Inquest into the death of Ivona Jovanovic

CORONERS COURT OF QUEENSLAND FINDINGS OF INQUEST CITATION: Inquest into the death of Ivona Jovanovic TITLE OF COURT: Coroners Court of Queensland

JURISDICTION: BRISBANE FILE NO(s): 2019/4164 DELIVERED ON: 26 June, 2025 DELIVERED AT: Brisbane HEARING DATE(s): 9 October 2024, 18 November 2024, 19 November 2024 and 20 November, 2024.

FINDINGS OF: Donald MacKenzie, Coroner CATCHWORDS: Coroners: Inquest, Cause of Death: Gunshot Wound to Chest, Suspicious Circumstances, Conflicting Witness Accounts, Inadmissible evidence at Criminal Trial; Discontinued Prosecution

REPRESENTATION: Counsel Assisting: Ms K. Bryson Jovanovic Family: Mr D. M. Kerr (Counsel) Instructed by Caxton Legal Centre Inc

Mr Christos Panagakos: Mr M.T. Gatenby, Gatenby Lawyers Witness “ABC”: Ms K. Bell, Solicitor, Bell Criminal Lawyers

Contents CONCLUSIONS, RECOMMENDATIONS and s45 Coroners Act (Qld)

Introduction On Saturday evening at 20:22:30 hours on 8 September 2019, a “000” call was made by Ms Michelle Panagakos to emergency services which was discontinued after 30 seconds. One minute later at 20:23:30 hours, she made a second “000” call requesting the assistance of the Queensland Ambulance Service (“QAS”) stating that her son’s friend had been shot and that somebody had been carrying a bag that had been dropped. This call lasted 17 minutes and was terminated with the arrival of Queensland Police Service (“QPS”) and QAS officers at 20:39 and 20:43 hours respectively at Ms Panagakos’s 6A Renfrew Drive, Highland Park residence.

Ms Ivona Jovanovic (the deceased”) was located on the floor of the kitchen near to the top of a stairwell from a lower floor. She was critically injured with a bullet wound to her chest area and extensive bleeding. QAS officers rendered emergency cares and transferred her to the Gold Coast University Hospital. The deceased succumbed to her injuries at 21:40 hours.

A subsequent autopsy established that Ms Jovanovic’s cause of death was a single gunshot wound to the chest. The mechanism of death was that the damage caused by the bullet produced a rapid accumulation of blood and airflow to the left chest cavity which caused compression of the heart and blood vessels.

This impeded the deceased’s ability to circulate blood to and from the major organs including the heart, lungs, liver and brain. A ballistics expert determined that the bullet was a common 9mm/.38 or 9mm/.57 calibre projectile likely fired from a handgun.

Ms Panagakos was interviewed by investigating QPS officers shortly after their arrival. She said that she had arrived home at 19:40 hours and spoke with the deceased. She remained in the upstairs area of the house but had heard voices downstairs and believed her son, Mr Christos Panagakos had visitors. She understood that Ms Jovanovic and Christos were going out for dinner. She recalled the deceased had a Louis Vuitton bag containing paperwork and make up in her right hand and another bag with her that was placed on the barstool near the kitchen area. Ms Jovanovic was the only person in the kitchen area at the time.

After a brief conversation, Ms Panagakos walked to the laundry and whilst there heard a “bang” like something fell followed by a second louder “bang” noise.

Immediately following the two noises, she heard Ms Jovanovic saying “Fuck, Fuck, Oh Fuck”. Ms Panagakos stated that she ran out of the laundry and saw the deceased holding her left side near her ribs. Ms Panagakos then saw Mr Christos Panagakos coming up the stairs putting on a jumper and another male behind him with dark hair. Ms Jovanovic asked for an ambulance to be called as she sat on the floor and blood droplets were landing on the floor. She also observed a “cowboy-like” handgun on the floor near the feet of Ms Jovanovic.

Ms Panagakos later told QPS officers that she called “000” and was on the telephone until QPS officers arrived, and she believed that the gun was still at Ms Jovanovic’s feet. However, just after QPS officers arrived she realised that it was Findings of inquest into the death of Ivona Jovanovic Page 3

gone. She was unable to state where Mr Christos Panagakos or the other visitors went. Ms Michelle Panagakos provided a formal statement to police on 9 September 2019 in company of her solicitor which was largely consistent with her earlier versions of events.

QPS investigators established that the deceased was a former girlfriend of Ms Michelle Panagakos’s son, Mr Christos Panagakos and that he had left the 6A Renfrew Drive, Highland Park residence prior to the arrival of QPS officers. He was located the following morning at 01:30 hours (Sunday 9 September, 2019), by police walking up Renfrew Drive. He provided limited details regarding the events of the previous evening to QPS investigators. He told them that he and a number of friends, including Ms Jovanovic were planning to go out for dinner. He stated that she and other persons were upstairs in the kitchen area while he remained on the lower level of the residence. He then heard a loud bang and walked up to investigate and found Ms Jovanovic’s body lying on the floor and observed that she was not responsive. He also observed a firearm gun on the floor next to Ms Jovanovic’s body which he described as a handgun with a long barrel.

He explained to QPS officers that he had left the residence because he did not want to be blamed for what occurred. He did not know what had happened to the firearm involved and denied any previous knowledge of it. Following an extensive QPS investigation, no person was able to provide any information regarding the ownership and location of the firearm.

A QPS homicide investigation was undertaken and the ultimate brief of evidence was immense. QPS officers spoke to a myriad of potential witnesses, interviewed neighbours and associates of the deceased and Mr Christos Panagakos, interrogated mobile telephone communications, CCTV footage and utilised a number of covert investigative techniques. This included compelling a number of witnesses to give undisclosable testimony before the Crime and Corruption Commission in October 2019 and March 2020 which, specifically, could not be used to incriminate each individual1: The QPS investigation established (generally) the following:

• On 8 September 2019, Mr Christos Panagakos had six associates in attendance 6A Renfrew Drive, Highland Park, prior to Ms Jovanovic’s arrival at about 19:40 hours.

• They were in attendance on a predominately social basis, having a gym session, taking illicit drugs and some intending to dine with Ms Panagakos later at a restaurant.

• Four of these associates left the address prior to the shooting: Mr Thomas Findlater, Mr Daniel Miller, Mr Terry Gottani and Mr Jake Zimmerman. (This was corroborated by CCTV footage interrogated by QPS investigators.)

