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Columbus Dispatch, Jeff Hinckley, Associated Press
The Westerville North High School entrance sign shows a tribute to Spanish teacher Leroy Gilkey, Tuesday, Jan. 10, 2011. A dispute over whether a terminally ill woman should have been given tea and toast or an orange apparently upset her husband so much that he shot and killed two of the woman's sisters and Leroy Gilkey, his own son, before killing himself, a sheriff said Tuesday.

LOGAN, Ohio — Authorities say family tension over the care of a cancer-stricken woman caused a Logan man to kill his adult son and two sisters-in-law in front of his wife before killing himself.

A dispute Monday over whether the woman should have been fed tea and toast or an orange apparently set off 63-year-old Paul Gilkey.

Hocking County Sheriff Lanny North says Gilkey spared his wife and allowed his grown stepson to leave unharmed. The stepson drove away from the house in rural southeastern Ohio to seek a cellphone signal and call for help.

Relatives say Paul Gilkey had been stressed and upset while trying his best to care for his ailing wife, 59-year-old Darlene Gilkey who was receiving hospice care.