need to put up with what he was doing.’

98. Service User B described how she had been affected by the Registrant’s actions. She had
become a lot more emotional and withdrawn and wanted to block her experiences out of her
mind.

99. In his oral evidence, Mr Edbrooke stated that there could be occasions, in a clinical
setting, when it would be necessary for a practitioner to unclasp a patient’s bra strap. Consent for this would be obtained verbally so as to enable treatment to be given to the area under the bra strap, so as not to cause pain or discomfort to the patient by having to unclasp the bra strap herself while lying on her front on the treatment table. Such a request would only ever be needed when the patient was lying face forwards on the treatment table. Mr Edbrooke stated that the undoing and removal of a patient’s bra when she was sitting would not be appropriate in any clinical setting.

100. The Panel considered Service User B’s written and oral evidence, which was consistent, and the evidence of Mr Edbrooke. The Panel was satisfied that the Registrant had removed and/or requested Service User B to remove her bra and that, further, the Registrant had touched the chest, breast and nipples of Service User B inappropriately and without clinical justification.

101. Accordingly, the Panel found allegations 3 a)i and 3 b)i proved.

e) Inappropriately used the Lymphatic Drainage technique on Service User B […]

102. In his email to MA, dated 16 September 2018, the Registrant stated that he had used the LD technique on Service User B.

103. In his report, Mr Edbrooke observed that the clinical notes for the last four sessions with
Service User B included LD as a technique. Mr Edbrooke stated:

‘Manual lymphatic drainage (MLD) is a light, skin stretching massage that helps promote the
movement of lymphatic fluid out of a swollen limb or tissue. It should not be confused with a
traditional massage.

[…]

MLD is most commonly used to drain lymphoedema, a long-term (chronic) condition that
causes swelling in the body's tissues. Lymphoedema can affect any part of the body, but
usually develops in the arms or legs. It develops when the lymphatic system does not work properly, most commonly following medical or surgical treatments affecting the lymph nodes.’

104. However, in respect of Service User B, Mr Edbrooke stated:

‘It is my opinion that lymphatic drainage of the upper back is usually used following treatment for melanoma in that area, and as a treatment for WAD [Whiplash Associated Disorder] would be considered unusual and would be unlikely to be supported by a significant body of opinion within the profession. Justification might be found in the presence of excess tissue fluid in the region, but again this would be unusual, and is not recorded in the clinical notes.”

105. In his oral evidence, Mr Edbrooke referred the Panel to the Registrant’s email dated 16
September 2018. The Registrant stated that he had performed the LD technique because Service User B had presented with, ‘secondary complains (sic) of vague pain in the arms, extending to occasional numbness or tingling sensations in the hand.’ When Service User B attended with the Registrant for an initial assessment on 18 April 2018, there was no reference to this presentation in the Registrant’s notes, or that the LD technique was performed.

106. Mr Edbrooke’s evidence was that the LD technique was not an appropriate
intervention for the type of injuries which Service User B presented with. Although it
would be regarded as unusual, the LD technique would conceivably only be appropriate in
the treatment of whiplash type injuries where there was an excess of tissue fluid in the region
and no such excess was recorded in Service User B’s notes. Further, Mr Edbrooke stated
that the LD technique would never involve massaging the breasts and nipples of a patient
and would never be performed on a patient who was seated.

107. The Panel noted that the Registrant had admitted using the LD technique on Service User B. The Registrant recorded LD in his clinical notes for Service User B on the following dates: 16 May 2018, 6 June 2018, 20 June 2018 and 4 July 2018. The Panel had regard to the evidence of Mr Edbrooke regarding the lack of clinical justification for the use of LD. Mr Edbrooke’s view was shared by MA in his evidence. The Panel, as a result, was satisfied that the Registrant inappropriately, and without clinical justification, had used the LD technique on Service User B.

108. Accordingly, the Panel found allegation 3 e) proved.

7. Your conduct in allegation 3 […]was sexually motivated.

109. The Panel had found that the Registrant had inappropriately touched intimate parts
of Service User B’s body during a number of treatment sessions. The Panel was satisfied that the Registrant’s actions were not clinically justified. In these circumstances, the Panel concluded that the only reasonable inference which could be drawn from the facts found proved was that the Registrant’s actions were sexually motivated.

5. You did not obtain written and/or verbal informed consent and/or up to date consent for
treatment at each appointment in respect of:

i. Service User B;

110. In an email to MA, dated 16 September 2018, the Registrant stated: ‘During each
and every session, patient’s verbal consent was gained before providing hands on therapy.’

111. In her witness statement, Service User B stated, “He [the Registrant] never asked
for my consent, either verbally or in writing, prior to treatment taking place.”

112. In his oral evidence, Mr Edbrooke drew the Panel’s attention to the Registrant’s
treatment notes for Service User B for sessions on 2 May 2018, 16 May 2018 and 20 June 2018. On each occasion it was recorded: ‘Informed consent has been gained prior to treatment and clinical justification + reasoning explained to the patient (as required).’ It was Mr Edbrooke’s evidence that these identical entries for each session were, on balance, likely to have been ‘copied and pasted’ by the Registrant, rather than being a true representation of the seeking of consent by him prior to treatment.

