What it was like in the courtroom as Mangione pleaded guilty

Friedman Agnifilo told the judge: “Mr Mangione is prepared to plead guilty at this time.”

From then on it was silent, as the judge asked Mangione a series of questions to ensure he understood the decision he was about to make. She asked him about his background and use of medications. He answered the questions tersely but firmly.

Asked if he understood that he could face life in prison – he replied, “yes”.

Only when began to read a statement to the court, did Mangione appear to falter. His speech was rushed, and somewhat mumbled.

After Judge Garnett politely suggested he lean into the microphone, he continued steadily until he reached his conclusion: an admission that he had killed Thompson.

There had been reports in US media leading up to the hearing that Mangione would be taking a plea deal. That is not what happened – Mangione simply changed his plea of not guilty to guilty.

“After years of enduring severe pains from a broken back” and dealing with the healthcare insurance industry, Mangione stated that he had learned UnitedHealthcare would hold an annual conference in Manhattan in December 2024.

He researched online and emailed the company posing as an investor to learn more about the event, Mangione told the court. “Unlike previous interactions with insurance” he got a quick reply, he said.

He told the court he used a 3D printer to make a gun.

And on the morning of 4 December 2024, Mangione confessed: “I shot Mr Thompson in Manhattan and he died.”