No one was monitoring the CCTV control room at Westfield Bondi Junction when schizophrenic knifeman Joel Cauchi began the rampage which left six people dead.
The control room had been staffed by one male and one female security officer on the day of the massacre but the male guard left for training about 3pm.
The female officer ducked out to use the toilet at 3.32:15pm and 40 seconds later while she was gone Cauchi killed his first victim, bride-to-be Dawn Singleton, at 3.32:55pm.
By the time that officer returned to the control room at 3.33:55pm, one minute and 40 seconds after she had left, six people had been killed and eight others injured.
Another, Ashlee Good, had been fatally stabbed before active monitoring of the CCTV system recommenced.
Apparent security failures at the shopping centre were addressed on Monday during the opening of an inquest into the April 13, 2024 massacre.
It was also revealed that Cauchi had attempted to get a firearm licence more than three years before the atrocity, about 18 months after he had ceased taking psychotropic medication.
At that time, in January 2021, a psychiatrist had deemed Cauchi a ‘fit and proper person’ to possess a firearm and Queensland police issued a ‘statement of eligibility’ for him to attend a pistol range.
Such a statement did not allow Cauchi to buy, own or possess a gun and he did not go through with his plan to go target shooting.
The State Coroners Court at Lidcombe heard on the day of the massacre there had been a breakdown in communication among emergency services at the shopping centre.
Senior counsel assisting the coroner, Peggy Dwyer, stressed it was not the objective of the inquest to lay blame on any individual for those failures.
But she said delays in realising exactly what was going on had meant ‘certain staff were effectively behind the eight-ball’ and ‘playing catch up’.
There was no contact between the CCTV control room and police until 10 minutes after Cauchi’s attack had started and five minutes after he had been shot dead.
An alarm was not activated until 3.39pm and when it was sounded it was to evacuate the centre rather to alert of an active armed offender.
The officer in charge of the investigation does not believe schizophrenic Cauchi deliberately targeted women.
Cauchi stabbed to death five women and one man during his rampage on April 13 last year before he was shot dead by Inspector Amy Scott.
Of the total 16 people Cauchi stabbed, 13 were female, but Detective Chief Inspector Andrew Marks said there was no evidence Cauchi deliberately went after women.
‘No, not at all,’ Detective Chief Inspector Marks said.
‘From the start of his attack he moved very quickly and he appeared to attack people that were not ready, that didn’t know what was happening.
‘He had an opportunity to stab numerous people and numerous females. I just believe that whoever was in his way is who he attacked.’
Detective Chief Inspector Marks said there had been far more women than men at the shopping centre on the Saturday of the massacre.
‘I did not see anything that suggested he was going to attack women,’ he said.
‘There was obviously information that he was going to attack but there was no information (that he was deliberately targeting women).’
Asked if Cauchi had exhibited any terrorist or extremist ideology, Detective Chief Inspector Marks said: ‘Not at all’.
Detective Chief Inspector Marks gave evidence about some of the internet searches Cauchi had conducted before the attacks.
In the previous two years he had looked up ’12 common traits of serial killers’, ’21 famous serial killers’ and ‘last mass stabbing ‘.
Four days before the massacre Cauchi had searched for ’14 bands that serial killers loved’, as well as ‘fine not hand in number plates’.
On more than one occasion he had typed the phrase ‘copy killer’ and on the morning of the killings Cauchi made three searches about the 1991 Columbine High School massacre.
Detective Chief Inspector Marks was asked if he was aware of any government agencies having been aware of the ‘dark and disturbing thoughts’ displayed in Cauchi’s internet searches.
‘Not that I was aware of, no,’ he said.
By the time the first public announcement was made at 3.52pm Cauchi had been dead for about 15 minutes, although emergency services were still unsure if there was a second attacker.
The ‘deafening alarm’ called for everyone to evacuate the shopping centre but police and some shop attendants were still advising shoppers to stay in place.
The lack of clarity over whether there was a second attacker also led to the declaration of an ambulance ‘hot zone’ at 4.30pm, which meant no more paramedics could enter.
Police and ambulance officers set up separate command centres and there was no multi-agency meeting also including security staff until about 5.30pm.
Dr Dwyer said there was no suggestion the confused messages made any difference to the number of stabbing victims who survived, as Cauchi was the lone killer.
‘Clearly these are individuals who have never been through something like this before,’ she said of those involved in the immediate reaction.
But it was important lessons were learned about what could have been done better in case of any future such mass casualty event.