113. Service User B’s oral evidence was credible and consistent with the account given
in her witness statement. The Panel preferred her evidence, and the evidence given by Mr
Edbrooke, over the accounts given by the Registrant. Further, the Panel was satisfied that
Service User B did not give consent, much less informed consent, to the type of contact which the Registrant engaged in during his treatment sessions with Service User B.

114. Accordingly, the Panel found allegation 5i proved.

Service User D:
Allegations 3 a)ii; 3 c); 4; 7; 6 and 5ii

115. Service User D was in a car accident in September 2017 and as a result started experiencing pain in her shoulder and neck. She attended three physiotherapy sessions with the Registrant.

3. Between 15 December 2016 and 10 January 2019, during treatments, you inappropriately touched and/or treated service users, without clinical justification, in that you:
a) Touched the chest and/or breast area and/or nipples of: ii. Service User D.
c) Touched Service User D’s Buttocks.

116. In her witness statement, Service User D stated she had no concerns about the Registrant’s conduct during the first session she had with him. However, during the second session, she began to have concerns about the treatment the Registrant was providing. The Registrant asked her to remove her top but she declined. Service User D stated:

‘I turned over and he began pressing on my back, while talking to me [redacted]. Underneath my t-shirt I was wearing a green coloured vest. [The Registrant] moved my t-shirt and vest up and put his hands inside my clothing. I thought that maybe he was going to put his hand on my shoulder to analyse how much my muscles were relaxed. However, then I realised his hands were not moving up to my shoulder but moving down towards my bottom. That was when alarm bells started to ring in my mind as I was not comfortable with this. ‘[The Registrant] started touching my bottom. This was through my clothing. At first, I thought his hand had slipped because he was using gel on my back. I showed him through my body language that I was uncomfortable with him touching my bum. I did this by tensing and squeezing my body and he moved his hands away. He started talking to me again [redacted] and engaged me in conversation then started touching my bum again. It was at this
point I realised that it was not an accident.’

117. Service User D stated that she again tensed her body to show the Registrant she
was uncomfortable. The Registrant moved his hands to the back of her neck and around to the front of her neck and then on to her chest. Service User D stated:

118. ‘He touched next to my neck and below towards my breasts but this was through clothing and not on my skin. I felt that this was an intentional action.’

119. Service User D told the Registrant that she thought the session should end and gave him
an excuse about having to be somewhere. She explained what happened next:

‘I recall that I got up from the bed and saw in [the Registrant’s] trousers that he was sexually
aroused. I found it very uncomfortable to see this and felt like I was going to cry so I excused
myself and went to the toilet. […] After this, I left the clinic and went home, feeling
embarrassed.’

120. In the HCPC referral, dated 13 January 2018, a record of Service User D’s telephone complaint to the company was included. Service User D was recorded as having stated:

‘I am a band 6 NHS staff nurse myself and what [the Registrant] does in his session is very
unprofessional…. He touches the patients for his physical needs. He treats the areas which
are not required and when he touches those areas anyone can see changes and his body parts which are disgusting to see… He is touching various part of the body where there is no therapy needed. Not just the upper chest but other areas where no therapy was even necessary.’

121. Service User D, in an email to the HCPC, dated 11 December 2019 stated:

‘[The Registrant] asked me to remove my top to deal with my shoulder pain, which was totally unrelevant (sic) towards the treatment of shoulder and neck pains. More over I found him sexually aroused during touching my shoulders and neck. I did not mentioned (sic) him any pains in my back but still he tried to put his hands in my trousers from the back…’

122. The Registrant had not made any admission in respect of Service User D’s allegations. The Panel also took into account that Service User D had not attended the hearing to give oral evidence. The Panel was entitled to place less weight on hearsay evidence than on oral evidence which could be tested before the Panel at the hearing. The Panel was mindful of the need to exercise care when addressing hearsay evidence. This was particularly so, as in this
instance, when the hearsay evidence was the sole and decisive evidence in respect of allegation 4.

123. The Panel was of the view that the available evidence did not identify, to its satisfaction,
the anatomical structures which Service User D alleged had been inappropriately touched by the Registrant. Further, as a result of imprecision concerning the places on Service User D’s body allegedly touched by the Registrant, the Panel could not be sure that he did not have a clinically justified reason for doing so.

124. Having carefully considered the written evidence, the Panel concluded that Service User D’s written evidence lacked the necessary specificity that would be needed for the Panel, on the balance of probabilities, to find allegations 3 a)ii and 3 c) proved.

125. Accordingly, the Panel found allegations 3 a)ii and 3 c) not proved.

4. During treatment of Service User D you were sexually aroused.

126. In relation to allegation 4, although Service User D’s evidence fitted into a general pattern which was similar to the other witnesses who attended at the hearing and who had given oral evidence, Service User D was the only witness who gave a written account that the Registrant was sexually aroused at the end of one session. This evidence, which was hearsay, was the sole and decisive evidence which was offered in support of allegation 4. The Panel did not have the benefit of Service User D’s oral evidence and, owing to her absence, her account on that point could not be tested. As a result, the Panel could not place sufficient weight on the evidence so as to find allegation 4 proved on the balance of probabilities.

