Luigi Mangione lashed out while being led inside a Pennsylvania courthouse for his extradition hearing Tuesday, serving as the latest flashpoint for the Ivy League graduate charged with murdering UnitedHealthcare’s CEO on the streets of Manhattan.  

Mr. Mangione, 26, yelled out that something was “completely out of touch and an insult to the intelligence of the American people” as Blair County Sheriff’s Office deputies wrangled the inmate and pushed him inside for his extradition hearing.

According to a manifesto posted online Tuesday, he saw American health-care executives as “parasites” who deserve to be killed.

He was also denied bail during his Tuesday hearing and is delaying his extradition to New York by fighting it in court.

Tom Dickey, a defense attorney retained by the suspect, said he’s been hired to resist the extradition effort.

“We’re going to fight this along the rules and with the Constitutional protections that my client has,” said Mr. Dickey, who is based in Altoona, Pennsylvania.

SEE ALSO: Journalist releases full text of Luigi Mangione’s manifesto

New York Gov. Kathy Hochul said she plans to file a warrant for Mr. Mangione’s extradition from the Keystone State.

“Public safety is my top priority and I’ll do everything in my power to keep the streets of New York safe,” Mrs. Hochul said in a statement.

Authorities are looking to return the suspect to Manhattan to face second-degree murder charges in the killing of United Healthcare executive Brian Thompson. He was arrested Monday morning after a McDonald’s employee spotted him inside the fast-food restaurant in Altoona, Pennsylvania, and phoned police.

New York Police Department officials have said from the beginning that Thompson, 50, was targeted in the Dec. 4 killing. But under New York state law, premeditation is not a sufficient circumstance to make a killing a first-degree murder.

The most serious murder charge in the state is reserved for people who kill law enforcement officers, kill for hire, kill a witness, kill people while torturing them, kill someone while robbing or kidnapping them, or kill someone while serving a lengthy prison sentence.

Mountains of evidence is linking Mr. Mangione to the slaying of Thompson as prosecutors filed charging documents against the once-affable young professional who lost touch with family and friends following a major back surgery months ago.

New York prosecutors said surveillance footage captured the suspect leaving a hostel in the Upper West Side roughly an hour before Thompson was gunned down on Sixth Avenue.

The suspect checked into the hostel with what police said was a fraudulent New Jersey ID under the name “Mark Rosario.” Pennsylvania authorities said Mr. Mangione presented the same fake ID to officers when he was detained Monday in Altoona.

He was also caught with what police said was the gunman’s clothing, a 3D printed gun with a silencer and a three-page manifesto that characterized Thompson’s killing as a “symbolic takedown” to the alleged corruption within the healthcare industry.

The manifesto largely resembles progressive talking points on health care, and, the Ivy League graduate said “frankly, these parasites simply had it coming.”

“A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No,” he wrote.

He acknowledges in the writing that health care is a complex issue on which he is not an expert, but he forthrightly blamed the profit motive and said everybody knows that.

“Evidently I am the first to face it with such brutal honesty,” he concluded.

White House press secretary Karine Jean-Pierre said it was “unacceptable” for anyone to resort to “horrific violence to combat corporate greed” during a Tuesday afternoon briefing.  

Mr. Mangione did not enter a plea during his initial arraignment late Monday in Pennsylvania.

In New York, Mr. Mangione is facing one count of second-degree murder, two counts of second-degree criminal possession of a weapon, one count of second-degree possession of a forged document and one count of third-degree criminal possession of a weapon in New York City.

“We do have a lot of evidence in this case,” NYPD Commissioner Jessica Tisch told Good Morning America on Tuesday. “There’s a lot of reasons that we feel very strongly that he is the person of interest.”

He is facing weapons and forgery charges in Pennsylvania as well.

The killing has completely blindsided those who have long known the suspected gunman.

