Luigi Mangione will use a psychiatric defense during his upcoming state murder trial for the killing of UnitedHealthcare CEO Brian Thompson, a Manhattan judge announced Wednesday.
Judge Gregory Carro stated that Mangione’s legal team has notified the court they will attempt to prove the 28-year-old was suffering from “extreme emotional disturbance at the time of the occurrence.” If the defense is successful, Mangione could be committed to a psychiatric treatment facility rather than being sentenced to prison.
The judge’s announcement follows a secret, closed-door hearing held two weeks ago at the request of the defense. Judge Carro revealed he now intends to unseal the records and transcripts tied to that hearing and the subsequent decision to mount a psychiatric defense.
“The reasons for the sealing was to give the defense an opportunity to determine whether they were going forth with that defense and the nature of that defense,” Carro said.
However, Mangione’s defense attorney, Karen Friedman Agnifilo, strongly opposed making the details public. She argued that releasing the transcripts of the hidden hearing would directly harm Mangione’s separate federal case, where a psychiatric defense is legally unavailable.
“The reason why we asked for the sealing is that this defense is not available federally and Mr. Mangione is being prosecuted federally and this is prejudicial to his defense to the exact same facts,” Friedman Agnifilo said in court.
The decision was initially scheduled to be handed down on Tuesday, but the proceeding was delayed by a day because prosecutors failed to inform the jail that Mangione was required in court. On Wednesday, Mangione sat quietly between his attorneys wearing a blue suit and a light-colored button-down shirt. His state murder trial is scheduled to begin on September 8.
Mangione has pleaded not guilty to both state and federal charges linked to the December 4, 2024, killing of the 50-year-old insurance executive. Thompson was shot from behind by a masked gunman as he walked toward a Manhattan hotel for UnitedHealth Group’s annual investor conference. Investigators later revealed that the words “delay,” “deny,” and “depose”—phrases commonly associated with how insurance companies reject claims—were written directly on the ammunition.
Mangione, an Ivy League graduate from a wealthy Maryland family, was arrested five days after the shooting at a McDonald’s in Altoona, Pennsylvania, roughly 230 miles west of New York City.
During a previous hearing on May 18, Judge Carro ruled that key items seized during the arrest—including a 3D-printed pistol matching the weapon used in the shooting and a handwritten notebook—could be introduced as evidence. According to prosecutors, the notebook detailed plans to “wack” a health insurance executive and described a desire to rebel against a “deadly, greed fueled health insurance cartel.”
In a separate ruling on Wednesday, Judge Carro dismissed one minor charge against Mangione regarding a gun magazine. The judge had previously deemed the magazine inadmissible because police discovered it during an improper initial search of Mangione’s backpack at the Pennsylvania McDonald’s.
Mangione faces a maximum sentence of life in prison if convicted in either his state trial or his federal stalking trial, which is scheduled to begin on October 13.
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