127. Accordingly, the Panel found allegation 4 not proved.

128. As a result of its findings in respect of allegations 3 a)ii, 3 c) and 4, the Panel did not
move on to consider whether the Registrant’s actions, as alleged, were sexually motivated.

5. You did not obtain written and/or verbal informed consent and/or up to date consent for
treatment at each appointment in respect of:
ii. Service User D;

129. In her witness statement, Service User D stated:

‘During my treatment sessions with [the Registrant] he did not explain the treatment that he would be conducting, and he did not obtain my consent for the treatment, either verbally or in writing.’

130. The Panel noted that, in Service User D’s clinical notes, there was no mention of consent
being obtained by the Registrant in respect of each of the sessions with Service User D.

131. The Panel considered that Service User D’s written account, supported by the clinical notes was sufficient to find allegation 5ii proved.

132. Accordingly, the Panel found allegation 5ii proved.

6. In respect of Service User D you did not adequately record the structures being treated and/or the techniques applied to each structure.

133. For this service user, Mr Edbrooke, in his report, stated:

‘Clinical notes record the application of a variety of soft tissue and manual therapy techniques, but do not specify the structures or areas of the body to which these were applied…’

134. Mr Edbrooke elaborated on this element of his report in his oral evidence. He referred the Panel to the notes of the Registrant’s initial assessment of Service User D on 13 June 2018. He took the Panel to the section of the assessment notes entitled, ‘On Examination’. As an example, he noted that the Registrant had recorded, ‘Patient has normal limb movements
and normal UL (Upper Limb) gestures.’ This note, in Mr Edbrooke’s view, was insufficiently
precise to make it clear what specific anatomical structures the Registrant was recording.
Similarly, under the heading, ‘Treatment Plan’, the Registrant set out a wide range of
possible clinical interventions without being specific in the notes to record what intervention the Registrant had, in fact, carried out in relation to each structure.

135. The Panel was satisfied that Mr Edbrooke’s evidence was sufficient to find allegation 6
proved.

136. Accordingly, the Panel found allegation 6 proved.

Service User E:
Allegations 2, 3di, 3dii, 3diii, 3div, 3e, 5iii, 7

137. Following a car accident in December 2017, Service User E saw the Registrant for
physiotherapy appointments from January, February, April and May 2018.

2. On or around 24 July 2018, you breached professional boundaries in that you sent a message to Service User E via WhatsApp.

138. In her witness statement, Service User E explained that, on 24 July 2018, a number of months after completing her treatment with the Registrant, he sent her a message via WhatsApp. She exhibited a screenshot of the message. The screenshot showed that the Registrant, on the date in question, sent five messages to Service User E. Among other things, he sent an emoticon of a winking face, said he had just seen her number on his WhatsApp list and asked, ‘How have you been?’ Service User E stated she found this contact very unusual and, as a fellow healthcare professional (she is a nurse), ‘very inappropriate’. Service User D, in an email to the HCPC dated 27 September 2019, made reference to the WhatsApp message.

139. The Panel was satisfied that Service User E’s oral evidence was credible and consistent
with her statement, emails and a screenshot and was sufficient to establish that the
Registrant had sent her a WhatsApp message.

140. In her oral evidence, Service User E stated that she found the Registrant’s actions to be ‘creepy’ and ‘intrusive’.

141. Whatever might have been the initial professional justification for the Registrant having Service User E’s contact details on his phone, he had accessed that information, after his treatment of her had ended, to make contact with Service User E via WhatsApp. There was no clinical or professional justification for the Registrant’s actions. The Panel considered that the Registrant’s actions had breached professional boundaries.

142. Accordingly, the Panel found allegation 2 proved.

3. Between 15 December 2016 and 10 January 2019, during treatments, you inappropriately touched and/or treated service users, without clinical justification, in that you:

d) In relation to Service User E on dates between 10 January 2018 and 30 May 2018, you:
i. On more than one occasion requested Service User E lowered her trousers and underwear to her hips and/or lower thigh area;
ii. Touched Service User E’s labia;
iii. Massaged Service User E’s buttocks;
iv. Did not offer and/or provide Service User E with a blanket or towel to cover herself upon the removal of clothing.
e) Inappropriately used the Lymphatic Drainage technique on Service User […] E

143. In her witness statement, Service User E stated that, at first, she had no concerns about
the Registrant’s treatment of her. However, she explained that there came a point when the Registrant started implementing ‘Lymphatic Drainage’ as part of her therapy. He explained that this was a way of releasing the build-up of toxins in the body.

144. Service User E described what the Registrant would do:

‘In order for [the Registrant] to perform the Lymphatic Drainage, I lay on my stomach on the
therapy table and he would ask me to lower the clothing on my bottom half, either jeans or
leggings and my underwear, down to my hips, an instruction which I followed. He would then proceed to massage me. At the beginning of each treatment he would start on my shoulders, but quickly move down to my waist, hips and upper thighs and buttocks. During the time he was performing the technique, he would ask me to lower the bottom half of my clothing gradually lower and lower, saying something along the lines of “a little bit lower, a little bit lower”, so that eventually the bottom half of my clothing was at my lower thigh/just above my knees.’

