Folks think that Ground Control 'failed' at noticing his start up and approach to the active. I do not think it unusual at all.
In the working year of a massive airport such as this, everyone expects that everyone will follow the rules. As he was so close to an active, the time for people to realise that he was not following the rules would have been very short. When first noticed, they would have attempted radio contact and, once sure that there is a problem - more time had passed.
If you think that Ground and ATC 'failed' ask how many times the situation they faced occurs in the lifetime of each member of staff? To realise what has gone wrong and take action for something utterly outside normality and for which training would be almost impossible? They did so well.