The complex case of Luigi Mangione, the alleged shooter of UnitedHealthcare CEO Brian Thompson, has raised significant legal and medical questions about culpability and treatment for individuals whose actions may stem from severe neuropsychiatric and biochemical impairments caused by infections like Lyme disease (LD). Leveraging findings from studies by Dr. Robert Bransfield and the recent case report on late-stage borreliosis and substance abuse published by Dr. Bransfield and Dr. Monica Embers et. al., this blog explores whether Mangione should be detained in jail or committed to a mental health institution under CPL Article 730.¹

CPL 730: Understanding Competency to Stand Trial
Under New York’s CPL § 730, a defendant must possess the mental capacity to understand the charges against them and assist in their defense. If a court finds reasonable grounds to question a defendant’s competency, it may order psychiatric evaluations. Defendants deemed incompetent are committed to a mental institution until they can participate in legal proceedings. ¹

The Role of Lyme Disease in Mental State Impairments
Research by Dr. Bransfield has identified Lyme disease as a significant contributor to neuropsychiatric symptoms, including impulsivity, paranoia, explosive anger, and disinhibition. ² These findings are supported by the case of a late stage borreliosis patient who committed homicide and suicide during a period of neuroinflammation exacerbated by substance withdrawal. ³

In Mangione’s case, if untreated Lyme disease or co-infections caused neuroinflammation and biochemical disruptions, his ability to control his actions or understand their consequences may have been severely impaired. Evidence of persistent brain inflammation, such as quinolinic acid (QA) accumulation and activated microglia identified in the borreliosis case report, further supports the hypothesis that these infections can alter behavior and impulse control. ⁴

Justice vs. Treatment
Sending Mangione to jail without addressing the underlying medical conditions would likely exacerbate his symptoms, perpetuating suffering without addressing the root cause. Commitment to a mental health institution would prioritize treatment, offering Mangione the care needed to manage his condition while ensuring public safety. ⁵

Policy and Prevention Implications
The Mangione case highlights the urgent need for better diagnostic protocols and treatment for Lyme disease and other tick-borne illnesses. Early intervention could mitigate the neuropsychiatric symptoms that contribute to such tragic outcomes. Courts must also consider these medical realities when determining appropriate pre-trial detention for defendants like Mangione.

This case is not just about one individual, it’s a call to reform how the legal and medical systems address the intersection of infectious disease and mental health.

About the Author
Richard Johannesen is an experienced attorney admitted to practice law in the State of New York. In addition to his legal practice, he is the co-host of the Tick Boot Camp Podcast, a platform dedicated to raising awareness about Lyme disease and other tick-borne illnesses.

Footnotes

1. CPL § 730.10 – New York statute outlining competency to stand trial.
2. Bransfield, R.C. (2018). “Aggressiveness, violence, homicidality, homicide, and Lyme disease.” Neuropsychiatric Disease and Treatment, 14, 693-694. DOI: 10.2147/NDT.S155143.
3. Bransfield, R.C., et al. (2024). “Late-stage borreliosis and substance abuse.” Heliyon, 10 (2024), e31159. DOI: 10.1016/j.heliyon.2024.e31159.
4. Quinolinic acid and activated microglia are associated with neuroinflammation, contributing to behavioral dysregulation. Heliyon, 10 (2024), e31159.
5. New York Criminal Procedure Law provides mechanisms to commit individuals to mental health institutions for treatment when they are deemed incompetent to stand trial. CPL § 730.