145. Service User E explained how the Registrant:

‘[…] would then massage my buttocks and up and down my thighs. […] Every session I was required to lower my trousers and underwear. Over time, there was less concentration on the sites of my injuries i.e. my neck and shoulders.’

146. Service User E described a particular occasion when she felt ‘incredibly uncomfortable’:

‘As usual, [the Registrant] asked me to lower my leggings and underwear to my lower thigh/ just above my knees and proceeded with the massage. [The Registrant] then began massaging upwards on my thighs, continuing upwards until his fingers made contact with my
labia. I instinctively jumped and moved away from his hands, making a sound along the lines of “woah” to voice my discomfort. He made a passing apology, something to the effect of “oh, sorry”, moved his hands lower and continued with the massage.’

147. Service User E stated that the more she has thought about it, and following her contact with the HCPC, she came to the conclusion that the touching of her labia was not an accidental occurrence on the Registrant’s part.

148. Mr Edbrooke, in his report, in relation to Service User E’s clinical notes, dated 3 January
2018 to 30 May 2018, stated:

‘There is no indication of an assessment being performed of the lower limb, and no finding of
swelling or lymphoedema in the legs or lower back either at the initial 31ˢᵗ assessment or on
January (sic). It is my opinion that there was no clinical justification for the use of lymphatic
drainage, and no indication for any treatment of the lower limb.’

149. In any event, it would not have been necessary for Service User E to remove her underwear in order to perform lymphatic drainage technique. Mr Edbrooke stated:

‘It is my opinion that in order to perform manual lymphatic drainage of the lower limb (calves) to the lower back it would not be necessary for the patient to remove their underwear. Removal of trousers/leggings would be necessary, and a reasonably competent therapist would explain this necessity, gain specific consent from the patient, and would provide adequate covering to maintain patient modesty.’

150. Service User E’s oral evidence was in keeping with her witness statement. She
confirmed that the Registrant had not offered her a blanket, towel or any other item
with which to cover herself during sessions after she had removed her clothing.

151. Service User E’s oral evidence was consistent with the account given in her witness
statement. The Panel was satisfied that Service User E’s evidence, taken together with the
evidence given by Mr Edbrooke, was sufficient to find the allegations proved.

152. Accordingly, the Panel found allegations 3di, 3dii, 3diii, 3div and 3e proved.

7. Your conduct in allegation 3 […]was sexually motivated.

153. The Panel had found that the Registrant had inappropriately touched intimate parts
of Service User E’s body during a number of treatment sessions. This included touching her labia and massaging her buttocks. The Panel was satisfied that the Registrant’s actions were not clinically justified. In these circumstances, the Panel concluded that the only reasonable
inference which could be drawn from the facts found proved was that the Registrant’s actions were sexually motivated.

5. You did not obtain written and/or verbal informed consent and/or up to date consent for
treatment at each appointment in respect of:

iii. Service User E.

154. In her witness statement, Service User E stated that, ‘I do not recall signing
any paperwork specifically relating to consent’ although she did recall that the Registrant would ask for permission to lower her bra straps or undo the back of her bra.

155. On the issue of consent, Service User E’s oral evidence was consistent with her account as set out in her witness statement.

156. In his oral evidence, Mr Edbrooke referred the Panel to Service User E’s clinical notes which had been completed in respect of each treatment session by the Registrant. In respect of sessions with the Registrant on 10 January 2018, 7 February 2018, 28 February 2018, 25 April 2018 and 30 May 2018, the following wording was recorded by the Registrant: ‘informed consent has been gained prior to the treatment with clinical justifications and reasoning
explained (as required).’ It was Mr Edbrooke’s evidence that these identical entries for
each session were, on balance, likely to have been ‘copied and pasted’ by the Registrant, rather than being a true representation of the seeking of consent by him prior to treatment. In relation to the remaining sessions, there was no mention of consent in the clinical notes.

157. The Panel preferred Service User E’s evidence which it found to be credible and
also the evidence given by Mr Edbrooke, and noted the lack of consent recorded in some of the clinical notes written by the Registrant. Further, the Panel was satisfied that Service User E did not give consent, much less informed consent, to the type of contact which the Registrant engaged in during his treatment sessions with Service User E.

158. Accordingly, the Panel found allegation 5iii proved.

Decision on Grounds

159. The Panel considered whether the allegations found proved amounted to misconduct and/or, in relation to allegations 5 and 6, lack of competence.

160. In relation to the panel's findings of fact, the Panel was of the view that the Registrant's
actions fell significantly short of the standards expected of a registered Physiotherapist.

161. By his actions, the Panel considered that the Registrant had breached the following
applicable standards of the HCPC’s ‘Standards of Conduct, Performance and Ethics’ (January 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.

1.7 You must keep your relationships with service users and carers professional.

Standard 2

Communicate appropriately and effectively

2.7 You must use all forms of communication appropriately and responsibly, including
social media and networking websites.

