Damien Bendall, aged 31, is charged with the rape and murder of 11-year-old Lacey Bennett, as well as being accused of killing her brother John Paul Bennett, 13, their mother Terri Harris, 35, and Lacey's friend Connie Gent, 11.
The charges come after four bodies were discovered at a house in Chandos Crescent, Killamarsh, near Sheffield, South Yorkshire, on September 19.
The 31-year-old was due to enter his pleas of guilty or not guilty today (January 26) at Derby Crown Court in front of a packed public gallery made up of the deceased’s families.
But the court heard delays at Bendall’s prison in performing a medical scan on the defendant meant the the case still could not proceed today.
It comes after a previous hearing in December was also delayed for similar reasons.
“Can I indicate the court is concerned – as I expressed on the last occasion – with the continued delay in this case,” said Her Honour Judge Nirmal Shant QC.
“In my view, an independent report is now required by the court [into this matter] and I will order that now.”
Bendall, who appeared in the Crown Court dock dressed in a grey sweatshirt and face mask, did not speak during the hearing except to confirm his name to the judge in the case.
He was remanded into custody and will now appear in court to enter his guilty or not guilty pleas on February 25.
A provisional trial date of March 21 has been set.
The murder charges allege that Bendall killed all four sometime between September 17 and September 19.
An inquest opening at Chesterfield Coroner's Court previously heard that the four died as a result of a “violent attack”.
Terri, the woman he is accused of killing, had recently moved to Killamarsh with her children from Woodhouse in Sheffield. Connie still lived in Woodhouse.
John Paul, Lacey and Connie all attended Outwood Academy City in Stradbroke, Sheffield.
Police remained at the scene of the killings for several days after the bodies were discovered.
Hundreds of flowers, cards and tributes were left outside the house in Chandos Crescent in the days following the killings.
In the wake of their deaths, Jason Bennett - father of Lacey and John Paul - said: “I've been left broken. I'm devastated. John and Lacey came into our lives and brought so much love and happiness and were adored by myself and their big sisters, forever loved and remembered.
“We would also like to thank everyone for their loving support and our thoughts go out to everyone affected by the tragic loss of four precious lives.”
Hundreds of people attended a vigil for them on the evening after the deaths, while more than £20,000 was raised in their memory and to pay funeral costs.
The investigation into the four deaths and rape was carried out by Derbyshire Constabulary.