On November 30, 2012, what began as a routine police drug patrol in Cleveland, Ohio ended in an unauthorized 59-car police chase in which 137 shots were fired and two unarmed individuals were left dead. The department-wide malfunction has prompted an investigation by the Department of Justice into the city police department’s use of excessive force and the “the adequacy of CPD’s training, supervision, and accountability mechanisms.”

In spite of a police policy that no more than 2 vehicles be involved in a chase, more than 59 vehicles joined the pursuit “without the sector supervisor’s knowledge or permission,” according to a state investigation of the incident. The chase began after a car pulled over for a turn signal violation drove away, and was later identified by several other officers driving at a high speed. Due to faltering communication, and the misimpression that the individuals were armed and fired a shot, the incident escalated until one-third of the police department had joined the chase.

During the pursuit, many of the officers had not followed instructions about switching their radios to the main communications channel and therefore did not hear orders to discontinue the chase. In a state report investigating the incident, officers described a scenario in which bullets were flying all around them, several officers had not put on their bullet-proof vests and one described it as the “scariest thing that I’ve seen in my whole life.”

They had also requested other means to stop the suspect, including spike strips to halt the car, and aviation support. However, neither of these resources were available to the officers. The state report describes the incident:

What you have just heard is a tragedy — a tragedy for Timothy Russell, a tragedy for Malissa Williams, and a tragedy for their families. This has also been very tough for each of the law enforcement officers involved. […] The large number of vehicles involved contributed to a crossfire situation at the pursuit’s termination that risked the lives of many officers. It is, quite frankly, a miracle that no law enforcement officer was killed. Clearly, officers misinterpreted facts. They failed to follow established rules. However, by failing to provide the adequate and necessary structure and support, the system, itself, failed the officers. Police officers have a very difficult job. They must make life and death decisions in a split second based on whatever information they have in that moment. In a situation like this, they are under tremendous stress. But, when you have an emergency, like what happened that night, the system has to be strong enough to override subjective decisions made by individuals who are under that extreme stress. Policy, training, communications, and command have to be so strong and so ingrained to prevent subjective judgment from spiraling out of control. The system has to take over and put on the brakes. On November 29, 2012, the system failed everyone.

In announcing the investigation, DOJ Civil Rights Division head Thomas Perez made clear that the investigation is civil, not criminal, looking at system-wide reform of a department that has facilitated violent and uncoordinated practices. Poor practices like these can lead to over-policing of drug and other crimes and end in more violence than that they are trying to prevent. Just this week, New York Police Department officers shot dead 16-year-old Kimani Gray in a controversial incident in which witnesses have said he was unarmed.