Marjory Stoneman Douglas High School student Madisyn Menthaca, 15, places roses on the memorials on a hillside with her mother, Kelly Savino, where 17 students and teachers were killed. (Jonathan Newton/The Washington Post)

The massacre of 17 students and staff inside a Parkland, Fla., high school earlier this year was marked by security lapses at the school and failures by multiple law enforcement officers to respond appropriately to the carnage, according to a draft report from a state commission investigating the shooting.

This report, which is not final, detailed myriad issues that occurred before, during and after the attack at Marjory Stoneman Douglas High School, including unlocked entrances allowing the attacker to get inside, sheriff’s deputies who did not rush in to confront the shooter and confusion among students, staff and law enforcement officials. The grim collection of missteps related to the Feb. 14 massacre includes many failures in school security that experts say are typical of situations in schools nationwide.

“The omissions that were in Parkland, sadly, could be found in the great majority of public secondary schools across the country,” said Joe Eradi, a safety consultant who was superintendent in Newtown, Conn., following the 2012 mass shooting at Sandy Hook Elementary School.

A public safety commission — which was charged with finding and addressing “system failures” the massacre exposed — is scheduled to discuss its findings during meetings in Tallahassee on Wednesday and Thursday. A final report is due to the governor on Jan. 1.

The commission’s work follows intense criticism of authorities for failing to heed the alleged shooter’s repeated red flags in the months leading up to the Parkland attack as well as how they responded to the shooting.

Mass shootings are routinely followed by investigations into what happened, revelations of warning signs and attempts to identify areas authorities can improve upon when trying to prevent or respond to similar attacks. But the Parkland shooting was notable for the sheer number of potential warnings that were missed, including repeated, specific concerns that Nikolas Cruz, who has been charged with the shooting, posed a threat to a school.

The shooting led to intense scrutiny of officials and agencies in South Florida, including Scot Peterson, the Broward sheriff’s deputy assigned to Stoneman Douglas who failed to go inside the building during the shooting; the Broward Sheriff’s Office, which pledged to investigate charges that multiple deputies failed to go inside as needed and to revisit how it handled calls about Cruz; the Broward school system, which has been accused of keeping information from the public; and the FBI, which acknowledged failing to act on a tip about Cruz weeks before the shooting.

The Broward Sheriff’s Office did not respond to requests for comment about the draft report. The Broward school system planned to use the report “as an important resource to help make all our schools safer,” said Kathy Koch, chief spokeswoman for Broward County Public Schools, noting that it had already made safety improvements.

“We are studying the observations to deepen our understanding of what happened, who was responsible, and what might have been done differently,” Koch said in a statement Wednesday.

The report paints a picture of Marjory Stoneman Douglas High School as a quintessential “soft target” — a place, such as a school or a shopping mall, frequented by many people but not as tightly secured as so-called “hard targets” with tight security, such as a federal agency’s headquarters. Experts have warned of the threats posed to soft targets, and this danger has been highlighted by recent attacks at schools, houses of worship and nightclubs.

In the report, the commission detailed numerous security issues, some of them tragically simple. A door to Building 12, where the shooting occurred, was unlocked when the shooter arrived, as was an unstaffed gate at the school’s entrance.

The commission also said some of the safety problems enabled the gunman to kill without ever entering a classroom.

Teachers inside Building 12 did not have coverings available to block the glass windows on their doors, which allowed the attacker to see victims inside, the commission said. Among the victims were students in classrooms who could not hide in areas obscured from view, also known as hard corners, the report said.

“Cruz only shot people within his line of sight and he never entered any classroom,” the draft report said. “Some students were shot and killed in classrooms with obstructed and inaccessible hard corners as they remained in Cruz’s line of sight from outside the classroom.”

The toll could have been far higher, the report noted, given that the shooter still had 180 rounds of ammunition when he stopped firing and fled the campus. Storm-resistant glass on a third floor teacher’s lounge kept him from positioning himself as a sniper, the report said. But the building’s physical structure also included a potential weakness: The attacker’s bullets went through drywall and metal doors, and had he “intentionally shot through the walls or doors, the amount of casualties could have been greater,” the report said.

There was also rampant confusion as the shooting took place, according to the report. When the fire alarm sounded, possibly because of smoke from the gun, some students and staff in Building 12 responded by evacuating as if there were a fire, rather than sheltering in place. That put them at risk, the report said.

Koch, the Broward schools spokeswoman, said the school system was looking at the report as it seeks to make improvements to how it handles security, communication and threats.