• Five people were in attendance at 6a Renfrew Drive, Highland Park at the time of this shooting: The deceased Ms Jovanovic, Ms Michelle 1 I do not propose to traverse any of the evidence before the Crime and Corruption Commission (“CCC”) in September, 2019 to ensure the privacy of that interrogation. I am comforted in that decision that the office of the Director of Prosecutions did not seek to use any of this CCC in Mr Panagakos’s Committal hearing brief.

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Panagakos, Mr Christos Panagakos, Mr Daine Walker and Mr Brendan Elliot.

• Mr Daine Walker and Mr Brendan Elliot both declined to provide police with formal statements. However, information was obtained that they were standing outside 6A Renfrew Drive, Highland Park at the time of Ms Jovanovic’s shooting and re-entered after the incident, confirmed from CCTV footage.

• That Mr Christos Panagakos had consumed illicit drugs leading up to the shooting death of Ms Jovanovic and had been in possession of a large revolver likely of 9mm/.38 calibre seen in an amateur production “home video” previously.

• There were other witnesses whose evidence was not particularly forthright, based on hearsay or simply vague regarding the disposal of the missing handgun and that Mr Christos Panagakos knew that there was a weapon in the bag.

• The information obtained in this investigation suggested that Ms Michelle Panagakos and Mr Christos Panagakos were the only persons in the upstairs area of the dwelling with the deceased at the time she was fatally shot.

• There was no evidence that Mr Christos Panagakos had any intention to kill Ms Jovanovic.

After speaking with police on the morning of 9 September, Mr Christos Panagakos was arrested and charged with the manslaughter of Ms Jovanovic along with drug offences and offences against the Weapons Act 1990 (Qld). He was remanded in custody pending the finalisation of these matters. He faced a committal hearing in relation to this manslaughter charge which concluded in the Magistrates Court at Southport in April and August 2022.

Remarkably, he was committed for trial to the Supreme Court at Brisbane. The prosecution had effectively called three witnesses: Mr Brendan Elliott, Mr Daine Walker and Mr Thomas Findlater at the Committal Hearing. They each gave evidence that they and Mr Panagakos were too intoxicated on a cocktail of illicit drugs to accurately recall anything from 8 September, 2019. Mr Walker was cross examined about a signed, prima facie properly obtained by QPS investigators, formal statement taken when he was in custody in New South Wales. He said that he neither recalled anything of the events of 8 September, 2019 nor making a statement for the QPS investigators whilst in custody in New South Wales. This was primarily because of his raging methylamphetamine addiction at the time.

Prima facie this made his statement inadmissible against Mr Panagakos in any manslaughter prosecution even as a “hostile witness”.2 Unremarkably, the Office of the Director of Public Prosecutions did not proceed with the manslaughter trial. Obviously, his flight from 6A Renfrew Drive, Highland Park, the disappearance of the firearm and his later inconsistent claims that he 2 See Collins v The Queen (2018) 265 CLR 178; R v Collins [2018] 1 Qld R 364 at [36] where Burns, J found a previous statement inadmissible where the author admits to making the prior statement but cannot recall making it nor the events in question (see Sections 18 & 19 Evidence Act (Qld).

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was so intoxicated on the night in question that he can recall very little, raise questions about his credibility but would not be irrepressible incrimination.

Image 1: A photograph of the stairwell up which Mr Christos Panagakos was climbing just before the fatal firearm discharge on 8 September, 2019. The photographer was standing in the position where the deceased was shot.

The Coronial Jurisdiction A coroner’s powers of investigation are supported by a number of specific powers under the Act. Pursuant to s11 of the Coroners Act 2003 (the Act), a Coroner may investigate the suspected death of a person if directed to by the State Coroner, and the State Coroner suspects that the person is dead and their death was a reportable death.

A coroner investigating a death has a discretionary power to order that an inquest be held if the Coroner is satisfied it is in the public interest to hold the inquest (s28(1)). Subject to exceptions, an Inquest must be held by the Coroners Court and in open court (s31(1)). The Coroners Court must publish a notice of the matter to be investigated, the issues to be investigated and of the date, time and place of the inquest (s32). A coroner holding an inquest may hold a pre-inquest conference to decide, inter alia, what issues are to be investigated, who may appear and what witnesses will give evidence (s34). Further, a Coroner holding an inquest has a discretionary power to order a person to attend an inquest to give evidence as a witness (s37(4)).

Section 45(2) of the Act provides: A coroner who is investigating a death or suspected death must, if possible, find:

(a) who the deceased person is; and Findings of inquest into the death of Ivona Jovanovic Page 6

(b) how the person died; and

(c) when the person died; and

(d) where the person died, and in particular whether the person died in Queensland; and

(e) what caused the person to die.

Further, by s46(1) of the Act a Coroner may, whenever appropriate, comment on anything connected with a death investigated at an inquest that relates to: a. public health or safety; or b. the administration of justice; or c. ways to prevent similar deaths from happening in similar circumstances in the future.

After considering all of the evidence presented at the inquest, findings must be given in relation to each of these matters to the extent that they are able to be proved. An inquest is not a trial between opposing parties but an inquiry into the death (or suspected death). Lord Lane CJ in R v South London Coroner; Ex parte Thompson (1982) 126 S.J. 625 described a coronial inquest in this way: “…an inquest is a fact finding exercise and not a method of apportioning guilt. The procedure and rules of evidence which are suitable for one are unsuitable for the other. In an inquest it should never be forgotten that there are no parties, there is no indictment, there is no prosecution, there is no defence, there is no trial, simply an attempt to establish facts. It is an inquisitorial process, a process of investigation quite unlike a criminal trial where the prosecutor accuses and the accused defends,”… (and) … “the function of an inquest is to seek out and record as many of the facts concerning the death as [the] public interest requires.” The focus is on discovering what happened, not on ascribing guilt, attributing blame or apportioning liability. The purpose is to inform the family and the public of how the death occurred with a view to reducing the likelihood of similar deaths.

As a result, the Act authorizes a coroner to make preventative recommendations (s46) but prohibits findings being framed in a way that appears to determine questions of civil liability or suggests a person is guilty of any criminal offence (s45(5)).

Two important observations should be made: First, whilst this Court, pursuant to Section 3 (d)(ii) of the Coroners Act (Qld) has the object of commenting on matters related to “the administration of justice”, it is improper for an inferior Court created by statute, such as the Coroners Court of Queensland, which is not of higher jurisdiction in the appellant hierarchy, to review an order of a another Court of equal or superior jurisdiction such as the Supreme, District and Magistrates Courts of Queensland. Second, I must not include in any Findings any statement that a person is, or may be, (a) guilty of an offence or (b) civilly liable for something pursuant to Section 45(2) of the Act.