Several times during her opening statement Dr Dwyer said police, ambulance officers, security staff, store attendants and shoppers had shown extraordinary courage to help victims.
Dr Dwyer said some victims were triaged more than once which may have led to delays treating security guard Faraz Tahir, but it was probable he could not have survived his injuries.
The court heard of missed opportunities for intervention as Cauchi’s mental health deteriorated over the years.
Cauchi had been diagnosed with schizophrenia in 2001 and had for the next decade been able to manage that illness.
He transferred from the public to private mental system in 2012 and continued to see a psychiatrist but in June 2019 his psychotropic medication was stopped.
When he moved away from his parents’ home in Toowoomba to live in Brisbane he had no treatment plan.
In January, 2023 police were called to the parents’ home where Cauchi accused his father of stealing his collection of knives.
Cauchi said he needed the knives because he feared he was at risk of being killed and both his parents said he needed treatment.
Police determined Cauchi was unwell but did not call for him to be psychiatrically assessed.
The inquest earlier heard Cauchi was preoccupied with violence, weapons and mass killings for years before the massacre.
Cauchi’s internet browsing in the lead up to his rampage showed he was obsessed with serial killers and may have made some ‘rudimentary plans’ for his own attack.
Details emerge about man behind Westfield Bondi Junction massacre
Before killing six people at the shopping centre he had conducted internet searches of the Columbine High School massacre in which 13 students were murdered.
Cauchi had been ‘floridly psychotic’ when he committed the outrage.
The inquest is investigating the deaths of the victims, the wounding of ten others and the death of Cauchi, who was shot by Inspector Amy Scott at the scene.
The inquiry began at the State Coroners Court at Lidcombe in Sydney’s west on Monday and is set to run for five weeks.
State Coroner Teresa O’Sullivan is presiding over the inquest into the killings, which Cauchi committed with a US Marines-style Ka-Bar utility knife he bought on February 24 last year.
Those killed were shoppers Dawn Singleton, 25, Jade Young, 47, Yixuan Cheng, 27, Ashlee Good, 38, Pakria Darchia, 55 and security guard Faraz Tahir, 30.
The families of Ms Singleton, Ms Young and Ms Good – excluding Dawn’s father, multimillionaire businessman John Singleton – have engaged prominent barrister Sue Chrysanthou SC to represent them at the inquest.
The families of Ms Cheng, Ms Darchia and Mr Tahir are also legally represented, as are shopping centre management and both NSW and Queensland police.
Mr Singleton had urged the NSW Attorney-General not to proceed with the inquest because it would be too traumatic for the families of those killed to relive the events.
‘If it was going to bring some justice I would understand – but it can’t, it’s just so unfair,’ he has said.
‘No good can come of making the details of this public all over again, the CCTV footage images.
‘We all know what happened and who did it and he’s gone, there’s nothing to gain.’
Ms Chrysanthou said at a directions hearing earlier this month the victims’ families ‘except for John Singleton… understand the mandatory nature of this inquest and they support it’.
‘Their lives have been changed in a way that none of us can really comprehend,’ she said.
‘It is important for them to understand if anything else could have been done.’
At the same hearing, senior counsel assisting the coroner, Peggy Dwyer, confirmed no graphic footage of the attacks would be played in court.
At an earlier hearing in November, Dr Dwyer said the massacre ‘shocked our community and has caused unspeakable grief for the families and loved ones of those who were killed and injured’.
Dr Dwyer said ns were fortunate to live in a country where such mass killings happened rarely but that was little comfort to the families of Cauchi’s victims.
She described their grief as ‘raw and deep’ and the depth of those losses ‘unfathomable’.
While most people who lost a loved one could grieve in private, the families of those killed at the shopping centre had been forced to do in public.
Joel Cauchi’s mental health will loom large in the inquiry. Evidence will include the reports of four psychiatrists and two general practitioners.
Dr Dwyer said evidence would be ‘clear and unanimous’ that Cauchi was ‘floridly psychotic’ on the day of the stabbings.
He had first been diagnosed as schizophrenic as a teenager at a time he was using cannabis and had been using cannabis in the days before the massacre.
Cauchi’s internet search records were ‘distressing’ and demonstrated he was ‘clearly unwell’.
He had made notes to himself about knives and on January 25 last year he had written ‘check out malls’.
There was no direct evidence he had a motive to commit the attacks but was consumed by ‘dark thoughts’.
‘The parents of Mr Cauchi have spoken publicly and express their shock and sadness at the actions of their son, a man who had struggled with mental illness since he was a teenager and had no criminal history,’ Dr Dwyer said.
