Luigi Mangione, who is accused of murdering UnitedHealthcare CEO Brian Thompson, pleaded to multiple charges in a Manhattan courtroom on Monday.
The 26-year-old defendant is being charged with first-degree murder in furtherance of terrorism, two counts of second-degree murder, and multiple counts of criminal possession of a weapon. He could face the death penalty if convicted of the federal charges against him and life in prison for the state charges, according to ABC News.
The state and federal proceedings are expected to occur simultaneously.
Upon his arrival in New York, Mangione was placed under arrest by federal authorities.
Defense attorney Karen Friedman Agnifilo said Mangione would not initially contest pretrial detention, and he was taken into police custody.
Mangione then made his initial appearance in Manhattan federal court the same day, hours after the unsealing of a criminal complaint charging him with stalking and murdering Brian Thompson. He did not enter a plea.
Agnifilo said her client was prepared to appear in state court and said the federal charges were sprung on them.
"This is a highly unusual situation we find ourselves in," Agnifilo said. "I have never seen anything like that."
She said the theories of the two cases appear to be in conflict, noting the state case accused Mangione of terrorizing a group of people while the federal case accused him of stalking an individual.
Luigi Mangione walking into court today. pic.twitter.com/YqyhcKYbLx
— Pop Crave (@PopCrave) December 23, 2024
Mangione, 26, is suspected of fatally shooting Thompson on December 4 outside a Manhattan hotel. The suspect fled using a electric bike and was later apprehended at a McDonald’s in Altoona, Pennsylvania after a days-long manhunt. Police officers found a gun, a manifesto, and $8,000 in cash. He was extradited to New York last week.
It was later revealed that Mangione suffered from a series of health issues. Years before the incident, he wrote about his struggles online, complaining about brain fog, chronic pain, and neurological problems, according to The Wall Street Journal. “The people around you probably won’t understand your symptoms—they certainly don’t for me,” Mangione wrote in July 2018, according to WSJ.
Mangione suffered from spinal conditions that had a negative impact on his life until he underwent surgery in 2023. I got caught in this loop for a year, all the while putting my life on hold in my 20s and damaging my nerves while I waffled with the decision,” Mangione said about spinal-fusion surgery.
Chronic pain can affect sleep and stress, and is often connected to mental health. Pain can also fray a person’s social connections, said Dr. Padma Gulur, a pain-medicine specialist at Duke Health.
“It can be very disruptive,” she said.
Mangione underwent surgery that July, his posts show. Spinal-fusion surgery involves connecting vertebrae with screws and rods to stabilize the spine. It is usually offered after more-conservative efforts such as physical therapy don’t work. The surgery is successful some 85% of the time, spine surgeons said.
“At day eight I was taking zero pain meds and haven’t had a bad day since,” Mangione said in October 2023.
The alleged shooter wrote a post on Reddit in which he suggested that readers tell doctors that they are “unable to work” if they need to get approved for spine surgery. He indicated that “the medical industry responds to these key words far more urgently than you describing unbearable pain and how it’s impacting your quality of life.”