Locum physio touched several patients' vaginas with no clinical justification
Locum physio struck off for sexually motivated behaviour on 11 service users
Published on 2nd October 2019
A locum physiotherapist whose sexually motivated behaviour spanned 11 service users has been struck from the Health and Care Professions Council register.
Mr Thirunavukkarasu Selvaraj touched several service users' vaginas without adequate clinical reasoning or justification, touched other female patients in the groin area with no justification for doing so, touched three women's breasts without adequate clinical reasoning and touched himself in the groin area while in the presence of a patient.
"The seriousness of the misconduct and, in particular, the Registrant’s sexually motivated behaviour, led the Panel to conclude that the need to declare and uphold proper standards of behaviour and to maintain confidence in the profession and its regulator required a finding of impairment in this case. The nature and number of incidents of sexually motivated behaviour which had been found proved by the Panel meant that public confidence and trust in the profession, together with the upholding of standards, would be gravely diminished if no finding of impairment were to be made in the circumstances," said the HCPC.
At the time, Mr Selvaraj was working at Upton Park Hospital at Berkshire Healthcare NHS Foundation Trust, as a Band 6 locum musculoskeletal physiotherapist.
On 18 July 2014, the Trust was contacted by Service User D (SUD) regarding an assessment that she had had with Mr Selvaraj on 9 July 2014. LH, the Head of Scheduled Care at Berkshire Healthcare NHS Foundation Trust, followed this up on behalf of the Trust by telephoning SUD. A note was made of the call.
SUD claimed that she had attended for an assessment for pain in her hip and outside leg, and after some discussion about the pain she was experiencing and exercises that would help, Mr Selvaraj started to press around the region of her hip and stomach, asked her to lower her trousers, continued to press along the area of her knicker line and towards her thighs, and then put his hand inside her knickers and moved his hand towards her vagina. SUD also reported her complaint to the police on 21 July 2014.
On 21 July 2014, LH was informed by GD, the Locality Leader responsible for musculoskeletal physiotherapy department at Upton Park Hospital and who had just returned from annual leave, that other complaints had been received by the Trust from Service User G (SUG) and Service User E (SUE).
SUG had complained on 26 June 2014 regarding an assessment which took place on 23 June 2014 for back pain. According to GD’s note of the conversation, SUG had asked if it was normal for the front of her chest to be examined when she had back pain.
SUE had complained on 11 July 2014 regarding an assessment which took place on 24 June 2014. According to GD’s note of the conversation, SUG had complained that the assessment had been “a bit intrusive”.
Following receipt of these complaints, LH - the Head of Scheduled Care at Berkshire Healthcare NHS Foundation Trust - was asked by the police to send a survey to all of Mr Selvaraj's former patients, which included the question: “do you feel that you have been treated with dignity and respect?”. This was sent out on 8 October 2014. SUB and SUC responded.
SUB stated that she had attended for an assessment of her knee but had been asked to take her trousers off and had been subjected to an unnecessary examination involving repeated prodding of her pubic bone. SUC stated that Mr Selvaraj had been “playing with himself” in the course of her appointment with him.
Criminal proceedings were instituted and Mr Selvaraj's court appearance led to a publication in a local paper which described the fact that a physiotherapist from Upton Park Hospital had been charged with sexual assault. The Trust decided to inform each of Mr Selvaraj's patients that he had been charged with sexual assault, and on 19 February 2015 a letter was sent out accordingly. Following this, six further service users contacted the Trust: SUA, SUF, SUK, SUJ, SUH and SUI.
The Panel found that in relation to Service User A, on or around 17 July 2014 Mr Selvaraj touched Service User A's breasts, nipple and underneath her bra without adequate clinical reasoning/justification, he did not adequately explain what treatment he would be performing on Service User A and did not provide Service User A with a towel to cover herself.
With regards to Service User B, in or around 2 July 2014, Mr Selvaraj repeatedly touched Service User B in her pubic area and the inside of her upper legs in close proximity to her pubic area without adequate clinical reasoning/justification. He provided treatment that was more intimate than necessary in the circumstances, did not provide her with a towel to cover herself, did not obtain her fully informed consent to perform treatment and did not inform Service User B of post-treatment exercises.
In relation to Service User C, on or around 24 June 2014, Mr Selvaraj repeatedly touched his groin area whilst in her presence of Service User C and did not inform Service User C of post-treatment exercises.
