“The mayor should know more than anyone about the presumption of innocence… he was trying to distract from those issues,” she said via the New York Post.

Mangione later gave a thumbs up to the more than 30 supporters outside the court room and was seen grinning in a police car while leaving the courthouse. The 26-year-old faces one count of first-degree murder and two counts of second-degree murder in relation to the killing of Thompson in Manhattan on December 4, as well as other weapon and forgery charges stemming from his arrest in Altoona, Pennsylvania, on December 9.

“This was a frightening, well-planned, targeted murder that was intended to cause shock and attention and intimidation,” said Manhattan District Attorney Alvin Bragg at a news conference Tuesday afternoon via CNN. “It incurred in one of the most bustling parts of our city, threatening the safety of local residents and tourists alike, and commuters and business people just starting out on their day.”

Mangione, an Ivy League graduate from a prominent Maryland real estate family, was arrested in Altoona after a McDonald's employee spotted him eating at the restaurant and believed he resembled the then-wanted gunman linked to the Manhattan shooting. The suspect was found carrying a ghost gun, masks and a manifesto linked to the incident at the time of his arrest, authorities confirmed.

Mangione was reported to have lost touch with his loved ones in recent weeks, with his mother reporting him missing, possibly from a home in San Francisco, on November 18, law enforcement sources told the New York Post after his arrest. Aaron Cranston, a former classmate at the Gilman School in Baltimore, told the New York Times that Mangione's family sent a message to peers indicating that he hadn't been in touch since undergoing back surgery several months prior while trying to find him earlier this year.

RJ Martin, a friend and former roommate who lived with Mangione in Hawaii, told CNN that the suspect had previously discussed his back issues.

“When I first interviewed him, before he moved in, I remember he said he had a back issue, and he was hoping to get stronger in Hawaii,” Martin said, who claimed the issues were so "traumatic and difficult" that Magnione was bedridden for a week after one basic surfing lesson.

Martin said Mangione sent him images of X-rays after he underwent surgery.

“It looked heinous, with just giant screws going into his spine,” he said.

Several sources indicated that Mangione may have held a grudge against the UnitedHealthcare CEO due to his interactions with the medical industry, having shared an X-ray photo that showed four pins in a spine on his X account, as well as having five books involving chronic back pain on his Goodreads account reading list.

Dennis Manoloff