“We are considering the best, most expedient ways to implement recommendations throughout all areas: security policies and procedures, training, communication systems, physical hardening, and threat assessments,” she said in the statement. “We hope that there will never be another assailant in any school anywhere, but we will do our best in Broward County Public Schools to be prepared to prevent another tragedy from occurring.”

Much of the focus for school security following mass shootings revolves around new technology, experts say, while the vulnerabilities more typically involve human failure, inadequate procedures and poor implementation of policies. Many school districts focus on physical hardware and other easily identifiable solutions, partly driven by companies looking to sell products and partly due to demands from the public to make visible improvements, said Ken Trump, a consultant who advises school districts on safety protocols.

“They’re looking at the `wow’ but they’re not thinking of the ‘how.’ It’s, `Do something, do anything, do it fast and do it differently,” Trump said. “This is not going to be solved with a quick fix of more cameras, more hardware, more equipment, more technology. It’s people, policies, procedures, communications and systems failures.”

Security measures can be only as strong as “the weakest human link behind” them, he said. For instance, districts can have security cameras installed but then buzz visitors in without checking who they are.

Bob Farrace, spokesman for the National Association of Secondary School Principals, argued that the draft report “kind of scapegoats” the school for the tragedy, rather than focusing intently on the many failures to properly identify Cruz as a possible assailant beforehand — something that might have kept weapons out of his hands.

Curt Lavarello, a former school resource officer in Broward County and now a consultant, said what he found surprising about Parkland was the failure of officers to contain the attacker. “I was a little taken back by the extreme delay for officers to go in,” he said.

The draft report added to the criticisms of how law enforcement officials responded to the shooting. The response was “hindered in part" by Peterson’s actions, the commission said, including his comments telling other authorities to stay away from the building where the shooting was occurring. That guidance runs counter to the widely accepted police practice of rushing to confront active shooters.

But the commission’s findings go beyond Peterson, and the draft report recommends that the sheriff’s office conduct an internal review into how seven deputies acted.

The report says “several” Broward sheriff’s deputies were videotaped or described as taking time to put on ballistic vests or remove other gear they were wearing, “all while shots were being fired," which the commission states is “unacceptable and contrary to accepted protocol under which the deputies should have immediately moved towards the gunshots to confront the shooter.” Other deputies arrived at a road near the school, heard the gunshots and remained on the road rather than going after the attacker.

Broward Sheriff Scott Israel, who has defended his leadership, has pilloried Peterson for not rushing inside, and his office released video showing the former deputy standing near the school building during the massacre. Peterson defended his actions by saying he thought the gunfire was coming from outside the building, and he wanted to take “a tactical position” to assess what was happening.

The report said Peterson’s decades of experience as a school resource officer likely “contributed to his inadequate response to this shooting,” because while he had been trained for such situations, officers in his position rarely face “high-risk, high-stress situations." An attorney for Peterson declined to comment on the draft report.


This Feb. 18, 2015 image taken from video provided by Broward County Public Schools shows school resource officer Scot Peterson during a school board meeting of Broward County, Fla. (AP)

Cruz, 20, could face a death sentence if convicted. Police say he quickly confessed after he was caught by officers following the shooting, and his attorneys acknowledge he was the gunman.

His troubled history has received considerable attention, and the commission detailed some of the many warning signs that preceded the attack. At least 30 people knew about Cruz’s “troubling behavior” beforehand, the commission states, details they either did not report or, if they did, that prompted no action from those they contacted. The new report suggests the school district conduct an internal probe into whether an assistant principal was warned about Cruz and acted appropriately.

Despite the repeated instances of unnerving behavior, there was “no evidence” Cruz had met the criteria to be involuntarily examined under the Baker Act, which would not have prevented him from buying or possessing firearms, the report said.

The commission’s report also described other issues related to the shooting, including with the 911 system, which routed some calls to multiple dispatchers the day of the attack. This created “an information void” for law enforcement, the commission said, while radio problems hindered the communication available to officers on the ground in Parkland.

While the report faulted the actions of some Broward sheriff’s deputies, it states that “many other deputies responded in the proper manner,” rushing to find the shooter, give medical aid and get victims out of harm’s way. Officers from nearby Coral Springs, Fla., who responded to the shooting, “consistently praised their training as preparing them for a proper response,” the report said, noting they attended the training annually and remembered it clearly.

Some Broward sheriff’s deputies “could not remember the last time they attended active shooter training,” and others could not remember what training they had received.

“A significant number of officers and deputies said that additional training would be beneficial; however, they also said that no amount of training can prepare you to face such an event,” the report states.

This story has been updated since it was first published.