When he assessed Service User D, on or around 9 July 2014, Mr Selvaraj touched her vagina and/or in close proximity of her vagina, her groin area and underneath her underwear without adequate clinical reasoning/justification. He did not provide Service User D with a towel to cover herself, did not adequately explain the treatment he would be performing on her and did not obtain her fully informed consent to perform treatment.
Mr Selvaraj assessed Service User E, on or around 24 June 2014, and touched her in close proximity to her vagina without adequate clinical reasoning/justification, conducted an assessment that was more intimate than necessary in the circumstances and did not obtain Service User E's fully informed consent before providing clinical treatment.
On or around 28 May 2014, in relation to Service User F, Mr Selvaraj touched Service User F's vagina and/or in close proximity to her vagina and her inner thighs without adequate clinical reasoning/justification. He failed to provide Service User F with a towel to cover herself and did not adequately explain the assessment and/or what treatment he would be performing on her.
On or around 18 June 2014 he then touched Service User F's clitoris, vagina without adequate clinical reasoning/justification and touched her underneath her underwear without her fully informed consent and/or clinical reasoning/justification. He pulled down her leggings without her consent, did not provide Service User F with a towel to cover herself and failed to adequately explain the assessment and/or what treatment you would be performing on her.
In relation to Service User G, on or around 23 June 2014, Mr Selvaraj touched Service User G's breast and nipple without adequate clinical reasoning/justification, did not provide Service User G with a towel to cover herself and did not obtain her fully informed consent to perform treatment.
Mr Selvaraj was also found to have touched Service User H on her vagina and/or in close proximity to her vaginal area without adequate clinical reasoning/justification, performed treatment that was more intimate than necessary in the circumstances, dd not provide Service User H with a towel to cover herself and dd not inform Service User H of post-treatment exercises.
He also touched Service User I's breast without adequate clinical reasoning/justification in or around 20 June 2014 and he did not obtain Service User I's fully informed consent to perform treatment on her breast/breast area and/or underneath her bra.
On a date in or around 9 June 2014, Mr Selvaraj did not adequately explain the assessment and/or what treatment he would be performing on Service User J and did not inform Service User J of post-treatment exercises. Then on a date in or around 7 July 2014, he touched Service User J near her groin area without adequate clinical justification/reasoning, pulled up Service User J's dress without her fully informed consent and did not provide Service User J with a towel to cover herself. He did not adequately explain the assessment and/or that treatment he would be performing on Service User J and did not adequately explain to Service User J her post-treatment exercises.
Mr Selvaraj was also found by the Panel to have touched Service User K her groin area without adequate clinical justification/reasoning on or around 8 July 2014, assessed Service User K's posture as relating to her described ankle complaint without adequate clinical justification/reasoning and did not adequately explain the assessment and/or what treatment he would be performing on Service User K.
Mr Selvaraj provided the Panel with a witness statement which formed the basis for his evidence in chief. In this, he explained that he had trained as a physiotherapist at The Tamil Nadu Dr MGR Medical University (‘Dr MGR’) in Chennai, India. He graduated in 2003 with a first class honours Bachelor of Physiotherapy degree. He was then employed between February 2003 and September 2003 as a physiotherapist in the Chennai Orthopaedic Centre, treating predominantly orthopaedic and musculoskeletal conditions.
In September 2003 he moved to the UK, where he completed a Master’s degree in Physiotherapy at Queen Margaret University College in Edinburgh, graduating in December 2004. He registered with the HCPC, and in June 2005 started his first job in the UK as an Occupational Health physiotherapist, treating employees in a car manufacturing company. The conditions he treated were predominantly musculoskeletal, orthopaedic, repetitive strain injuries, and peripheral nerve injuries.
He commenced work as a Band 6 locum physiotherapist at Upton Park Hospital, Berkshire NHS Trust, in Slough in March 2014.
Mr Selvaraj stated that he had been unaware of any complaints about his work at Slough and had not been the subject to any disciplinary action until he was suspended from work without pay on 18 July 2014 as a result of the current allegations. He said that in March 2014, the hospital went through a re-organisation, as a result of which his caseload was increased. By July 2014, he was the only physiotherapist locum still working in the outpatients department.
