Luigi Mangione—Accused of Murdering UnitedHealth CEO—to Invoke Psychiatric Defense in State Trial

Luigi Mangione, who stands accused of murdering UnitedHealth CEO Brian Thompson in 2024, will assert a psychiatric defense in his state murder trial, the New York judge presiding over the case revealed Wednesday.

The Associated Press reported that Judge Gregory Carro of the New York State Supreme Court in Manhattan said Mangione’s legal team informed him that they will argue that the 28-year-old defendant suffered from “extreme emotional disturbance" when he allegedly gunned down Thompson outside the New York Hilton Midtown Hotel just after dawn on December 4, 2024.

The defense strategy would be an admission that Mangione killed Thompson, but did so due to mitigating circumstances. The precise nature of the claimed psychiatric issue remains under seal, but it has been reported that Mangione suffered chronic back pain for years and harbored deep animosity toward the for-profit health insurance industry that dominate the US system.

Court documents indicate that Mangione's lawyers previously sought additional time to decide whether to pursue a mental health defense.

Extreme emotional disturbance is not the same as pleading guilty by reason of insanity, which would result in a convicted defendant being sent to a psychiatric facility instead of prison.

On Wednesday, Carro revealed that he had held a secret hearing on the matter earlier this month, and that the session's proceedings were sealed "to give the defense an opportunity to determine whether they were going forth" with the extreme emotional disturbance defense.

The June 3 hearing focused on the psychiatric basis for such a defense, its procedural consequences, disclosure obligations, and potential examinations.

Mangione's attorney, Karen Friedman Agnifilo, decried Carro's decision to unseal details of the secret hearing.

“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,” she said.

Last year, then-US Attorney General Pam Bondi said she would seek the death penalty for Mangione at his federal trial. New York state effectively abolished capital punishment in 2004.

Mangione allegedly shot Thompson, 50, as he walked to the New York Midtown Hilton for UnitedHealth Group’s annual investor conference. Police said the words “delay,” “deny,” and “depose”—a description of how insurance companies avoid paying claims—were engraved in shell casings of bullets used in the attack, which was carried out with a 3D-printed pistol. New York police also said they recovered a three-page handwritten note that expressed "some ill will toward corporate America."

Five days after the shooting, Mangione was arrested after a customer in an Altoona, Pennsylvania McDonald's recognized him and alerted authorities.

Thompson's murder exposed the depth of public rage over corporate greed and a for-profit healthcare system in which thousands of people die each year because they have no insurance, while millions more face financial hardship or bankruptcy.

Mangione is facing state charges of second-degree murder, multiple weapons violations, and possession of a fake ID. More serious charges, including first-degree murder and terrorism, have been dismissed. Mangione's New York trial is set to begin on September 8.