Cauchi’s parents had been able to keep him on a treatment program until he was 36 but while living homeless in Sydney he had been completely unsupervised.
Among the issues to be canvassed will be Cauchi’s previous treatment and the circumstances of him ceasing the use of psychotropic medication since 2020.
The coroner will consider the emergency response of Westfield Bondi Junction staff and whether there should be restrictions on weapons such as the Ka-Bar knife Cauchi used to kill his victims.
Expert evidence will be heard comparing what happened at Westfield Bondi Junction with the Manchester Arena bombing of 2017 and the mass shootings in Christchurch in 2019.
At the time of the Westfield Bondi Junction attacks, Cauchi had been living rough around Maroubra in Sydney’s east and had not taken his psychotropic medicine for the past four years.
On the morning of April 13 he went to a Kennards storage unit at Waterloo in the inner-city and at 11.10am retrieved a backpack containing the Ka-Bar knife.
For the next four hours Cauchi used public transport to move between the city and eastern suburbs before entering Westfield Bondi Junction via Bronte Road at 3.12pm.
Dr Dwyer told the directions hearing in November what happened next as Cauchi began to attack unsuspecting shoppers with the knife he had hidden in his backpack.
‘In less than three minutes, he stabbed 16 people, killing six and injuring ten others,’ she said.
‘At 3.31pm, Mr Cauchi walked over the air bridge on level four towards the Sourdough Bakery, and he stood in line behind Ms Dawn Singleton.
‘Mr Cauchi removed the knife from his backpack, and as everybody knows, tragically, he stabbed and fatally injured Dawn, who was the first of his 16 victims.’
For the next 57 seconds Cauchi stabbed or attempted to stab anyone who came within his reach.
He stabbed Jade Young near the Sourdough Bakery at 3:33:01 and Yixuan Cheng between Cotton On and the Peter Alexander store at 3:33:18.
‘At 3.34, after exiting Myer and running back towards the Sourdough Bakery, and outside AJE Athletica, Mr Cauchi attacked Ashlee Good in the back from behind,’ Dr Dwyer said.
‘When Ashlee was stabbed, she turned and then saw Mr Cauchi attacking her daughter’s pram.
‘She ran at him and fought him off, receiving another stab wound as a result of that, this time in the chest, but undoubtedly saving the life of her daughter.’
Cauchi ran back past Sourdough Bakery and at 3:34:26 stabbed Faraz Tahir then fellow security guard Muhammad Taha.
‘He fatally wounded Faraz, and he seriously injured Muhammad,’ Dr Dwyer said.
Cauchi fatally stabbed Pikria Darchia at 3:34:51.
‘Pikria was the last person who was stabbed fatally that day, but other people were injured after that time,’ Dr Dwyer said.
‘At 3:35:40, Mr Cauchi stabbed the final 16th victim, who was seriously injured.’
Inspector Scott had been in her car when she heard a police radio alert and headed for the shopping centre. She entered level four of Westfield Bondi Junction at 3.37pm.
Civilians helped direct Inspector Scott to Cauchi, who began to run as she gave chase.
Four members of the public, armed with chairs and other objects, followed Inspector Scott, ready to assist.
Cauchi had fled along the level five air bridge and was about 15m from Inspector Scott when she first confronted him.
When Cauchi ran towards the police woman with the Ka-Bar held in his right hand she stepped back, yelled at him to stop and drop the knife, and drew her service weapon.
Cauchi did not stop and from 3:38:40 Inspector Scott discharged her pistol three times, killing the knifeman with shots to the shoulder and neck.
The fatal shots were fired less than six minutes after Cauchi had begun his stabbing spree and one minute and 19 seconds after Inspector Scott had arrived at the shopping centre.
Of Inspector Scott’s response that day, Dr Dwyer said: ‘There is no question as to the propriety of her actions.’
Dr Dwyer praised Inspector Scott’s ‘professionalism and courage’ and said she had clearly saved lives.
She also noted the ‘hope, courage and selflessness’ of civilians who witnessed the atrocity and moved quickly to help others.
Cauchi grew up in Queensland, mostly in Toowoomba, with his parents Andrew and Michele. They say he was diagnosed with schizophrenia around the age of 18 and for the next 18 years generally complied with taking medication.
From 2012 until February 2020 Cauchi regularly saw a psychiatrist and his medication was reduced over the years until it was stopped entirely in June 2020.
Cauchi had moved to Brisbane in February that year and from about that time until the Westfield Bondi Junction stabbings had no particular treatment plan.