Second, Judicial officers have no right to critique or criticise a prosecutorial Findings of inquest into the death of Ivona Jovanovic Page 7

discretion such as whether or not to prosecute a particular charge, to enter a nolle prosequi, to proceed by way of ex officio indictment, to present particular evidence, to decide the particular charge to be laid or prosecuted and what advice is given to the Attorney-General in relation to the lodging of an appeal. In DPP v Tutera [2023] VSCA 188, the Victorian Court of Appeal, citing High Court of Australia authority, said: “[79] It is axiomatic that decisions made in the exercise of prosecutorial discretion are not amenable to review or enquiry by the court. (see Barton v The Queen (1980) 147 CLR 75; Maxwell v The Queen (1996) 184 CLR 501 513-514). There is an important constitutional division between the executive and the judiciary with respect to the bringing, maintenance and discontinuance of criminal charges.” The appropriate persons to whom such complaints about prosecuting authorities are the Commissioner of Police, Director of Public Prosecutions or the AttorneyGeneral. Further, as a matter of good public policy, it is undesirous for a judicial or jury verdict to be reviewed by a Coroner whose role is primarily a therapeutic one where the standard of proof is on the balance of probabilities and compulsive powers, not permitted in criminal jurisdiction, are available.3 However, a Coroner retains a “residual investigatory function” beyond a review of a previous court’s decision within the above-mentioned constraints.4 Section 37 of the Act provides that “the Coroners Court is not bound by the rules of evidence but may inform itself in any way it considers appropriate”. This flexibility has been explained as a consequence of being a fact-finding exercise rather than a means of apportioning guilt: an inquiry rather than a trial. However, the rules of evidence and the cornerstone of relevance should not be disregarded and in all cases the evidence relied upon must be logically or rationally probative of the fact to be determined.5 A Coroner should apply the civil standard of proof, namely the balance of probabilities, but the approach referred to as the Briginshaw sliding scale is applicable.6 This means that the more significant the issue to be determined, the more serious an allegation or the more inherently unlikely an occurrence, the clearer and more persuasive the evidence needed for the trier of fact to be sufficiently satisfied that it has been proven to the civil standard.7 It is also clear that a coroner is obliged to comply with the rules of natural justice and to act judicially.8 This means no findings adverse to the interest of any party may be made without that party first being given a right to be heard in opposition to that finding. As the High Court made clear in Annetts v McCann9 this includes making submissions against Findings damaging to a person’s reputation.

3 Domaszewicz v State Coroner (2004) 11 VR 237 at [81[] and Rolfe v Territory Coroner [2023] NTCA 8 [53].

4 Mirror Newspapers v Waller (1985) 1 NSWLR 1 at [16].

5 See Evatt, J in R v War Pensions Entitlement Appeal Tribunal; Ex parte Bott (1933) 50 CLR 228 at 256; Lockhart J in Pearce v Button (1986) 65 ALR 83, at 97; Lillywhite v Chief Executive Liquor Licensing Division [2008] QCA 88 at [34]; Priest v West [2012] VSCA 327 at [14] (Coroners Court matter) and Epeabaka v MIMA (1997) 150 ALR 397 at 400.

6 Anderson v Blashki [1993] 2 VR 89 at 96 per Gobbo J 7 Briginshaw v Briginshaw (1938) 60 CLR 336 at 361 per Sir Owen Dixon J 8 Harmsworth v State Coroner [1989] VR 989 at 994; Freckelton I., “Inquest Law” in The Inquest Handbook, Selby H., Federation Press, 1998 at p 13 9 (1990) 65 ALJR 167 at 168 Findings of inquest into the death of Ivona Jovanovic Page 8

After considering all of the evidence presented at the inquest, findings must be given in relation to each of those matters to the extent that they are able to be proved.

The authorities are clear regarding the use of an inquest with respect to criminal proceedings: ‘…it is not the function of a coroner's inquest to provide a forum for attempts to gather evidence for pending or future criminal or civil proceedings’.10 Further, ‘An inquest is not an investigation into criminal or civil liability. Evidence may be given which is relevant to those issues, but the coroner has to be astute to ensure that before him or her the proceedings are properly conducted with a view to their own legitimate end’.11 per Kennedy LJ, in R (Mulholland) v HM Coroner for St Pancras [2003] EWHC 2612 (Admin) at [17] (DC); and However, Justice per Mullins J in Atkinson v Morrow & Anor12 stated: ‘…the Act prohibits the Coroner from framing a finding in such a way as to appear to determine any question of civil liability or as to suggest that any particular person is found guilty of any indictable or simple offence. This prohibition makes it clear that the fact-finding inquiry of the coroner should not be used for any ancillary purpose for which the coroner has no jurisdiction. The prohibition does not preclude the coroner from exploring facts for the purpose of making the findings required under [s.43(2) of] the Act which may also incidentally have a bearing on civil or criminal liability’ The Autopsy In relation to the cause of Ms Jovanovic’s death, an autopsy was performed by an experienced forensic pathologist Dr Christopher Day on the 10 September

2019. His examination evidenced a single perforated gunshot wound to the left chest. The wound was seen to have exited through the left anterior chest wall inferior to the breast, and there was an exit wound evident at the upper – left upper back, adjacent to the midline. General observations made in relation to the wound track of the projectile, included that it had travelled through the skin and subcutaneous tissue, between the fifth and sixth ribs, and had entered the chest cavity. The wound also caused a perforation to the hemidiaphragm and the underlying left lobe of the liver, which had been herniated into the left chest cavity.

In turn, that perforated the left lower lobe of the lung, and the projectile then exited through the left sixth rib, soft tissue and skin at the posterior chest wall.

In effect, the gunshot wound caused by the projectile perforated the left chest and upper abdominal cavities. As a consequence, there was an injury to the left lung and liver which resulted in a collapse of the left lung and an accumulation of a 10 R v Poplar Coroner ex parte Thomas [1993] QB 610 (CA), per Dillon LJ at 629H, cited with approval R v Sussex Coroner, ex parte Homberg & Ors (1994) 158 JP 357 at 372D; 11 per Kennedy LJ, in R (Mulholland) v HM Coroner for St Pancras [2003] EWHC 2612 (Admin) at [17] (DC); 12 At [2005] QSC 92 at [26], citing R v Coroner for North Humberside and Scunthorpe, ex parte Jamieson [1995] QB 1 (CA) at 24 per Sir Thomas Bingham MR (judgment of the Court).

