Terrified patients and staff fled as a man went on a shooting rampage at a hospital, killing two fellow employees, then himself.
The gunman was identified as hospital worker Mario Ramirez, 50, who died of an apparent self-inflicted gunshot wound, police in Long Beach, California, said.
His victims were Hugo Bustamante, 46, who died at the scene, and Kelly Hales, 56, who was taken to the hospital’s casualty unit in a critical condition, but died several hours later.
Police Chief Anthony Batts said the gunfire erupted just before noon yesterday, local time, at Long Beach Memorial Medical Centre.
“This is a trend of active shooters that you have seen nationwide,” Mr Batts said. “This is becoming a national trend, probably because of the tension that’s going on in our society today.”
Hospital spokeswoman Stacie Crompton-Hime said all three men worked in an outpatient pharmacy where Mr Bustamante was the manager and Mr Hales the executive director.
Asked if the shooting stemmed from a dispute or possible redundancies at the hospital, Ms Crompton-Hime said there were job losses last month, but no other reductions were planned.
Mr Batts said officers responding to the shooting found one victim inside the hospital, then discovered a second victim outside, near the emergency room. Ramirez was found dead outside on the north side.
Diana Hendel, the hospital’s chief executive, said the victims’ families were receiving counselling.
Carmen Ortiz, 47, a hospital housekeeper, said she was outside for her break when she heard a shot and saw people running away from the building. She said her manager rushed out and told her to get inside.
“Then there was another shot, but I was inside,” Ms Ortiz said. “I was very frightened.”
Hospital worker Edward Collins trembled as he told of the violence.
“When I got off the elevator, I heard screams,” he said.
A distressed friend told him she had just seen someone she knew shoot someone. Mr Collins then saw Ramirez holding what appeared to be a black handgun.
“He was standing over the guy he shot,” he said.
Mr Collins said the gunman eventually pointed the gun at his own head and pulled the trigger.
Melo Dotski, a radiology department clerk, said she had known Ramirez for about two years.
“He made all kinds of jokes, he was a funny man,” she said. “He was smiling, laughing, making sure everybody was doing OK.”
Laura Harris said she saw the gunman walk up, pull out the weapon and shoot a hospital employee in the leg.
“Then the young man fell and then he stood over him and shot a couple more times. Then he (the gunman) put the gun up under his chin,” and shot himself, she said.
Justin Hawkins said doctors got people into rooms during the shooting, before police arrived.
“The doctors did the best job possible,” he said. “They made us feel safe, they got us in the rooms as fast as possible, making sure nobody was in the hallways, making sure everyone was fine. And then the cops showed up really fast.”
Ms Crompton-Hime said the hospital had 24-hour security and “there were no signs or indications that anything like this could have happened”.
“I don’t believe that there was anything different we could have done,” she said.
The 460-bed hospital is one of six health care centres in Southern California operated by the non-profit MemorialCare system, run by Memorial Health Services.
Long Beach is about 25 miles south of central Los Angeles.