Standard 9

Be honest and trustworthy

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

Standard 10

Keep records of your work.

10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

162. By his actions, the Panel considered that the Registrant had breached the following
applicable standards of the HCPC’s ‘Standards of Proficiency’ (2013) for
Physiotherapists:

1 be able to practise safely and effectively within their scope of practice

- 1.1 know the limits of their practice and when to seek advice or refer to another
professional

2 be able to practise within the legal and ethical boundaries of their profession

- 2.1 understand the need to act in the best interests of service users at all times

- 2.3 understand the need to respect and uphold the rights, dignity, values, and autonomy of
service users including their role in the diagnostic and therapeutic process and in maintaining
health and wellbeing

- 2.4 recognise that relationships with service users should be based on mutual respect and
trust, and be able to maintain high standards of care even in situations of personal incompatibility

- 2.6 understand the importance of and be able to obtain informed consent

- 2.7 be able to exercise a professional duty of care 3 be able to maintain fitness to practise
- 3.1 understand the need to maintain high standards of personal and professional conduct

10 be able to maintain records appropriately

- 10.1 be able to keep accurate, comprehensive and comprehensible records in accordance
with applicable legislation, protocols and guidelines

- 10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines

163. Although not determinative of the issue, the Panel was assisted in deciding the question of the statutory grounds by its finding that the Registrant had breached relevant and applicable professional standards of performance and conduct.

Panel’s Decision on lack of competence - Allegations 5 and 6:

164. It was alleged in allegation 9 that allegations 5 and 6 constituted misconduct and/or lack of competence.

165. Allegation 5 had been found proved by the Panel in that the Registrant had failed to obtain appropriate consent in respect of the treatment of Service Users B, D and E. Mr Edbrooke, in his report, stated:

‘It is my opinion that treating a patient without adequate explanation or consent constitutes
action falling below the standards expected of a reasonably competent physiotherapist.’

166. Allegation 6 had been found proved by the Panel in that, in respect of Service User D, the Registrant had not adequately recorded structures being treated, nor had he adequately
recorded the techniques to be applied to each structure. In his report, Mr Edbrooke stated:

‘It is my opinion that failure to accurately record the structures being treated, and the techniques applied to each structure, constitutes action falling below the standards expected of a reasonably competent physiotherapist.’

167. When assessing lack of competence, the Panel was careful to apply the standard that was applicable to the post to which the Registrant had been appointed and the clinical work that was expected of him as a registered Physiotherapist.

168. The Panel considered whether it could come to a judgement on the Registrant’s
performance based on a fair sample of the Registrant’s work. The Panel had regard to the clinical records of Service Users A, B, D and E. The Panel also had regard to the notes of clinical supervision of the Registrant by SP, who was the Registrant’s supervisor at the company. The supervision was conducted on 5 and 6 October 2018. In addition, the Panel considered a list of patients (with redacted personal information) treated by the Registrant. In the list, the Registrant confirmed whether he had asked each patient to remove their clothing, together with the clinical justification for each request. The Panel was satisfied that the information to which it had access represented a fair sample of the Registrant’s work, upon which it could make a decision, about his professional performance.

169. In relation to allegation 5, the Registrant had failed to obtain the consent of three service users, involving multiple treatment sessions with them and over an extended period. During the sessions supervised by SP, the Registrant was noted not to have been able to answer clients’ questions, ‘to a satisfactory level on occasions and had been advised to use nonclinical terms when discussing the condition with the clients.’ In relation to allegation 6, the Registrant had failed to properly document the anatomical structures of a patient and record the techniques to be applied to those structures.

170. In the view of the Panel, its findings of fact represented failings by the Registrant in
several fundamentally important aspects of safe and effective practice.

171. The Panel concluded that the Registrant’s failings, at allegations 5 and 6, were of an
unacceptably low standard for a registered Physiotherapist and had the potential to put patients at risk.

172. Accordingly, the Panel was satisfied that the Registrant’s conduct, as found proved
in allegations 5 and 6, was serious and amounted to a lack of competence on his part.

Misconduct - Allegations 1-3 and 7:

173. By virtue of allegations 1 and 2, the Registrant had been found to have made contact on
social media with two service users, after his treatment of both had ended. He had the service users’ contact details on his phone which he used to initiate contact. In the case of
Service User A, the Registrant, over a protracted period, made contact with the service user via her mobile phone and through various social media platforms. With regard to Service User A and Service User E, the Registrant had breached professional boundaries.

174. Allegations 3 and 7 concerned, among other things, repeated inappropriate touching by the Registrant of service users’ intimate body parts, without clinical justification, and the repeated brushing of his groin against the body parts of another service user. He had removed a service user’s underwear without clinical justification and had failed to provide her
with anything with which to cover herself. His actions had been sexually motivated.

175. With regard to the finding that the Registrant had brushed his groin against Service User A’s arm, Mr Edbrooke’s evidence was, if the Registrant’s actions as alleged by Service User A were as a result of carelessness on his part, that would fall below the standard expected of a reasonably competent Physiotherapist. If his actions were deliberate, that would fall far below the standard expected.