He denied the allegations. In trying to comprehend how the complaints could have come about, he said that on reflection his communication skills may have been wanting and he may have missed non-verbal cues. He also accepted that he had not been sensitive enough to the patients’ feelings. He said that he lacked experience working within the NHS and that, even though he had numerous years of experience in musculoskeletal physiotherapy, most of it had been in an industrial, non-hospital setting. The majority of his clients had been male.
In oral evidence to the Panel, he said that whilst he had learnt from his training in India that patient dignity had to be maintained, he had not received any specific training relating to dignity, communication, or non-verbal cues. He said that none of the Service Users in the case had indicated to him that they had felt unhappy in any way, nor had they indicated that they did not want him to carry on with the treatment he was providing. In cross-examination he agreed that maintaining a patient’s dignity is fundamental, and did not require a “class” in order to understand it.
In relation to the provision of towels to protect patients' dignity, he said that towels were usually available in the department but that these had not always been made available in the cubicle: “…more than two or three times this happened at least”. He said that if towels were available he would “… get a towel for each of the patients – when it’s required”; for example, “… if you ask a patient to undress certain area”.
He was asked whether he was aware of having accidentally touched anyone in an intimate area during treatment, to which he replied, “No, as far as I’m aware, I haven’t. If I did, I would have apologised”. He was asked whether he could provide an explanation as to why so many Service Users had made allegations in such a short period of time, to which he replied that the only possible reason he could think of was misinterpretation or a lack of explanation on his part, or, as one Service User had commented, as a result of his lack of good bedside manner. He also mentioned they may have come forward a result of the “strongly worded” letter they had received from the Trust.
Mr Selvaraj explained his assessment methodology. He said that he would first undertake a subjective examination, followed by an objective examination, which involved asking the patient to undertake movements which he would observe. He would then move the patient passively to see whether there was a true restriction or restriction due to pain. He would then ask the patient to move, but would resist their movements in the affected area in order to assess strength and power and to assess what was wrong. If the patient presented with a nerve root symptom, he would check for sensation by assessing the dermatomes and myotomes in order to check the muscle strength. He would then move to special tests to help pinpoint the problem. Following that, he would undertake palpation to see if there was swelling, spasm, increased tone, increase in temperature, or if there were any muscle knots or trigger points. He would usually palpate along the length of the muscle. He said that if a test was normal on assessment he would not necessarily record it.
Mr Selvaraj explained that he had only ever asked for a chaperone once, due to language barriers. He said that as a result of these allegations he now understood the need for good communication.
He denied being sexually aroused or acting with sexual motivation. He denied offering to treat SUA privately at home.
In his witness statement, Mr Selvaraj denied touching his own groin in the presence of SUC. In his oral evidence to the Panel, he stated that he may have been scratching his groin. When it was pointed out to him in cross-examination that a minute was a long time to have been scratching himself, he said he may have been looking at his phone.
In cross-examination it was suggested that there was an inconsistency between the answer he had given LH when she asked whether he had put his hands in SUD pants, namely “No, no, I would not do that”, and the answer he gave in his police interview when asked why he put his hands in her pants, to which he had answered, “the muscle is in there”. He did not accept that these remarks were inconsistent. He said he had been “telling what I do” and that any differences were due to the fact that he could not remember.
In oral evidence before the Panel, Mr Selvaraj said that he did not remember touching underneath SUA’s bra but that accidental touching of a patient’s nipple is a possibility, “depending on the position you are palpating”. He agreed that it would not have been necessary to palpate under SUA’s bra, except possibly the straps.
He said that he could not remember whether he had palpated over the pants or underneath. He said that he palpated the iliopsoas and adductor longus, which was the “closest I’d have gone [to the pubic area]”. He said that he palpated the iliopsoas because it is one of the main muscles that gets tight or overactive and is one of the muscles that causes back pain.
Regarding consent, Mr Selvaraj said his usual practise was to explain to the patient why they were there and what he was going to be doing with them, and to ask them whether they were happy to continue.
In relation to the second appointment with SUF on 18 June 2014, Mr Selvaraj said in his witness statement that he had not touched SUF’s clitoris, nor had he touched in close proximity to her vagina. He said that the closest that he would have come to SUF’s vagina was to touch the top of the hip area, which he would have done to check the iliopsoas muscle.
