EP07 S05: TBI Lawyers discuss the Glascow Coma Scale – Traumatic Brain Injury Series
Traumatic Brain Injury Lawsuits & Glascow Coma Scale Scores
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Hi, good afternoon. My name is Arkady Frekhtman and I’m an attorney at the F&A Injury Lawyers here in Brooklyn, New York.
Today we’re talking about traumatic brain injuries and specifically how the defense lawyers and the insurance companies sometimes use the Glasgow Coma Scale to either dismiss an otherwise meritorious case of a true traumatic brain injury or to confuse the jury and to say that it’s not a brain injury when it really is.
So, what is the Glasgow Coma Scale? It is a scale from one to 15 that was created in the 1970s in Glasgow, Scotland, and it was created in triage so that people who are at the scene and in an emergency, usually emergency technicians, could quickly assess if this victim has a potential or a possibility of suffering a traumatic brain injury. And so if the possibility exists, they would alert subsequent medical treaters, such as treating doctors and neurologists, just to let them know that it’s a possibility. That’s all it was ever intended for.
And it was from the 1970s, 50 years ago, and brain injury medicine has really evolved in 50 years. So, a lot of people misunderstand the scale and they mistakenly dismiss a true TBI case based on this Glasgow Coma Scale result. And the scale is not meant to diagnose or treat, and it’s not meant to even diagnose brain damage. The purpose of the Glasgow Coma Scale is exclusively for individuals in the field who are quickly assessing injury in triage, to alert subsequent medical providers that TBI is a possibility. It’s a simple alert to be on the lookout, and it’s not a diagnosis of anything, and it was never intended to be, but crafty defense lawyers harp on positive Glasgow Coma Scale numbers to confuse and dismiss real traumatic brain injury cases. And that’s unfortunate.
So like we said, it was developed in the 1970s in Scotland, by neurosurgeons. It was developed in Scotland before they even had CAT scans and it was developed as a form of triage to help first responders evaluate patients because, for some of these patients, they would have to cut open the skull to have pressure relief from the brain, to save them. And so, the scale was a quick assessment as to whether or not they would have to cut open the skull.
And so, I’m going to include some visuals of how to assess the Glasgow Coma Scale. It’s usually done in three parts. Part one is an eye-opening response. So for example, if the patient opens their eyes spontaneously on their own, they get four points. If they can only open their eyes in response to your voice saying, “Please open your eyes.” And they do. They get three points. If they open their eyes only with pain or to pain, they get two points. And if there’s no response, they can’t open their eyes, they get one point.
The second part of the Glasgow Coma Scale is the verbal response. And so, if they’re oriented to time and place and person, and they can speak and give a verbal response, they get five points. If they’re confused, they still get four points. If they use inappropriate words, as you ask them, “What’s your name?” And they say, “Jibber Jabber,” they still get three points. And if they say incomprehensible sounds, like you say, “What’s your name?” And they say, “Booboo gachuchu.” They still get two points. You see, so this is why this scale is not very reliable. And then, if there’s no response, if they can’t even respond when you ask them their name or something simple, they still get one point.
And so, the third part of the Glasgow Coma Scale is the motor response. If they obey commands like, “Can you hold up two fingers?” They get six points. If they move only to localized pain, they get five points. If they can flex and withdraw from pain, they get four points. If there’s abnormal movement or abnormal flection, they get three points. If there’s an abnormal extension, they get two points. And if there’s no response, they get one point. I mean, there have been cases where there has been a traumatic, traumatic brain injury like somebody is bleeding in the brain or even has been shot and they still get a perfect Glasgow Coma Scale of 15 points. So, it just goes to show that you should not rely on this.
And sometimes when you have a doctor on the stand, the defense neurologist, who is claiming that your client has not suffered a brain injury, what you could do is you could ask them and you could say, “Well, the law basically says that most pattern jury instructions,” and in New York as well, “say that you do not have to accept an expert’s opinion.” The law knows that experts are paid money for their opinions and the law carefully points out, so that everybody, the judge, the jury, and everybody knows that you do not have to accept an expert’s opinion. I mean, obviously, right? Because there’s one opinion for the plaintiff and there’s another opinion for the defendant. So, you can only accept one of them.
And then you could ask the doctor, “Do you have opinions about the importance of the Glasgow Coma Scale? But those are just your opinions, they’re not necessarily facts, isn’t that true?” And they’ll probably have to say, “Yes.” “And there are other well-respected neurologists and brain injury specialists who don’t share your opinions or your thoughts about the Glasgow Coma Scale.” And they would have to agree with that most likely. And then, “The Glasgow Coma Scale goes from zero to 15, and if you were to do a Glasgow Coma Scale on me right now, what would you do?” And have the doctor tell you. “You would ask me my name. You would ask me something like, ‘Who’s the president?’ You would ask me to squeeze your finger or wiggle my finger, or some kind of motor response. And you would see if I’m responsive to pain, like a pinch. And then you would ask me to blink my eyes.
And if I could look at you and say, ‘My name is Arkady, the President is Joe Biden, and I’ve been in an accident and I could feel the pinch.’ I get a perfect Glasgow Coma Scale of 15. And I could even have a Glasgow Coma Scale of 15 and die of a bleeding brain. And there have been cases of Glasgow Coma Scales of 15, for people who have been shot to the brain and the patient is bleeding.” So, as we talked about, it’s a really old scale in the ’70s, in Scotland, and brain injury has really, really evolved.
And then, you would finish up by saying, “But you were not at the scene,” because obviously, the defense neurologist expert was not at the scene, “and you might’ve done an evaluation before the paramedics got there and you might’ve found a Glasgow Coma Scale of less than 15, had you been at the scene. And you’re accepting facts of what the paramedics wrote down. And there’s something known as an inherited diagnosis because you’re not doing your own independent evaluation, you’re just writing down what others told you. And an inherited diagnosis may have been done in this case.”
So, those are some of the ways that you can cross-examine if they’re claiming the Glasgow Coma Scale is a reason why your client is not heard and does not have a traumatic brain injury. And I’ll drop a link from the CDC about the sheet on Glasgow Coma Scales. So, I hope this has been helpful, but just remember, if you feel like you’ve suffered a traumatic brain injury and you have positive scanning, like a 3T MRI or a functional MRI, and you’re working with a neuropsychiatrist or neuropsychologist, and you have a treating neurologist and you have an attorney, and you believe that you have a case of merit, don’t be afraid of the defense using this Glasgow Coma Scale, because it’s just a bunch of nonsense. Okay, I hope this has been helpful. Let us know what questions you have and we’ll see you soon. Have a great day, everyone. Bye-bye.