176. With regard to the finding that the Registrant, without clinical justification, had
inappropriately touched Service User B’s chest, breast and nipples, Mr Edbrooke, in his report, stated:

‘It is my opinion that there is nothing in SUB’s history that would clinically justify significant
contact with a patient’s breasts, particularly without the patient’s express consent, and that such contact would constitute action falling significantly and seriously below the standards
expected of a reasonably competent physiotherapist.’

177. With regard to the finding that the Registrant, without clinical justification, acted
inappropriately towards Service User E, including touching her labia and leaving her exposed without any covering during a treatment session, in his report, Mr Edbrooke stated:

‘It is my opinion that to request a patient to remove clothing unnecessarily and to leave a patient exposed throughout treatment without covering them with a blanket or towel would constitute action falling significantly below the standards expected of a reasonably competent
physiotherapist.’

178. The Panel was aware that while it could take into account the expert opinion of
Mr Edbrooke, the question as to whether the Registrant’s conduct amounted to
misconduct was a matter for the Panel’s professional judgement. In the view of the Panel, the Registrant’s actions had fallen significantly and seriously below the standard to be expected of a registered Physiotherapist. He had acted in a reprehensible manner. In the Panel’s judgement, the Registrant’s actions would be considered deplorable by his professional colleagues and the public in general.

179. Accordingly, the Panel was satisfied that the Registrant’s actions, as found proved
in allegations 1-3 and 7, were serious and amounted to misconduct.

Decision on Impairment

180. Mr Mansell made a submission to the Panel that, in light of its findings on facts and
grounds, it should make a determination that the Registrant’s fitness to practise is currently
impaired. A finding of current impairment was required, in Mr Mansell’s submission, both to protect the public and in the public interest.

181. The Panel heard and accepted the Legal Assessor’s advice. He reminded the Panel that, in approaching the question of impairment, the test is expressed in the present tense: ‘is impaired’ (GMC v Meadow [2006] EWCA Civ 1319).

182. As for the factors to be taken into account at the impairment stage, the Panel was advised to have regard to the guidance provided by the relevant authorities and, in particular, the cases of Cohen v GMC [2008] EWHC 581 (Admin) and CHRE v NMC and Grant [2011] EWHC 927 (Admin) (‘Grant’).

183. The Panel considered its findings that the Registrant’s actions amounted to a lack of
competence. The Registrant had failed to obtain consent from three service users who had attended with the Registrant for treatment. Further, he had failed to adequately record structures of Service User D and had failed to record the techniques to be applied to each structure. In these respects, the Registrant had discharged his professional responsibilities to an unacceptably low standard. In principle, the Panel was of the view that the Registrant’s failings were capable of remedy. In terms of whether the Registrant had remedied his clinical failings and was unlikely to repeat them, it was noted that the Registrant had failed to place any evidence of reflection or up to date training before the Panel at the hearing. In addition, the Registrant had not provided evidence of insight into and remorse about the seriousness of his clinical failings. For these reasons, the Panel concluded that there was a high likelihood of repetition.

184. The Panel next considered its findings that the Registrant’s actions amounted to
misconduct. In doing so, the Panel drew a clear distinction between those aspects of the
Registrant’s performance which amounted to a lack of competence and his misconduct.

185. In relation to his misconduct, the Registrant had acted in a reprehensible and deplorable
manner. As a registered Physiotherapist, the Registrant would have been expected to act in the best interests of patients in his care. The service users who the Registrant treated were vulnerable; they had been injured in road traffic collisions and some had stated that their treatment was the first time they had come into contact with a Physiotherapist.

186. The Panel had heard from service users who had doubted themselves, both during and after treatment sessions, and, in spite of their instinctive misgivings at the time, had persuaded themselves into thinking that the Registrant’s actions had been clinically appropriate. Rather than act in their best interests, the Registrant had instead breached the trust and confidence of service users who had placed their trust in him. The Registrant had abused the privilege which his profession afforded him by inappropriately touching service users in his care, without their consent, in a variety of different ways, repeatedly and over a protracted period. His actions were not clinically justified and were motivated to give him sexual gratification.

187. Further, after treatment had ended, the Registrant had acted in a predatory manner
by accessing service users’ personal information, which he had retained on his phone, to make contact with service users, by phone and various social media platforms, when there was no objective clinical justification for him doing so.

188. The Panel considered that such behaviour, at best, would be very difficult to remedy. In
the event, the Registrant had not placed any evidence before the Panel to demonstrate
insight into the seriousness of his misconduct, evidence of regret and remorse, or evidence that he had addressed the regulatory concerns so as to ensure there would be no repetition. The Panel, accordingly, concluded that the likelihood of the Registrant repeating his misconduct was very high.

189. The Panel therefore concluded that a finding of current impairment of the Registrant’s
fitness to practise was required to protect the public.