“Our family is shocked and devastated by Luigi’s arrest,” Mr. Mangione’s family said in a statement, which was released by his cousin, Maryland state Delegate Nino Mangione, a Republican. “We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved.”

Mr. Mangione’s mother filed a missing person’s report on Nov. 18 after not hearing from him for a period of time following back surgery.
New York Police Department officials said his last known address was in Honolulu.

R.J. Martin, the co-founder of a community living space named Surfbreak, told local ABC news station KITV that Mr. Mangione moved to the city in 2022.

He said it’s “unimaginable” that Mr. Mangione, who was well liked by the other people living at Surfbreak, would be implicated in the health care executive’s killing.

“Never once talked about guns, never once talked about violence,” Mr. Martin told the station. “He was absolutely not a violent person, as far as I could tell.”

Mr. Martin did say that the suspect talked about a lingering back issue when he arrived at the commune.

Mr. Mangione read multiple books about dealing with chronic back pain, according to his GoodReads profile, and CNN reported that posts from a Reddit user matched Mr. Mangione’s own back issues.

The user talked about wrestling with spondylolisthesis, a condition in which vertebrae in the lower back can slip out of place.

The Reddit user mentioned a surfing accident where his back and hips locked up and caused sporadic numbness. The user said he was “terrified of the implications.”

Mr. Martin told Honolulu media that Mr. Mangione injured his back during a surf lesson, and it left him bedridden for a week.

Mr. Mangione needed surgery to fix the issue, Mr. Martin said. An X-ray photo of the spinal fusion surgery — where four large screws were implanted into his back — can be seen in the banner photo on the suspect’s X account.

“I know it was really traumatic and difficult,” Mr. Martin said. “You know when you’re in your early 20s and you can’t, you know, do some basic things. It can be really, really difficult.”

Possibly reflecting a personal angle on the manifesto’s critique of the health-care system, Mr. Mangione could be heard yelling about “lived experience” on Tuesday as deputies pushed him into the courthouse.

The Surfbreak founder said he stayed in touch with Mr. Mangione even after he moved out of the community in mid-2022. However, he said the suspect went “radio silent” in June or July.

Interactions on Mr. Mangione’s social media accounts appear to verify his retreat from social life.

One friend reached out in July on X to say “Hey man, I need you to call me. I don’t know if you are ok or just in a super isolated place … But I haven’t heard from you in months.”

In late October, another friend reached out on X to say ”Hey, are you ok? Nobody has heard from you in months, and apparently your family is looking for you.”

Mr. Mangione comes from a wealthy Maryland family that owns the nursing home chain Lorien Health Services, a Maryland radio station, the Turf Valley Resort and the Hayfields Country Club.

He attended the private Gilman School in Baltimore, graduating as valedictorian in 2016. He later graduated with a bachelor’s and a master’s degree in computer science from the University of Pennsylvania.

According to his LinkedIn page, after graduating, Mr. Mangione worked as a software engineer for the online car sales company TrueCar.

That all seems so distant after Mr. Mangione was pegged as the gunman who shot Thompson dead in Midtown Manhattan last week and managed to evade a massive law enforcement search for five days.

The shooter lurked nearby and waited for Mr. Thompson to come into view before firing at least three rounds at point-blank range at the health care executive.

The suspect then ran through an alley and hopped onto an electric bike, which he rode into Central Park.

Police said the gunman ditched his backpack in the park and caught a taxi to the George Washington Bridge Bus Station in northern Manhattan. Authorities said he boarded a commuter bus that took him out of the state.

The gunman appeared to be undone by one minor slip: a brief moment when he pulled down his mask to flirt with someone in New York City.

Joseph Kenny, the chief of detectives for NYPD, said mass distribution of a photo of the suspect’s uncovered face was “the key to this case” during a Tuesday appearance on Good Morning America.

A McDonald’s employee in Pennsylvania noticed Mr. Mangione’s distinctive look, and called police soon afterward.

• Matt Delaney can be reached at mdelaney@washingtontimes.com.