A pharmacy technician showed up for work at Long Beach Memorial Medical Center on Thursday brandishing two handguns, killed his boss and another manager and then fatally shot himself, witnesses said.
The shootings just before noon sent panicked patients, visitors and hospital workers running for cover as the agitated gunman stalked the corridors in search of his victims.
Long Beach police officers called to the scene found two bodies, one inside the hospital and another outside the emergency room entrance, Police Chief Anthony Batts said.
The gunman was identified as Mario Ramirez, 50, of Alhambra, said Lisa Massacani, a Long Beach Police Department spokeswoman. The two victims were Hugo Bustamante, 46, of Cypress and Kelly Hales, 56, of Redondo Beach. Bustamante was pronounced dead at the scene and Hales after about six hours of emergency treatment.
According to witness accounts, Ramirez went first to the pharmacy, near the emergency room and outpatient area, and fatally shot Bustamante, firing at least twice at his face. He then went in search of Hales, whom he confronted outside the emergency room.
Laura Harris, 64, saw the second shooting as she drove by the emergency entrance en route to visit her hospitalized mother.
"I just saw the gun," she recalled later, her voice quivering.
The gunman shot Hales in the leg and, after he fell to the ground, "stood over him and shot him again," Harris said. Ramirez then put the gun to his own head but appeared to be wavering, she added.
"I don't know if he tried to shoot or if he was making up his mind," Harris said, describing how he began pacing and appeared frustrated.
"Then he put it to his head" and pulled the trigger, she said.
X-ray technician Ed Collins was stepping out of an elevator in the main lobby as that scene unfolded and a "code blue" alarm sounded, signaling a security emergency.
He witnessed an anguished exchange between a female co-worker and the gunman, with Ramirez telling her "Get out of here! Leave!" just before turning the gun on himself.
Inside the hospital, "people were frantic -- really scared," said Justin Hawkins, 18, who had been in the main lobby when he heard a shot. "I heard people screaming and yelling. Then a nurse came in and told everyone to hurry up and leave as soon as possible."
Doctors herded him and others into back rooms after making sure it was safe to do so, he said.
LuAnn Howe was at the hospital to visit her 7-month-old granddaughter and had stepped outside to smoke when she heard shots.
"There was 'boom, boom, boom,' " said Howe, 55. Everybody around her began running and panicking, she said, describing how a security guard opened a door beside the ambulance entrance and tried to corral people inside.
She said the hospital went into an immediate lockdown, forcing all inside to stay put for about an hour.
Batts, the police chief, declined to speculate about a motive for the rampage, which witnesses described as a deliberate seeking out of the victims. Bustamante was the pharmacy manager, and Hales was executive director of the hospital's outpatient pharmacy, hospital spokeswoman Stacie Crompton-Hime said.
Friends and co-workers, who described Ramirez as a congenial man with a wife and children, said he had recently become aware of reports of pending layoffs. But Crompton-Hime said that although there had been layoffs in March, no further job reductions were planned. She said Ramirez had no previous personnel problems.
"There were no signs or indication that something like this could happen," she said. "I don't believe there was anything we could have done."
Charity Perez, whose husband works at the hospital as a valet, said she knew the gunman as "a great and wonderful guy." She said Ramirez had heard about layoffs expected in June, but didn't know if that was what motivated the shootings.
Radiology department clerk Melo Dotski, 21, said she was friends with Ramirez, whom she described as "a very sweet man." Dotski had worked as a teller at a nearby bank before being hired by the hospital and had known Ramirez as a friendly customer, someone "funny, humble, nice."
"I've known him over 2 1/2 years. I used to call him George Lopez because he was always making jokes," Dotski said. When she called him by the comedic actor's name, she said, he'd play along by answering: " 'How are you doing, baby girl?' with a smile."
Thursday's bloodshed was the latest in a spate of high-profile multiple killings in recent months.
"This is becoming a national trend, probably because of the tension going on in our society today," Batts said, referring to shootings that have been linked to the troubled economy.
In California, a Porter Ranch man wiped out by the stock market plunge killed five family members and himself in October; a high-tech employee laid off in Santa Clara is suspected of killing three co-workers, including the company chief executive, and himself in November; and a Wilmington man who had just lost his job killed his wife, five children and himself in January.
Times staff writers James Wagner, Ari B. Bloomekatz and Andrew Blankstein contributed to this report.