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large amount of blood in the left chest cavity. No determination was able to be made as to the range of fire of the firearm that was involved in discharging the projectile. Unfortunately, life-saving surgical measures performed at the Gold Coast University Hospital prevented a post-mortem identification of the tracking of the projectile through the deceased’s body. That tracking should have allowed identification of the position of the firearm when it was discharged.

It was concluded by Dr Day that the mechanism of death was the rapid accumulation of blood and airflow to the left chest cavity which caused compression of the heart and blood vessels. This, as well as the ongoing blood loss associated with the injury to the lungs and the liver impeded their ability to carry blood to and from the major organs. Dr Day determined the cause of death was a gunshot wound to the chest.

The Inquest The Inquest into this death took place on Monday, 18 November, 2024, Tuesday, 19 November, 2024 and Wednesday, 20 November, 2024. For the purposes of s. 46(1) of the Act, the only issue dealt with at this Inquest was:

1. The findings required by s 45(2) of the Coroners Act 2003 (Qld); namely the identity of the deceased, when, where and how she died and what caused her death; At the outset, the deceased’s father, Mr Veljko Jovanovic read a statement into the record: “Okay. My name is Veljko Jovanovic and I am Ivona Jovanovic father.

The purpose of this statement is to share with you the person my daughter was, and to impress upon those here that her death has an ongoing impact on my life, the lives of my family… … and those who close to us. My wife, Dajana, gave birth to our firstborn daughter, Ivona, on May 1, 1992, in Zenica, Bosnia. Dajana then left for London with Ivona in June ‘92 because of the civil war in our country. I met them then nine months later in London. Ivona’s younger sister was born four years later in London in 1996. We moved to Adelaide, Australia, in November ‘98. We settled at the Gold Coast in January 1999 where Ivona attended Merrimac Primary School and then Robina High School.

We have always been close… Knit.

… knit family and known what was going on in each other lives, even as my children became adults. Ivona and her sister have always shared a close relationship. When Ivona was a child she was happiest playing with her friends and enjoying our Saturday family day which involves going on adventure in the local area or having barbecues at Findings of inquest into the death of Ivona Jovanovic Page 10

home. She – she would love that I was – I was like her taxi driver, and that couldn’t rely… She – she could rely on.

She could rely on me to drive her - to drive her and her friends around.

Ivona had a few different shades to her personality. She could get really angry if someone upset her, but she was o – she was soft too and would easily cry. She wouldn’t even cry when take- talking to her grandparents. She was very sensitive like that. She was also strong to take … No. She was strong though.

…though, and she knew how to protect herself. Ivona was ready to grow up when she even was a young teenager. She had – she had lots of different plans for the future like beauty therapy and end up clinic, working maybe in a coffee shop. My favourite memory of Ivona include my birthday lunches. She always bought me present and would call and say “Tata I wish you happy birthday”. Tata is ‘father’ in Serbian language and I loved to hear her say that. I miss that so much.

On 8th September was a day that I always remember. The police called us at home. We were told she was shot and didn’t survive.

Myself, Ivona’s mother and sister went to the hospital to see Ivona.

We didn’t even get the chance to say goodbye to her. This is a day I will never forget. Since this day, our family has not been the same. I struggle to try to remember without remembering things about Ivona and feeling upset. I cry all the time. Ivona’s death leaves my daughter without a sister, and she struggles with this loss every day.

I still cannot understand why this has happened to our family. Ivona was such a happy person with so much life left to live. I really want the answer as to how she died. The impact of Ivona dead, and the circumstances around it have been devastating. I have to make sure I am busy everyday so that I can try to cope. It has been the hardest 5 years of my life. I know my pain can’t be removed but I just want to find out what happened. I am hoping this inquest will help me to find out what happened, and so I can close that page.” A total of 13 witnesses out of a total of 200 potential witnesses were to be called in order to establish the circumstances of Ms Jovanovic’s death:

1. Michelle Panagakos,

2. Christos Panagakos,

3. Daine Walker,

4. Brandon Elliott, Findings of inquest into the death of Ivona Jovanovic Page 11

5. Melissa Vance,

6. Tyson Barber,

7. James Sperling,

8. Witness “ABC”

9. Christopher Harth

10. Daniel Miller

11. Stephanie Sperling

12. Melissa Hoge

13. Tammy Higginson Ms Michelle Panagakos Ms Michelle Panagakos told the inquest that as at 8 September 2019, she resided at 6A Renfrew Drive, Highland Park for 10 years with her son Christos Panagakos, who occupied the downstairs of the dwelling, for a large part of that time.

She gave evidence that she had arrived home after finishing work at about 19:40 hours on the evening of 8 September 2019 and described walking into the house, hearing voices downstairs and going straight into her bedroom, getting changed and coming back with some washing. As she walked towards the laundry, she said that she had encountered lvona whom she had known for almost 10 years near the top of the staircase from downstairs.13 Ms Panagakos described her first encounter with the deceased was when Ms Jovanovic she was coming from the lounge room.14 She said they discussed hair extensions and the fact that the deceased was hungry and planning on going out for dinner with Mr Christos Panagakos. She claimed she then got up from where the bar stools were and said "I'll just drop this off" referring to the clothes she was carrying. She then walked towards the laundry.

At this point, Ms Panagakos claimed to have heard two bangs which made her think a bar stool or one of the deceased’s bags had fallen over. After the second bang, Ms Panagakos claims to have immediately gone to investigate and when she did, she observed Ms Jovanovic pacing up and down. Curiously, and despite what must have been a very loud bang consistent with the discharge of a firearm, Ms Panagakos' assumed the deceased had broken a nail or something similar.15 Ms Jovanovic told Ms Panagakos that she had been shot and requested an ambulance be called. For the first time, Ms Panagakos claimed to have then seen a firearm spinning on the ground. When questioned as to where Mr Christos

13 T1-21 L10-15.

14 T1-22 L20-25.

15 T1-23 L25-30 Findings of inquest into the death of Ivona Jovanovic Page 12

Panagakos was at the time the deceased was shot, Ms Panagakos initially said he was downstairs. However, when challenged she then claimed he was on the stairs and “it all happened so quick”.16 Ms Panagakos gave evidence that Mr Christos Panagakos was on the stairs and she could see him coming up the stairs with his arm reaching into a jumper, however later in her evidence, claimed it was a few seconds after she asked the deceased what was wrong that she saw him.17 It must be observed the varying accounts Ms Panagakos provided to the “000” operator, to investigating police at the scene, to police with whom she spoke later than evening and then during the course of her evidence at this Inquest, were not consistent. In the second call made to Emergency Services from Ms Panagakos' phone, it was suggested to her and she accepted she told the Operator the following when asked what happened: "It's - there was - someone was carrying a bag, and it dropped, and something fell out, and, all of a sudden, I just heard a gun go off."18 The Operator then enquired by saying, "A gun go off?" and the following exchange occurred:19 M PANAGAKOS: Yes OPERATOR: In the house there, was it?