190. The Panel next considered the public interest. The Panel reminded itself that the public
interest comprised public protection but also included broader concepts such as the need
to declare and uphold proper standards of conduct in the Physiotherapy profession and in order to maintain the public’s trust and confidence in the reputation of the profession. The Registrant had acted egregiously and had breached the trust and confidence placed in him by service users in his care. His actions had, in the Panel’s estimation, the potential to erode the public’s trust and confidence in the Physiotherapy profession. Accordingly, the Panel considered that a finding that the Registrant’s fitness to practise was currently impaired was required in order to declare and uphold proper standards of conduct in the Physiotherapy profession. Further, the Panel considered that such a finding was also necessary to maintain public confidence in the profession.

191. The Panel concluded that a finding of current impairment of the Registrant’s
fitness to practise was also required on public interest grounds.

192. The Panel considered the formulation provided by Dame Janet Smith in the Fifth Report to the Shipman Inquiry (cited with approval by Cox J in Grant) as follows:

a. “Do our findings of fact in respect of [the Registrant’s] misconduct, deficient professional performance…show that his fitness to practise is impaired in the sense that s/he:

b. 1.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

c. 2.has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

d. 3.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

e. 4.[…]”

193. In its judgement, having regard to its observations about the absence of insight on the
Registrant’s part and the high risk of repetition, together with the public interest considerations identified, the Panel considered that all elements of limbs 1 to 3 in Grant were engaged in this case.

194. For these reasons, on grounds of public protection and in the public interest, the
Panel has decided that the Registrant’s fitness to practise is currently impaired by reason of his lack of competence and misconduct.

Decision on Sanction

195. In his submission, Mr Mansell set out for the Panel the range of available sanctions and the Sanctions Policy (‘the SP’) issued by the HCPC (Last updated March 2019). In particular, Mr Mansell referred the Panel to what he submitted were relevant extracts from the SP, which addressed abuse of professional trust and sexual misconduct. Mr Mansell did not make a submission on what, if any, sanction the Panel should impose in respect of the Registrant’s registration.

196. The Panel heard and accepted the advice of the Legal Assessor. The Panel, he advised,
should exercise its judgement to arrive at a proportionate sanction that would adequately protect the public and uphold the public interest. The Panel was also advised to have regard to the SP.

197. The Panel, in accordance with paragraphs 25-41 of the SP, considered the mitigating
factors. The Panel recalled, in his evidence, MA had suggested that the Registrant's actions might have been accounted for by the fact that he had not been in the United Kingdom for very long prior to the regulatory concerns being raised in respect of his practice. However, in the view of the Panel, the Registrant, as a registered Physiotherapist would be expected to adhere to the standards set out by his professional body. In addition, the Panel considered that the type and pattern of behaviour which had been exhibited by the Registrant would not be acceptable on the part of any professional Physiotherapist in any clinical setting. The Registrant had provided no evidence of insight, remorse or remediation. Therefore, after careful assessment, the Panel was unable to identify any mitigating factors in all the circumstances of this case.

198. The Panel, in accordance with paragraphs 42-55 of the SP, considered the aggravating factors. These were:

a. The sexual misconduct was a gross breach of trust and a breach of the Registrant’s position as a trusted professional;

b. There was a repeated pattern of wholly unacceptable behaviour;

c. In the manner by which he made contact on social media with service users, without any objective or clinical justification, there was evidence of predatory behaviour on
the Registrant’s part;

d. There was evidence that the Registrant’s behaviour had had a significant impact on service users, who were made to feel vulnerable in a clinical setting; and

e. There was no evidence of any kind, either to the Panel or the company, of apology, remorse or remediation on the Registrant’s part or evidence of insight into the
seriousness of his wrongdoing.

Consideration of Sanction

199. The Panel first considered the sanction of Mediation and concluded that it was not
appropriate - the matter was too serious to be resolved in this way. The Panel was of the same view in relation to the conclusion of the proceedings by taking no action.

200. The Panel next considered a Caution Order. Such a sanction, in accordance with paragraphs 101 and 102 of the SP, was deemed to be appropriate where:

‘101. […] the issue is isolated, limited, or relatively minor in nature; there is a low risk of
repetition; the Registrant has shown good insight; and the Registrant has undertaken appropriate remediation.

102. A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate.’

201. In light of its findings, the Panel considered that the imposition of a Caution Order would
fail to adequately protect the public, nor would such a sanction protect the public interest. This case did not relate to an isolated incident, nor were the Registrant’s failings of a relatively minor nature. Accordingly, the Panel concluded that a Caution Order would be neither appropriate nor proportionate.

202. The Panel next considered whether a Conditions of Practice Order would be appropriate and proportionate. In considering a Conditions of Practice Order, the Panel had particular regard to paragraphs 107 to 109 of the SP which states as follows:

‘107. Conditions will only be effective in cases where the Registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the Registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings.

108. Conditions are also less likely to be appropriate in more serious cases, for example those involving: […]

• abuse of professional position, including vulnerability;

•sexual misconduct…

109. There may be circumstances in which a panel considers it appropriate to impose a
Conditions of Practice Order in the above cases. However, it should only do so when it is satisfied that the Registrant’s conduct was minor, out of character, capable of remediation and unlikely to be repeated. The panel should take care to provide robust reasoning in these cases.’