The Panel noted that Mr Selvaraj was very composed and confident when he gave evidence. The Panel concluded that Mr Selvaraj displayed an arrogant indifference to the impact of his contact with the Service Users. The Panel was of the opinion that, given his experience as a physiotherapist, he displayed very little compassion for them. He was dismissive of their complaints and he surmised that they came forward to complain solely as a result of a “strongly worded letter” sent by the Trust.
The Panel assessed Mr Selvaraj as being, technically, a highly knowledgeable physiotherapist. In relation to the important features of his evidence, the Panel did not accept what he said and found him to be an unreliable witness.
The Panel found each Service User who had been called to give evidence to be credible. SUA had immediately spoken to her friend and colleagues at work about how Mr Selvaraj had touched her “boobs” and she now no longer trusted professionals. SUB had spoken with two other physiotherapists to find out what they thought about Mr Selvaraj's treatment of her, saying that he had touched her in an intimate pubic area on two occasions, until she had asked him whether that was absolutely necessary, at which point he stopped.
SUD had a strong and consistent memory of Mr Selvaraj's hand inside her knickers, and said she felt shocked, dirty, unclean, and violated, her whole life had been broken, and she had required therapy to deal with it. SUE said she felt extremely unhappy during the examination, and felt violated, felt that dignity had been taken from her, and felt very sad.
She said that immediately after the session she asked herself why it had happened. She told the next physiotherapist she saw about her previous appointment.
SUG said in her statement that she felt vulnerable and traumatised and returned to the hospital to complain to a manager.
In reaching its conclusion, the Panel reminded itself that Mr Selvaraj’s actions had had a significant and lasting impact on each service user. SUD said she had been left feeling shocked, violated, and that her “whole life had been broken”, requiring her to undertake therapy. SUF had said that she could no longer visit a medical professional when unaccompanied. SUH had not returned for further physiotherapy due to her loss of confidence. SUC had described how her trust in medical professionals had been wholly undermined. SUJ had described feeling let down by the physiotherapy department. SUA had not returned to the NHS for any further physiotherapy treatment. In relation to the service users whose evidence had been read rather than given in oral evidence, SUB had sought advice from other physiotherapists in light of her experience, and Service Users E, G, I, and K all described feeling violated.
"The Panel accepted that the Registrant is a man of hitherto good character. However, he had continued to deny the allegations of sexually motivated behaviour throughout the hearing and had not attended to provide any evidence of remediation, insight, or remorse.
The Panel concluded that there was a total lack of evidence of remediation, insight, or remorse and that there is a high risk that the Registrant will repeat his misconduct. The Panel concluded that the Registrant’s fitness to practise is impaired under the personal component," said the Panel.
The Panel concluded that Mr Selvaraj presented a risk to service users, had brought the profession into disrepute, and had breached the fundamental tenets of the profession.
His behaviour was mitigated by his previous good character, combined with the testimonials that had been submitted on his behalf. His misconduct was aggravated by the following features: the behaviour had been sexually motivated; Mr Selvaraj had embarked on a deliberate course of conduct; 11 service users had been targeted; psychological harm had been incurred by many of them; the behavior had been predatory; there had been a clear breach of trust; Mr Selvaraj had demonstrated no remediation, remorse, or insight into his sexually motivated behaviour.
The Panel considered a Suspension Order and took into account Mr Selvaraj's previous good character. However, the Panel had concluded in its findings on impairment that the risk that Mr Selvaraj would repeat his misconduct was high. There was no evidence of remediation, insight, or remorse, and sexually motivated behaviour is by its nature difficult to remediate. His predatory behaviour had involved an abuse of trust in relation to numerous service users. In light of these factors, the Panel concluded that a Suspension Order would be insufficient to protect the public or uphold standards of behaviour and maintain confidence in the profession and its regulator.
The Panel concluded: "In all the circumstances, the Panel concluded that a Striking Off Order was the only sufficient, proportionate, and appropriate sanction to impose. The Registrant had continued to deny sexually motivated behaviour which had amounted to a deliberate course of action in relation to 11 women whilst working as a physiotherapist."
"He had shown no remediation, remorse, or insight into his behaviour. It was the judgement of the Panel that he remains a high risk to the public, and only a Striking Off Order was sufficient to protect the public from him. Furthermore, a Striking Off Order was required to declare and uphold proper standards of behaviour and to maintain confidence in the profession and its regulator," the Panel added.
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