Anthony Garcia, 45, was convicted in the revenge killings of four people connected to a Nebraska medical school.

OMAHA, Neb. — A former doctor convicted in the revenge killings of four people connected to a Nebraska medical school was sentenced Friday to death.

A three-judge panel handed down the sentence against Anthony Garcia, 45, of Terre Haute, Indiana. The judges, who heard arguments earlier this year during the sentencing phase of Garcia's trial, also had the option of sentencing him to life in prison.

Garcia was convicted in two attacks that occurred five years apart on families connected to Creighton University School of Medicine in Omaha, where Garcia once worked.

Investigators said that in 2008, Garcia fatally stabbed 11-year-old Thomas Hunter, the son of university faculty member Dr. William Hunter. Garcia also was convicted of killing the family's housekeeper, 57-year-old Shirlee Sherman, at the family's home in an upscale Omaha neighborhood. While police gathered plenty of evidence from the scene, they struggled to find a suspect in the killings, and the case went cold in the following years.

That changed five years later, with the 2013 Mother's Day deaths of another Creighton pathology doctor, Roger Brumback, and his wife, Mary, in their Omaha home. Police recognized many similarities in the 2008 and 2013 killings, and Garcia was quickly developed as a suspect. He was arrested two months later in a traffic stop in southern Illinois.

Prosecutors argued the killings were motivated by Garcia's long-simmering rage over being fired in 2001 by Hunter and Brumback from the Creighton medical school's residency program.

At his trial, prosecutors presented massive amounts of circumstantial evidence in the case, including credit card and cellphone records placing Garcia in and around Omaha the day the Brumbacks were killed. One receipt showed Garcia eating a meal at a chicken wings restaurant within two hours of when police believe the Brumbacks were attacked.

Prosecutors also presented evidence that Garcia had sought to attack another Creighton medical school faculty member on May 10, 2013 — the same day the Brumbacks were killed. Prosecutors said Garcia pushed in a back door of that woman's home but fled when the home's alarm went off. Police believe he then found the Brumbacks' address on his smartphone and attacked them.

Roger Brumback was shot in the doorway of his home and then stabbed. His wife was stabbed to death, much the same way Thomas Hunter and Sherman had been stabbed, according to investigators.

Nebraska had not executed an inmate in more than 20 years until last month, when Carey Dean Moore died by lethal injection for the 1979 shooting deaths of two Omaha cab drivers. However, the state's mode of execution remains riddled with controversy and legal challenges in the face of difficulty in obtaining some of the drugs used to carry out lethal injection.