A hospital worker shot and killed two employees and then killed himself at a medical centre in California, sending panicked people fleeing, police and witnesses said.
The gunman was identified as Mario Ramirez, 50, who died yesterday of an apparent self-inflicted gunshot wound, police said.
The victims were Hugo Bustamante, 46, who died at the scene, and Kelly Hales, 56, who was taken to the hospital's emergency room in critical condition and died several hours later.
Police Chief Anthony Batts said the gunfire erupted just before noon at Long Beach Memorial Medical Centre. He said the motive remained under investigation but noted the violence came amid a flurry of recent shootings in America.
"This is a trend of active shooters that you have seen nationwide," Batts said at a news conference. "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 Bustamante was the manager and Hales was the executive director. Asked if the shooting stemmed from a dispute or possible layoffs at the hospital, Crompton-Hime said there were layoffs last month but no other reductions were planned.
A message left at Bustamante's home was not immediately returned last night. Hales' daughter, reached at the family's home, declined to comment.
Carmen Ortiz, 47, a hospital housekeeper, said she was outside for her break when she heard a gunshot 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," Ortiz said. "I was very frightened."
Hospital worker Edward Collins trembled as he recounted coming upon the violence.
"When I got off the elevator, I heard screams," Collins said. An upset friend told him she had just seen someone she knew shoot someone. Collins then saw the shooter holding what appeared to be a black handgun.
"He was standing over the guy he shot," he said.
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 the shooter by his first name for about two years. She said she used to help him with transactions when she worked as a teller at a bank at the medical centre.
"He made all kinds of jokes, he was a funny man," Dotski said. "He was smiling, laughing, making sure everybody was doing OK."
Laura Harris told KCAL she saw the shooter walk up, pull a gun 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 shooter) put the gun up under his chin," and shot himself, she said.
A youth, Justin Hawkins, said doctors got people into rooms during the shooting before police arrived.
"The doctors did the best job possible," he told KCAL. "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."
Crompton-Hime said the hospital has 24-hour security and "there were no signs or indications that anything like this could have happened."
The approximately 460-bed hospital is one of six health care facilities in Southern California operated by the not-for-profit MemorialCare system, run by Memorial Health Services.
Long Beach is about 25 miles south of downtown Los Angeles.