Suspect Luigi Mangione is taken into the Blair County Courthouse on Tuesday, in Hollidaysburg, Pa. Benjamin B. Braun/Pittsburgh Post-Gazette via AP

Authorities have charged Luigi Mangione, 26, with murder in the shooting death of Brian Thompson, the UnitedHealthcare chief executive who was killed in New York City last week.

While arriving at the courthouse for his extradition hearing, Mangione appeared to struggle with officers and shouted something about “an insult to the intelligence of the American people” toward a throng of journalists nearby.

At the hearing, he did not consent to being extradited to New York, where he faces a murder charge and other counts in connection with Brian Thompson’s death there, Mangione’s lawyer said Tuesday at a hearing where the suspect appeared.

Thomas M. Dickey, Mangione’s attorney, argued that his client deserved to have bail set. The judge declined to do so, and Mangione will remain in a Pennsylvania state prison.

Peter J. Weeks, district attorney in the area where Mangione was arrested in Pennsylvania, has said that if Mangione challenges his extradition, the process could take up to 45 days.

New York police say Mangione killed Thompson, 50, with a fatal shot to his torso. According to a complaint made public Tuesday, police think Mangione is the person who killed Thompson based on evidence that includes “written admissions about the crime” as well as surveillance footage.

A handwritten document found with Luigi Mangione expresses anger toward the U.S. health-care system, according to police.

Joseph Kenny, chief of detectives for the New York Police Department, said Tuesday that the document gives “some indication that he’s frustrated” with that system.

“Specifically, he states how we are the number one most expensive health-care system in the world, yet the life expectancy of an American is ranked 42 in the world,” Kenny said on “Good Morning America.”

Law enforcement officers escort Luigi Mangione, handcuffed, into a courthouse building in Hollidaysburg, Pa. on Monday. WJAC/Pennsylvania Department of Corrections via AP

Kenny said there were other criticisms as well. In the document, Kenny said, the suspect wrote “a lot about his disdain for corporate America, and in particular the health-care industry.”

Authorities arrested Mangione Monday in central Pennsylvania after a five-day manhunt that began when Thompson was shot on a Manhattan sidewalk Wednesday.

Mangione is charged in New York with second-degree murder, gun possession and possessing a false instrument, a charge that covers a fake New Jersey identification under the name Mark Rosario that authorities think Mangione used to check into a Manhattan hostel on Nov. 24, 10 days before the crime. He faces five counts in total.

He was arraigned in a courthouse near Altoona, Pennsylvania, and was denied bail. He also faces five counts in that state, including carrying a firearm without a license, possessing instruments of a crime and providing law enforcement with false identification.

The Mangione family said in a statement it was devastated but couldn’t comment further.

“Our family is shocked and devastated by Luigi’s arrest,” said the statement posted by Nino Mangione, the suspect’s cousin and a member of the Maryland House of Delegates. “We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved.”

The Mangione family’s impact can be found throughout the Baltimore area.

Family businesses include radio station WCBM-AM and Lorien Health Services.

Maryland House of Delegates member Nino Mangione, R, is Luigi Mangione’s cousin. Nicholas “Nick” Mangione Sr., Luigi Mangione’s grandfather who died in 2008, was a real estate developer and prominent businessman. His grandmother Mary was described in her 2023 obituary as a board member of the Baltimore Opera and past president of the Catholic Daughters of the Americas.

Nick and Mary Mangione purchased Turf Valley Country Club in Ellicott City, Maryland, in 1978. About two decades later, they established the Hayfields Country Club in Cockeysville, Maryland, where, records show, Luigi Mangione’s parents have long owned a home.

In the criminal complaint document, a New York City detective gives the reasons for the charges and the timeline around the crime. He wrote that he reviewed video footage of UnitedHealthcare CEO Brian Thompson’s killing, stating that it showed a man “wearing a distinctive clothing outfit” approach the executive and fire a gun with a silencer attached at him early Wednesday. Mangione “is the person shooting and killing Brian Thompson” in that footage, the detective wrote.

The detective said that conclusion was based on surveillance footage showing “the same man, wearing the same clothing,” departing from a hostel on New York’s Upper West Side earlier that same morning. Surveillance footage also showed the same person checking into that hostel on Nov. 24 and providing a driver’s license to check in, the detective continued. The hostel’s records then showed that the person used a New Jersey license with the name Mark Rosario on it.

Police in Altoona, Pennsylvania, who arrested Mangione on Monday after a five-day manhunt, have said that when they approached him, he handed them a New Jersey license with the name Mark Rosario on it. That license, the Altoona police concluded, was a fake, and New York police say it was the same one used to check into the hostel on Nov. 24.

In Mangione’s belongings, the New York police added, an Altoona officer found a pistol, silencer “and written admissions about the crime.”

The information on Thompson’s cause of death is attributed to a New York City police detective who said they were present for the UnitedHeathcare CEO’s autopsy.