GCS Scores and You
July 07, 2007, Kitchener, Ontario
Posted by: Robert Deutschmann, Personal Injury Lawyer
Arbitrator: Robert Kominar
Decision date: July 20, 2006
Veronica Tournay was injured in a car accident on March 12, 2003. She applied for a catastrophic impairment designation as a result of the car accident. Dominion denied the designation and the parties could not resolve the dispute at mediation.
Ms. Tournay suffered severe orthopedic injuries in the car accident. Her right leg was crushed under part of the car. She had an open fracture of her foot and large laceration on her right thigh. She also suffered a traumatic brain injury in the car accident. She was unconscious in the car after the accident. The paramedics recorded a Glasgow Comma Scale (GCS) rating of 14 or 15 soon after they removed her from the car. She was brought to the emergency room at McMaster Hospital where she became increasingly combative and respirate and that she was in significant pain from her injuries. The emergency room doctor stated that such observations caused him to have serious concerns about Ms. Tournay´s rapidly declining neurological functioning and he intubated her. After intubation there were recorded GCS scores of 3 and 5 within 4 hours of the car accident.
The issue for arbitration was whether the GCS scores recorded after intubation of Ms. Tourney were valid scores for the purpose of determining whether Ms. Tourney would be designated as catastrophically impaired. The expert retained by Dominion was of the view that the GCS scores recorded after intubation were "confounded" by the intubation and therefore were not reliable for the purpose of determining whether Ms. Tourney was catastrophically impaired.
It was noted by the arbitrator that the medical professionals attending to Ms. Tourney continued to apply the GCS after intubation and that the GCS scores were still valid for medical purposes. The arbitrator concluded that if the GCS scores were valid for medical purposes then they were valid for the purposes of the Statutory Accident Benefits (SABs). The arbitrator noted that the SABs did not provide for any exceptions to the validity of GCS tests administered by a qualified person on an intubated patient. Of interesting note is that if Ms. Tourney was given full value (score of 5) under the verbal response section of the GCS test she would have recorded a score of 9 which would still qualify her for a catastrophic designation.
This case did not consider other issues with respect to the administration of a GCS score. Other issues would include whether the GCS was administered within a reasonable period of time (4 hours in this case) or the effect of any paralytic drug that would have been administered to Ms. Tourney.
This case reflects the importance of taking a close look at the facts of each insured or patient and determine whether their circumstances meet the criteria for a catastrophic designation. It also requires a careful review of the wording of the SABs since it is the interpretation of this document that governs the relationship between the insurance company and the insured. The SABs have been through many amendments and the arbitrators and courts are very mindful of the fact that if the changes have not been made then the legislature has deliberately determined to leave the wording of the SABs as they are and it is this wording that guides their interpretation.
|Posted under Accident Benefit News, Automobile Accident Benefits, Brain Injury, Car Accidents, Catastrophic Injury, Fractures, Pain and Suffering
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Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us toll-free at 1-866-414-4878.
It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.