The widow of sheep shearing legend Koro Mullins wants to see changes in the health system to prevent the same mistakes that led to her husband's death.
Koro died three years ago when air was injected into his artery during a stent procedure.
For Mavis Mullins the heartache of losing her husband is still very raw.
"All we've ever asked for as a whanau is the truth. As painful and ugly as it might've been, it's what we actually need for closure," she said at the coronial inquest into his death.
The Dannevirke farmer was a family and community man. In the sheep shearing industry he was world-renowned, not only as a top shearer himself but a commentator too - becoming the voice of shearing.
In September 2019 during a stent procedure on his heart at Wellington Hospital he died, aged 65.
For the past week his death has been the focus of a coronial inquest with Coroner Brigitte Windley.
"It is a collective responsibility, a collective opportunity to learn from the past and prevent further deaths," she said.
"After days of evidence it appears that doctors have accepted Koro died a terrible death," his widow said.
During the inquest it was accepted that Koro died when air was injected into his artery, mostly likely due to human error.
"That term human error has only just been spoken about, it hasn't for the last three years," Mavis said.
The Coroner's Court was told today that since Koro's death further backstops have been added at Wellington Hospital to prevent this from happening again.
In a statement, Te Whatu Ora Health New Zealand said it "recognises how distressing it can be to lose a loved one in difficult circumstances, and we wish to express our sincerest condolences to the patient's whānau for their loss".
"While today was the last day of the inquest, the Coroner is yet to release their decision. This means that we are not able to comment publicly or release any information as the matter is still before the court."
Mavis hopes the Coroner's final report next year will lead to improvements at every hospital.
"The lid has been lifted and the driver now is to save the next Koro, and the next and the next and the next."
And to save another whanau from the same heartache.