M PANAGAKOS: Yes. Just like I was coming up the stairs, and she was just, standing there talking, and then bang, something just went off.

When questioned about her account to the “000” operator, Ms Panagakos claimed that statement was based on an assumption she made because she had seen the deceased with a handbag. This explanation by Ms Panagakos was not persuasive.20 Ms Panagakos was also questioned about the account she gave to investigating police at a house at Carrara in the hours after the shooting. As recorded on a police body worn camera, Ms Panagakos told police she was in the laundry when she heard a thud followed by a bang and when she went to see what the noise was, she saw her son Christos at the top of the stairs putting on his jumper.

When challenged about this contradiction, it is submitted Ms Panagakos did not provide a compelling explanation for the differences in her accounts. It is submitted Ms Panagakos presented as an evasive witness and her account of events in oral evidence at the hearing, did not accord with what one might expect her to have witnessed from the location she says she was in when the deceased was shot.

16 T1-23 L15-30. T1-24 L1-5 17 T1-23 L20-45.

18 T1-52 L20-25.

19 T1-50 L5-10.

20 T1 59. and TI 60.

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Ms Panagakos was also questioned about her mobile telephone records which showed two separate “000” calls: the first at 20:22 hours for a duration of 30 seconds and the second call within one minute later at 20:23 for 17 minutes and 14 seconds. She was not able to offer an explanation for these 2 separate calls except to speculate the first call may have cut out. Telstra Call records showed that the first call was at her discontinuance. She did not deny making both calls.21 In contrast to her evasive evidence with other cross-examiners, she was a much more confident witness under cross-examination by her son’s lawyer.

Christos Panagakos Mr Panagakos readily acknowledged that he and the deceased were close friends and had “dated” briefly as teenagers. Mr Panagakos gave evidence that on 8 September 2019, he had consumed a large quantity of methylamphetamine, had been under the influence of methylamphetamine “on and off” for the two days prior to this death and had not slept.22 He claimed his drug use at the time substantially affected his ability to recall the events the subject of the inquest.23 He told the court earlier on 8 September 2019, he had been at a friend's house at Emerald Lakes prior to returning to 6A Renfrew Drive Highland Park. He said he consumed drugs regularly throughout the day and into the evening. He recalled Daniel Miller, Brendan Elliott and Daine Walker being at his mother's residence that afternoon.24 He thought Thomas Findlater may also have been at the house at some stage and confirmed plans with the deceased to go out for dinner that evening but was unsure if others were involved in those plans.

Mr Panagakos confirmed the persons downstairs at his residence prior to the shooting were Ms Jovanovic, Daine Walker, Brendan Elliot and himself.25 When questioned about the circumstances in which Ms Jovanovic was shot, Mr Panagakos said that he walked up the stairs and when he was putting his head through a jumper and he heard bang or bangs. He said he had difficulties remembering much about that night but that he remembered Ms Jovanovic asking for an ambulance to be called.26 When it was suggested the deceased walked up the stairs first, followed by Daine Walker, Brendan Elliot and then himself, Mr Panagakos said that he could not be certain but that sounded correct.27 Mr Panagakos claimed to be uncertain as to where he was at the time Ms Jovanovic was shot with reference to the stairs and the top floor but said he was somewhere to near the top. (This was in contrast to

21 T1-50 L5-10.

22 T2-63 L45, T2-64 L15-20.

23 T2-16 L42.

24 T2-19 L40-45.

25 T2-21 L25-35.

26 T2-22 L25-30.

27 T2-23 L5.

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the evidence of Ms Panagakos who claims he was downstairs28 and then claimed he was coming up the stairs.29 He was unsure as to whether he heard one or multiple bangs but recalled going to the deceased's aid and her requesting an ambulance be called.30 When pressed for further detail, Mr Panagakos repeatedly claimed that he could not remember “because of the drugs”.

When Mr Panagakos was asked to give his best recollection of the events of 8 September 2019 he gave this evidence: “Um – I’ll start by saying I was under the influence of drugs…”31 He later accepted that he was using drugs regularly throughout that day and evening32 and that the drug was methylamphetamine otherwise known by its colloquial name “ice”.33 However, when questioned by police on 9 September 2019, Mr Panagakos gave a different account:34 “308. KIDD: You guys on any drugs yesterday?

309. PANAGAKOS: I did, yeah, to be honest yeah.

310. KIDD: What did you do?

311. PANAGAKOS: I’m prescribed (inaudible) so, I’d taken a few of them, don’t know if they’re in my bag, and that was it for me.

312. KIDD: Yep

313. PANAGAKOS: I don’t know if they were drinking or not.

314. KIDD: Do you drink?

315. PANAGAKOS: Yeah. Not much. Not (inaudible).

316. KIDD: You weren’t drinking yesterday?

317. PANAGAKOS: Yeah. I drank, I drank (Inaudible) the first time in like, two months, three months. (Inaudible).

318. KIDD: Any ice?

319. PANAGAKOS: No. Previous in the week, yeah.

320. KIDD: You have?

321. PANAGAKOS: Yeah.

322. KIDD: When was that? Sorry, when abouts was that?

(Inaudible) Sunday, yesterday.

323. PANAGAKOS: Yeah, Saturday, Yeah, Saturday.

324. KIDD: A lot, a little?

325. PANAGAKOS: Depends on what you deem a lot.

326. KIDD: How long have you been under the influence for do you think?

327. PANAGAKOS: A day or two. I struggle, I’m a drug addict.

328. KIDD: Yeah, you were saying that before.

28 T1-23 L24.

29 T1-23 L27.

30 T2-29 L5-10.

31 T2-16 L20.

32 T2-16 L40.

33 T2-20 L 19.

34 Exhibit C10 “C” Q308 to Q329 Findings of inquest into the death of Ivona Jovanovic Page 15

329. PANAGAKOS: Tried to stay awake all day, cause yeah, causes some serious problems with your head.” Clearly, this interview with QPS investigators contradicts Mr Panagakos’s assertion that he was seriously affected by methylamphetamine intoxication and his memory unreliable.

