A High Court judge tried breach of duty and causation in a clinical negligence claim over a 2019 spinal operation, after which the claimant lost much of his sight following a cardiac arrest.
Key facts
- Who: Callum Joe Guest, the claimant, and Nottingham University Hospitals NHS Trust, the defendant
- From: Judgment of 31 March 2026
- Source: Callum Joe Guest v Nottingham University Hospitals NHS Trust [2026] EWHC 704 (KB)
Her Honour Judge Claire Evans, sitting as a Judge of the High Court in the King's Bench Division at Manchester, heard the trial between 12 and 18 March 2026. Judgment was handed down on 31 March 2026 in Guest v Nottingham University Hospitals NHS Trust [2026] EWHC 704 (KB).
Background. Mr Guest had surgery at the Trust's hospital on 29 May 2019 to address scoliosis and an associated chest wall deformity. It was the second stage of a two-stage process. The operation was long and complex. During it his condition deteriorated and a decision was made to stop. While he was being turned from lying face down (prone) to face up (supine), he suffered a cardiac arrest. He was successfully resuscitated, but it later emerged that he had suffered posterior ischaemic optic neuropathy (PION), causing substantial loss of vision in both eyes.
The question. PION is a recognised but rare complication of this surgery. Mr Guest claimed it arose from the cardiac arrest rather than from the surgery itself. He said the arrest was caused by hyperkalaemia (high potassium in the blood), which the treating anaesthetist negligently failed to treat.
The evidence. The judge read evidence from Mr Guest and his parents and heard from the treating consultant anaesthetist, Dr Leong. Expert evidence covered anaesthetics (breach of duty and causation), cardiology (causation) and ophthalmology (causation). All the experts gave oral evidence. Blood gas results taken during the operation, including potassium readings, were set out in the judgment.
The competing explanations. The defence anaesthetic expert's opinion was that the most likely cause of the arrest was a pulmonary embolism (a blood clot in the lungs), dislodged by the turn from prone to supine. The defence cardiology expert also thought, on the balance of probabilities, that a pulmonary embolism caused the arrest. A post-operative scan was said to show significant clots through much of the lung.
The claimant's anaesthetic expert accepted several points made in favour of pulmonary embolism, including that the arrest could reasonably be linked to the turning and that such an arrest typically presents as pulseless electrical activity (PEA). He disagreed that chest compressions could break up a massive clot, calling the idea plausible but "vanishingly unusual".
What this means for patients and NHS trusts
This was a trial of one claim on its own facts. The judgment records that the claimant said the arrest was caused by untreated high potassium, while the defence experts pointed to a pulmonary embolism. Anyone considering a claim over surgery should get advice on their own circumstances before any time limit passes.
Sources
- Callum Joe Guest v Nottingham University Hospitals NHS Trust [2026] EWHC 704 (KB), High Court (King's Bench Division), 31 March 2026: https://caselaw.nationalarchives.gov.uk/ewhc/kb/2026/704