For two decades, Joseph James Pappas has held a grudge against the Houston cardiologist who performed the surgery that left his mother dead on the operating table, police say.

Pappas, 62, planned Dr. Mark Hausknecht’s killing over his mother’s death, and last month followed him as he rode his bicycle to work at Houston Methodist Hospital, according to authorities.
Both men were on their bikes on July 20 when Pappas rode past Hausknecht before turning around and fatally shooting him, police said.
The prominent surgeon and former cardiologist for President George H.W. Bush was found near a construction site with hundreds of workers, but the equipment was loud enough to mask the sounds of gunfire.
“It appears that this may be a 20-year-old grudge that this man held,” Police Chief Art Acevedo said Wednesday. “There was a lot of planning that went into this. There was a lot of planning and sadly some skill.”
Police issued an arrest warrant for Pappas after they searched his home and did not find him. The suspect has multiple firearms and has made phone calls indicating he was considering suicide, Acevedo said.
“This man is dangerous, this man is capable, this man has some skills (with firearms),” he said.
In the days following the shooting, the motive and the suspect’s identity remained a mystery. Police said the doctor was likely targeted and implored witnesses to come forward with any information.
Stunned friends and neighbors canvassed the area where police believe the gunman may have fled. They encouraged residents to look through their security camera footage for images of the suspect.
Surveillance video obtained by a neighbor allowed investigators to enhance the suspect’s photo, which helped identify him, police said. On Tuesday, someone said they recognized the suspect in surveillance video released a day before.

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