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41. Coming to the treatment aspect, it is submitted by the learned counsel appearing for the petitioner that the deceased N.Arumugam was not given proper treatment in the Hospital, apart from the fact that the Doctor, nurses and staff attending the deceased N.Arumugam had not taken any effort to trace his identity and inform his family members about his admission and treatment at Coimbatore Government Medical College Hospital. It is his submission that Doctors employ 'Glasgow Coma Scale' to ascertain consciousness level measurement of patients. 'Glasgow Coma Scale' is a scoring scale of eye opening, motor and verbal responses that can be administered to individuals, to objectively measure the level of consciousness and severity of the head injury. According to him, the minimum GCS score https://www.mhc.tn.gov.in/judis  W.P.Nos.32765 & 32766 of 2014 is 3 and the maximum is 15. A GCS score of less than 8 is generally considered a serious medical emergency due to problems with the airway. GCS score can fluctuate minute-by-minute, especially in critically ill patients. Medical records produced by the eighth respondent recorded the 'Glasgow Coma Scale' of the deceased N.Arumugam from 01.11.2014 to 12.11.2014.

43. In response, learned Additional Advocate General appearing for the eighth respondent submitted that the deceased N.Arumugam was given best possible treatment in the Hospital. When he was admitted to Udumalpet Hospital on 31.10.2014, he was responding to painful stimuli and he also smelled of alcohol. In medical parlance it means that the patient was unconscious and not oriented. He was referred to Coimbatore Government Medical College Hospital on 01.11.2014 for further investigations and management. There is a vast difference between “conscious” and “oriented”. “Conscious” is defined as the state of awareness and arousable with response to external stimuli. “Orientation” is defined as the state of awareness of https://www.mhc.tn.gov.in/judis  W.P.Nos.32765 & 32766 of 2014 oneself and one's surroundings in terms of time, place and person. Petitioner's claim that the deceased N.Arumugam was fully conscious is not correct and false. When he was received at Coimbatore Government Medical College Hospital on 01.11.2014, he was drowsy, breath had the smell of alcohol and he was admitted to the Trauma ward. He was not in a state of disclosing his identity. The Trauma ward Duty Assistant Surgeon mentioned that the patient was under the influence of alcohol, his identity could not be elicited. He was drowsy, irritable with Glasgow Coma Scale E4V4M5. Neurosurgeon has clinically examined the patient and found the patient was conscious, disoriented with right eye periorbital edema with GCS E4V4M5. CT Brain scan report, dated 01.11.2014 showed that left fronto temporo parietal acute subdural hemorrhage width 7 mm, intra ventricular hemorrhage in lateral third and fourth ventricle and acute subarchnoid hemorrhage in left ITP sulci. Appropriate course of medical management was started. Glasgow Coma Scale is a subjective assessment method. It has poor accuracy and validity and that alone cannot be considered for the conscious state of mind and orientation of a person. Neurosurgeon has given the Glasgow Coma Scale as E4V4M5, which shows that the patient was in a confused state (V4) https://www.mhc.tn.gov.in/judis  W.P.Nos.32765 & 32766 of 2014 and that he was not in a state of mind to disclose his identity. Patient had a mild head injury category, subdural clot was small and mass effect produced by it was insignificant.

44. He further submitted that the assessment by Neurosurgeon on 02.11.2014 showed that the patient was conscious with an irritable state and the Glasgow Coma Scale was E4V4M6 (14/15), which means that the patient was arousable and not in a state to understand and respond to commands. The recording by Neurosurgeon on 03.11.2014 shows that the patient was conscious, but disoriented with a GCS score of E4V4M6 (14/15). The recordings by Neurosurgeon on 04.11.2014 and 05.11.2014 show that the patient was in a conscious and disoriented state with Glasgow Coma Scale of 14/15. Patient was on Ryles tube feeding. In reality, the patient was in a disoriented and confused state. Followup CT taken on 04.11.2014 showed acute subdural hemorrhage noted in left fronto parietal temporal region, acute sub arachnoid hemorrhage note in left fronto parietal region, midline shift of 3 mm, interhemispheric bleed with bilateral lateral ventricular hemorrhages. Clinical examination showed that the patient was conscious, disoriented with GCS of 12/15. Since https://www.mhc.tn.gov.in/judis  W.P.Nos.32765 & 32766 of 2014 there was no indication requiring surgical treatment, the patient was treated medically. Evaluation of patient by Trauma Ward Assistant / Neurosurgeon on 07.11.2014, 08.11.2014 and 09.11.2014 shows that the status of the patient was conscious, disoriented with Glasgow Coma Scale of 12/15. Patient was shifted to Neurosurgery ward on 09.11.2014 and necessary treatment was continued.

 Laceration over right clavicle 1 X 1 X 1 cm (sutured).

 GCS E4V5M6.” https://www.mhc.tn.gov.in/judis  W.P.Nos.32765 & 32766 of 2014

49. The Doctor who examined the deceased N.Arumugam at 01.50 a.m on 01.11.2014 recorded that Neurological examination could not be done as the patient was drowsy. Strapping was done for right clavicle fracture. Glasgow Coma Scale was recorded as E4V4M5. He was found in a drowsy and irritable, conscious and irritable condition and then in conscious and disoriented condition on 01.11.2014 and Glasgow Coma Scale was recorded at E4V4M5, E4V4M6. On 02.11.2014 he was in a conscious and irritable condition. Glasgow Coma Scale stood at E4V4M6 (15/15). On 03.11.2014, he was found conscious and oriented with GCS 15/15. Nuerosurgeon found him conscious and disoriented. On 04.11.2014, he was conscious, but found in an irritable condition and GCS score stood at 15/15. On the same day, his condition was noted as conscious and disoriented by Neurosurgeon. The recording on 05.11.2014 shows that he was conscious, but irritable and GCS score stood at 15/15. Neurosurgeon noted that he was conscious, but disoriented and recorded a GCS score at E3V3M5. On 06.11.2014, he was found in conscious, but disoriented condition and GCS score stood at 15/15. Neurosurgeon recorded the report of CT brain and that patient was https://www.mhc.tn.gov.in/judis  W.P.Nos.32765 & 32766 of 2014 conscious and disoriented with GCS of E4V3M5.