It was suggested to Mr Panagakos that after the deceased was shot, Mr Daine Walker and Mr Brendan Elliott came inside the house and he said "Fuck, what did I do. I was just coming up the stairs". He claimed he could not recall making that statement.35 When questioned about his statement to police in which he said "Yeah, all I can tell you, is, yep, had an accident up in there and to my knowledge an accident happened", he again claimed he was unable to recall saying that to police. When asked how he knew it was an accident, he claimed he did not know.

Mr Panagakos told police when questioned that the gun only fired once yet in his evidence was not able to explain how he knew that and suggested that may have been a guess on his part. He accepted he told police that he was at the upper part of the stairs and she was on the floor screaming, saying she had been hit.36 Again, this is to be contrasted with Ms Panagakos' account which involved the deceased pacing after she had been shot.

Mr Kerr, for the Jovanovic family, submitted that Mr Panagakos did not present as an honest and reliable witness who was doing his best to recall events. I accept that submission. While claiming to have significant issues with his memory due to illicit drug-taking, he was not able to offer explanations for contemporaneous statements made to police. It is accepted that his ability to recall events was impacted by his substantial drug use but not the extent proffered by him. This is primarily because his recorded contemporaneous statements of 8 and 9 September, 2019 did not seem to be overtly affected by drug use and his selfserving “recalled” evidence often neither made logical sense nor was it consistent with other witnesses’ accounts.

Mr Kerr, for the Jovanovic family, also made a salient point in his submissions: “With respect, it is very difficult for the family to believe that Mr Panagakos does not recall many details from the evening of 8 September 2019 even if it is accepted it was possible he was under the influence of methylamphetamine, It is beyond question that he was, at least inside the house, when Ivona sustained the gunshot wound. Even Mr Panagakos, quite candidly, accepted that it is hard to believe he does not know where the gun came from, who owned it, and why it was loaded (see T2-60 II1 to 25): “Do you have any knowledge as to why there was a gun in your house?---No. At that time, no.

Do you have any knowledge as to where the gun came from?---No.

Do you know who owned the gun?---No.

35 T2-36 L44 - T2-37 L15.

36 T2-45 L40.

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Do you know why the gun was loaded with live ammunition?---No.

Do you know who was in possession of the gun when it went off?--- No.

Right?---I - - - Do you know why the gun disappeared by the time police had arrived?- --No.

Do you accept that the family desperately want to know how Ivona died?---Yes.

And I take it that you would understand that the family will never have closure unless they know that. You accept that? You have to - - -?--- Yes.

• • • respond?---Yes.

And I suggest that it’s hard to believe that you have no knowledge of where the gun came from, who owned it, and why it was loaded. Do you accept that?---Yes.

And I also suggest that it’s equally hard to believe that you don’t know who was in possession of the gun when it went off, given, on your own evidence, how close you were to Ivona when she died?---Yes.” Another interesting body of evidence was the “painted man” video which was saved on to Mr Christos Panagakos’s mobile telephone. The video depicted a handgun not dissimilar to that described by witnesses as the fatal firearm on 8 September, 2019.37 Mr Panagakos gave evidence about specific details of this home video making event including on topics such as whether the firearms were fake or real, whether it was some kind of joke, who the “painted man” depicted in the video was and where in his house the video was recorded. In answering a question from his lawyer, Mr Gatenby, Mr Panagakos gave evidence about specific details of this event including on topics such as whether the firearms were fake or real, whether it was some kind of joke, whom the “painted man” depicted in the video was meant to be and where in his house the video was recorded.38 Mr Panagakos confidently dismissed the painted man video as an irrelevant homemade video even though he conceded that video was made under the heavy influence of Methylamphetamine and “GHB”. Mr Kerr also pointed to the duplicity of Mr Panagakos’s evidence in that he could hardly recall the events of 8 September, 2019 because of methylamphetamine and other drugs intoxication yet his evidence regarding the “painted man” video also under methylamphetamine and other drugs intoxication was supposedly solid and reliable.

Daine Walker Mr Walker was an associate and friend of Christos Panagakos and gave evidence regarding his movements on 8 September 2019 and observations he made while at the Panagakos' residence that evening. He also claimed to be a poor historian 37 Exhibit C21

38 T2: 25-28 Findings of inquest into the death of Ivona Jovanovic Page 17

as he was on drugs at that time in his life. More importantly he claimed to have no memory of providing an official Justices Act statement to QPS investigating police when in custody in New South Wales.39 Mr Walker agreed his statement contained the following passages:

1. My Full name is Daine Gregory John WALKER.

2. I am presently 29 years of age. My place of birth is Sydney, New South Wales.

3. I am presently an inmate at the St Heliers Correctional Centre in Muswellbrook, New South Wales, after being sentenced to a term of imprisonment of fifteen months. I am eligible to be released on parole on the 31st of July 2021.

4. I am providing this statement of my own free will. I have not been threatened or promised anything in return for providing this statement.

5. I know Christos PANAGAKOS. I first met Christos when I was about eighteen or nineteen years old. We met through having the same group of friends on the Gold Coast.

6. I had not met Ivana JOYANOVIC prior to the 8th of September

2019. I knew that Christos and Ivana had previously been in a relationship as he had spoken about her to me.

2020. On the evening of the 8th of September 2019, I was at Christos' house at 6A Renfrew Drive, Highland Park. I got there in the afternoon and was mainly just hanging out in the downstairs area of the house where Christos lives.

2021. There were other people who came and went from the house while I was there. There was another male there who I know as 'Brendan'. I do not know his surname. I had first met Brendan a few years ago and had seen him at Christos' house a couple of times before.

2022. A female arrived sometime that evening and was sitting in the downstairs lounge area. I remember that she had blonde hair and was well dressed. I was not introduced to her and did not speak to her however, I now know that this person was Ivona.

2023. That night, Christos, Ivona, Brendan and I were planning on going out to dinner. Christos went into his room to get ready and was taking a long time getting dressed and changing outfits.

2024. The deceased, Brendan and I walked upstairs to try to hurry Christos up. When we walked upstairs, I saw Christos' mum, Michelle walking from the kitchen area into the loungeroom. I have met Michelle numerous times before.

