The former nursing student One Goh has pleaded not guilty to killing seven people during a shooting rampage at a Christian college in Oakland on April 2.
Reuters reports that the 43-year-old Korean-American from California appeared in Alameda County Superior Court shackled at the hands and feet and spoke through a Korean interpreter.
CBS says the attack on Oikos University is the deadliest gun attack on a school in the United States since 32 people were killed at Virginia Tech in 2007.
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It describes how Goh is charged with seven counts of murder and three counts of attempted murder.
Law enforcement officials have said that Goh was angry that he had been denied a tuition refund by Oikos University, and had arrived on campus with a .45-caliber gun looking for the administrator, according to AFP.
When he was unable to find her, he "essentially executed" seven people and wounded three others, the news agency adds.
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The BBC quotes Alameda County Sheriff's Office spokesman Sergeant J.D. Nelson as saying that Goh has been refusing food for several weeks and had lost about 20 pounds. However, Nelson said "he would not characterize the act as a suicide attempt or a hunger strike".
Goh is due back in court on 25 June for a pretrial hearing, after which prosecutors will decide whether or not to seek the death penalty.
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