Stanwood Elkus (Hand In, Daily Pilot / August 8, 2014)

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A man facing murder charges in the shooting death of a Newport Beach doctor in an exam room entered an insanity plea in Orange County Superior Court on Friday.

Stanwood Elkus, 76, cupped his ears and leaned forward as Judge Gregg Prickett explained that he could spend the rest of his life in a state mental hospital if a jury found him insane.

"Yes, your honor," Elkus said twice from a cage in the courtroom, affirming that he understood.

Elkus, a retired barber from Lake Elsinore, already faces up to life in prison without the possibility of parole if convicted of special-circumstances murder with the use of a firearm.

Prosecutors say Elkus used a fake name to make an appointment with prominent urologist Ronald Gilbert and then shot the doctor to death in his Hoag Hospital-affiliated office in January 2013.

During a hearing last May, a police detective testified that Elkus told a nurse, "Call the police, I'm insane, call the police," moments after firing multiple bullets into Gilbert's chest.

Elkus, however, not only pleaded insanity but also entered a standard not-guilty plea Friday.

His attorney, Colleen O'Hara, said she will pursue the insanity defense if Elkus is convicted of murder. If he is convicted of a lesser crime, like manslaughter, she won't.

During a 2013 jailhouse interview with the Daily Pilot, Elkus said Gilbert performed prostate surgery on him at a Veterans Affairs hospital decades ago and that the effects of the operation left him angry.

Gilbert worked at the VA hospital during that period but didn't perform the surgery on Elkus, a lawyer for the doctor's family said at the time.

Elkus' trial won't begin for at least a month, according to O'Hara.

Before that, the court will appoint at least two mental-health experts to evaluate Elkus, she said.

O'Hara said she has already consulted her own medical experts.

"Very quickly I saw what the issues are related to the defense," she said.