2025. The deceased stopped to talk to Michelle, I just greeted her by saying something like "Hey" and Brendan and I kept walking out the front door into the driveway to wait for Christos.

2026. When we got outside, Brendan and I stood in the driveway leaning on Christos' Black BMW which was parked there and we each smoked a cigarette.

39 T3-32 L27.

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14. About two minutes later, I heard thud and then a bang, like a gun going off, from inside the house. The sounds were one after the other.

15. Brendan and I went back in the front door and I could see someone laying on the ground. I could just see their legs from the front door.

16. Christos was standing at the top of the stairs; I remember him saying "I tripped" and "It just went off'. Michelle was crying and screaming.

17. I saw a gun on the floor at the top of the stairs. I would describe it as looking like a 'Cowboy' gun with a wooden handle. I don't know much about guns so can't really describe it more than that.

18. I remember Christos said something like "What'd I do? Fuck, I didn't mean it, I was corning up the stairs". I said something like "Brother, relax just call the ambulance".

19. The deceased was just lying there, I remember seeing blood on her lower back and she make a sound like a gasp of air.

20. Michelle had a phone in her hand and was going to call the ambulance. I remember Christos said something like "No, don't call yet, wait".

21. I only stayed for a short period of time after that before I left the house.

22. On the 11th of May 2021, I provided this statement to police.” In a sterling and disciplined repetition of the same answer, Mr Walker claimed in his evidence at the Committal Hearing in 2019 that he was not unable to remember not only the events of the evening of 8 September, 2019, but also the making and signing of this formal statement to QPS investigators whilst in custody in New South Wales in 2021. This was due to methylamphetamine and other drugs intoxication on both occasions. Clearly, he had been given sound legal advice on how to avoid his statement being admissible against Mr Panagakos in a criminal trial.

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In my view, this statement is, on the balance of probabilities, the true account of what took place on 8 September, 2019. It is the most reliable account of Ms Jovanovic’s death.

Brendan Elliott Mr Elliott was called as a prosecution witness at the Committal Hearing in 2019 where Mr Panagakos was charged with Manslaughter. Unlike Mr Walker, he had not provided a formal statement to QPS investigators. However, like Mr Walker, he too provided a “I know nothing” account about the death of the deceased. At the Inquest, Mr Elliott was much more co-operative. I directed that he answer questions notwithstanding that they might incriminate him pursuant to Section 39 of the Coroners Act (Qld). This meant that he could not be prosecuted on the basis of any admissions that he made against interest.

He gave evidence that he was another associate and friend of Mr Panagakos.

He was present at the residence at the time Ms Jovanovic was shot on 8 September, 2019. He had spent time with Mr Panagakos at an address at Emerald Lakes earlier in the day. They planned to go to dinner that night and also discussed recovering money that was owed from a third party. Whilst at the Panagakos' residence, Mr Elliott said he consumed ice and fantasy (methylamphetamine and ecstasy). He said that he observed a firearm in the downstairs area of the house but said it definitely was not a “revolver” and could have been a gel blaster. He was unsure if it was real or fake and described it as over one metre long.40 Mr Elliott recalled Ms Jovanovic as being at the house when he arrived and that he said hello to her. He recalled being outside the house with Mr Walker near a utility when he heard a loud noise and when he went back inside with Mr Walker.

He saw the deceased on the ground, Mr Christos Panagakos at the top of the stairs and a short handgun on the ground.41 Mr Elliott told the court that his recollection was that the deceased, Mr Christos Panagakos and Ms Michelle Panagakos were talking at the top of the staircase.

Shortly afterwards, Mr Panagakos gave him clothes which he put in the utility just before Mr Walker drove off. He was unsure what had happened to the gun but he only saw it briefly. Mr Elliott initially remained at the house but later left with Mr Panagakos on foot before they separated.42 The account of events given by Mr Elliott is largely corroborated by the account given by Mr Walker in his statement to police. Accordingly, the evidence of Mr Elliott should be accepted.

40 T3-33 L32-45.

41 T3-36 L1-10.

42 T3-41-44 Findings of inquest into the death of Ivona Jovanovic Page 20

Melissa Vance Ms Vance is an associate of Mr Elliot and in September 2019, they resided at the same address. In her evidence, she confirmed that she attended a vacant lot at Highland Park at the instruction of Mr Elliot and collected him on the morning of 10 September 2019. Otherwise, Ms Vance had no other involvement in this matter.43 Tyson Barber A number of witnesses were called to give evidence in an attempt to establish the nature of the firearm used in shooting, whether the firearm was in working order, any knowledge Mr Christos Panagakos might have had of it and what happened to the firearm after the shooting. Mr Tyson Barber was an associate of Mr Panagakos and described himself as very close to Mr Daine Walker in 2019.44 He was adept at maintaining firearms. He gave evidence he was told by Mr Walker that an accident had happened and that the deceased had been shot.45 Further, he was told by Mr Walker that the trigger mechanism of the firearm that discharged killing the deceased was faulty. If it was dropped and hit the ground, the firearm would automatically discharge.46 He also gave evidence of an unidentified firearm that he “melted down” which was faulty in that way.47 The evidence of Mr Barber did not establish the faulty firearm he was the subject firearm in the coronial investigation.

James Sperling Mr Sperling told the Inquest that between early September 2019 and when he went into custody on 15 November 2019, he had access to two firearms which he we thought were inactive. He confirmed they had been purchased from Tyson Barber.48 It also remained unclear from the evidence of Mr Sperling whether either of these weapons were the subject firearm of this coronial investigation or were in any way connected with the death of the deceased.

Mr Sperling's mother, Tammy Higginson, and his two sisters Stephane Sperling and Melissa Hoge came to the attention of QPS investigating officers from monitored recorded conversations from a correctional centre between Mr Sperling and his family while he was in custody. The evidence of Ms Hoge, Ms Sperling and Ms Higginson did not cast any further light on the ultimate whereabouts of the firearm in the subject coronial investigation.

43 T1-100 – L25-40 44 T3-6 L42.

45 T3-6 L48-50.

46 T3-9 L7-8.

47 T3-9 L42-4.

48 T3-84 L23-37.

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Witness “ABC” This witness was given the benefit of a non-disclosure ruling which remains in place for reasons which do not concern issues in this Inquest. He told the inquest he was a friend of James Sperling and that he received a revolver from Mr Sperling in return for clearing a debt.49 He said the firearm was “rumoured” to have caused the death of the deceased but that said he “didn't know for sure”. 50 Further, he was told it had a problem with the trigger mechanism but he did not fire the weapon himself. This witness said after he took possession of the firearm, he was pressured into selling it in return for illicit drugs.51 Christopher Harth Mr Christopher Harth became available to give evidence at the Inquest but had previously given a version of events that he had seen Mr Sperling with a revolver type firearm. He had no personal knowledge from where the gun had originated but there were rumours that it was linked to the death of a girl on the Gold Coast.