203. The Panel had no up-to-date information as to the Registrant’s current employment status. There was no evidence before the Panel to suggest that he would comply with any conditions imposed upon his practice and therefore the Panel was led to the conclusion that, against a background of his non-engagement at this hearing, the Panel had no confidence that the Registrant would be willing or able to comply with any conditions.

204. However, the most important factor when addressing the appropriateness of a Conditions of Practice Order was the seriousness of the findings which had been made against the Registrant. To the Panel’s mind, the seriousness of those findings combined with an absence of evidence on the Registrant’s part of insight and remediation, were such that the Panel was unable to formulate workable, enforceable, verifiable and measurable conditions which would adequately protect the public and uphold the public interest.

Accordingly, the Panel concluded that a Conditions of Practice Order would be neither
appropriate nor proportionate.

205. The Panel next considered imposing a Suspension Order and noted paragraph 121 of the
SP which states:

‘121. A suspension order is likely to be appropriate where there are serious concerns
which cannot be reasonably addressed by a conditions of practice order, but which do not
require the Registrant to be struck off the Register. These types of cases will typically exhibit the following factors:

• the concerns represent a serious breach of the Standards of conduct, performance and ethics;

• the registrant has insight;

• the issues are unlikely to be repeated; and

• there is evidence to suggest the Registrant is likely to be able to resolve or remedy their failings.’

206. The Panel had no evidence from the Registrant or any assurance by him that his misconduct would not be repeated, particularly given his lack of insight. There was no evidence to suggest the Registrant was able or willing to address his other clinical failings.

207. The Panel assessed the gravity of the Registrant’s misconduct. The Panel’s view was
that the Registrant’s conduct was extremely serious and had the potential to damage the reputation of Physiotherapists and undermine the public’s trust and confidence in the profession.

208. Taking into account the guidance in paragraph 121 of the SP, the Panel concluded that a
Suspension Order was not an adequate or appropriate sanction in this case.

209. The Panel noted the guidance in the SP that a Striking-Off Order is a sanction of last resort for serious, persistent, deliberate or reckless acts.

210. At paragraph 131 of the SP, it states:

‘A striking off order is likely to be appropriate where the nature and the concerns are such
that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where is the
registrant:

• lacks insight;

• continues to repeat the misconduct;

• is unwilling to resolve matters.’

211. There was no evidence before the Panel to demonstrate that the Registrant had insight into the seriousness of his misconduct. Further, there was no evidence of a willingness on
the part of the Registrant to resolve matters.

212. The Panel had careful regard to the following paragraphs of the SP, which states:

‘Abuse of professional position

67. The relationship between a registrant and service user or carer is based upon trust,
confidence and professionalism. However, it is also a relationship in which there is an unequal balance of power, in favour of the registrant. Whilst registrants should endeavour to have positive relationships with service users…, it is essential that they remain aware of this dynamic and take care not to abuse their position.

68. … This means being honest and trustworthy and acting in the best interests of service users, as well as ensuring that their relationships with service users … remain professional. Where a registrant is found to have abused their professional status, this is highly likely to reduce the public’s trust in them and their profession. The greater the alleged abuse of trust, the
more serious the panel should consider the concerns.

Predatory behaviour

71. A registrant's behaviour should be considered predatory where they are seen to take
advantage of others, motivated by a desire to establish a sexual or otherwise
inappropriate relationship with a service user…. The panel should take predatory
behaviour particularly seriously, as there will often be significant risk to the targeted
service user….

Sexual misconduct

76. Sexual misconduct is a very serious matter which has a significant impact on the public and public confidence in the profession. It includes, but is not limited to, sexual
harassment, sexual assault, and any other conduct of a sexual nature that is without consent, or has the effect of threatening or intimidating someone. The misconduct can be
directed towards: •service users…’

213. The Panel carefully considered the seriousness of the Registrant’s misconduct. The
Registrant had engaged in seriously reprehensible and deplorable behaviour. Over a protracted period, and on multiple occasions, he had used his trusted position as a registered Physiotherapist to inappropriately touch service users in his care. His actions were without clinical justification and were sexually motivated. He had attempted to make contact with them, after his treatment of them had ended, via phone and various social media platforms. There was an absence of evidence of insight, remorse or remediation on the Registrant’s part.

214. The Panel concluded, for these reasons, that the Registrant’s actions were at the
uppermost end of the spectrum of seriousness and that no lesser sanction, other than a Striking-Off Order, would be appropriate or proportionate to protect the public and uphold the public interest.

215. In making its decision, the Panel considered the severity of the impact of a Striking-Off
Order on the Registrant but concluded, having regard to all the circumstances, that his
interests were outweighed by the need to protect the public and uphold the public interest.

216. Accordingly, the Panel decided that the only appropriate and proportionate
sanction to impose, in all the circumstances, was a Striking-Off Order.

ORDER: The Registrar is directed to strike the name of Mr Aaradhya Arya
from the Register on the date this Order comes into effect.

No notes available

History of Hearings for Aaradhya Arya

Date	Panel	Hearing type	Outcomes / Status
19/04/2022	Conduct and Competence Committee	Final Hearing	Struck off