Petar Josipovic, aged 62, died at the Royal Adelaide Hospital (RAH) on September 14, 2023, following delays to his category one cardiac surgery that was initially scheduled for June 2023. The operation, classified as high priority, should have been performed within 30 days but was postponed multiple times, eventually being scheduled 54 days later on August 14, 2023.
Josipovic became unwell on August 24 and was rushed to hospital where he suffered a cardiac arrest. State Coroner David Whittle, in findings handed down on August 13, 2026, stated that on the balance of probabilities, Josipovic's death "would have been unlikely if surgery was performed" on or before August 22, 2023. However, the coroner noted that the "opportunity to perform it earlier did not genuinely arise."
The inquest revealed that Josipovic did not attend the emergency department on earlier occasions when invited, which limited clinicians' ability to assess the seriousness of his condition. Whittle also expressed that he was impressed with the witnesses and "did not make any finding that decisions that led to the cancellations were the result of ill-will or lack of due care."
Had the surgery proceeded as scheduled on August 14, Josipovic's "chance of survival was high," the coroner said. Additionally, the inquest was told that the elective surgery would have cost less than $75,000, whereas the emergency care following his cardiac arrest cost approximately $250,000.
The coroner highlighted that South Australia's overworked health system contributed to the delays, stating that performing Josipovic's surgery sooner "might have come at the cost of the chance of survival of another patient."
Two recommendations were made to South Australia's health minister following the inquest.
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