Thomas Findlater and Daniel Miller By the time of the inquest, Mr Findlater was deceased and Mr Miller was unavailable to give evidence at the Inquest. However they had supplied versions of events to investigative authorities and their limited knowledge of events on 8 September, 2019. Mostly, they confirmed the drug-taking lifestyle of Mr Christos Panagakos and the culture of involvement with firearms. Neither was present when the deceased was shot.

Conclusions, Recommendations and s45 Coroners Act (Qld) Findings On 8 September, 2019, Ms Ivona Jovanovic was killed by Mr Christos Panagakos when a hand gun discharged from inside a bag he was carrying when he tripped on a staircase facing her. A 9mm/.38 or 9mm/.357 calibre bullet penetrated her chest causing blood to flood the thoracic cavity and making the heart and lungs dysfunctional. She died at the Gold Coast University Hospital several hours later.

The circumstances of what had occurred are not lucid. However, based on the evidence before me, the most credible account of the deceased’s death comes from the signed QPS statement52 made by Mr Daine Walker. I will again cite it verbatim:

49 T3-78 L35.

50 T3-77 L40-45.

51 T3-86 52 Exhibit B18 Findings of inquest into the death of Ivona Jovanovic Page 22

“That night, Christos, Ivona, Brendan and I were planning on going out to dinner. Christos went into his room to get ready and was taking a long time getting dressed and changing outfits.

The deceased, Brendan and I walked upstairs to try to hurry Christos up. When we walked upstairs, I saw Christos' mum, Michelle walking from the kitchen area into the loungeroom. I have met Michelle numerous times before.

The deceased stopped to talk to Michelle, I just greeted her by saying something like "Hey" and Brendan and I kept walking out the front door into the driveway to wait for Christos.

When we got outside, Brendan and I stood in the driveway leaning on Christos' Black BMW which was parked there and we each smoked a cigarette.

About two minutes later, I heard thud and then a bang, like a gun going off, from inside the house. The sounds were one after the other.

Brendan and I went back in the front door and I could see someone laying on the ground. I could just see their legs from the front door.

Christos was standing at the top of the stairs; I remember him saying "I tripped" and "It just went off'. Michelle was crying and screaming.

I saw a gun on the floor at the top of the stairs. I would describe it as looking like a 'Cowboy' gun with a wooden handle. I don't know much about guns so can't really describe it more than that.

I remember Christos said something like "What'd I do? Fuck, I didn't mean it, I was corning up the stairs". I said something like "Brother, relax just call the ambulance".

The deceased was just laying there, I remember seeing blood on her lower back and she make a sound like a gasp of air.

Michelle had a phone in her hand and was going to call the ambulance.

I remember Christos said something like "No, don't call yet, wait".

I only stayed for a short period of time after that before I left the house.” The account of events given by Mr Elliott at the Inquest corroborates the account given by Mr Walker in his statement to police. This is most cogent and reliable body of evidence heard in the Inquest. It is clear to me that Mr Walker was being untruthful in denying that he could not recall making this statement in custody in New South Wales. It was also clear to me that he had been given good advice as to how to answer in such a way so that the statement would not be admissible in a criminal trial against Mr Panagakos.53 They were friends and associates at the time of Ms Jovanovic’s death.

Curiously, the statement does not establish criminal negligence by Mr Panagakos. He said the gun accidentally discharged because he tripped. There is no direct evidence that Mr Panagakos knew that the firearm was loaded or 53 See Collins v The Queen (2018) 265 CLR 178; R v Collins [2018] 1 Qld R 364 at [36] where Burns, J found a previous statement inadmissible where the author admits to making the prior statement but cannot recall making it or the events in question (see Sections 18 & 19 Evidence Act (Qld).

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indeed in the bag and a number of individuals with serious criminal antecedents were in a position to have placed the firearm in the bag without Mr Panagakos’s knowledge.

Mr Panagakos’s own versions of events can easily be rejected. He initially maintained, that, as a coincidence with the firearm discharging, he was placing a jumper over his head. This is inconsistent with his ability to recall little at the Inquest due to methylamphetamine intoxication.

Ms Michelle Panagakos’s version of events was risible in many respects also.

She clearly was not being full and frank with the “000” operator and QPS investigators. One can understand her motive in trying to protect her son.

However, her attempt initially to suggest that the deceased herself, brought the handgun in a handbag to 6A Renfrew Drive, Highland Park residence and her placing her son, Christos at the bottom of the staircase at the time of the firearm discharge, was in my view reprehensible. She was not a witness of credit.

Findings required by s. 45 Coroners Act (Qld):

(a) Identity of the deceased – Ms Ivona JOVANOVIC

(b) How she died - Inadvertent discharge of a firearm by Mr Christos Panagakos causing a .38 or .357 calibre bullet to penetrate her chest causing blood to flood the thoracic cavity and making the heart and lungs dysfunctional. She died at the Gold Coast University Hospital several hours later.

(c) Place of Death - Gold Coast University Hospital

(d) Date of Death - 8 September, 2019

(e) Cause of Death - Gunshot Wound to the Chest It is evident from the statement read aloud at the Inquest by Mr Vejiko Jovanovic, the deceased's father, that the deceased was a happy, kind and caring person.

Her death has had a devasting and lasting impact on her family and those close to her. The lack of clarity about how she died since can only have aggravated that grief.

Considering the evidence before this Inquest, I cannot make any meaningful recommendations.

I have concluded that Mr Christos Panagakos caused the death of Ms Ivona Jovanovic. However, on the evidence before me this was essentially an accident.

In terms of the Criminal Code (Qld), his criminal negligence could not be established to warrant a prosecution for involuntary manslaughter. Clearly many of the witnesses at this Inquest were not telling the truth or were obfuscating its Findings of inquest into the death of Ivona Jovanovic Page 24

discovery. Should further relevant evidence become available, there will always be an opportunity to re-open this Inquest.

I close the Inquest and Investigation.

Donald MacKenzie Coroner

BRISBANE 26 June, 2025.

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