Dr. Nassar, 54, was accused of sexually molesting girls for years under the guise of undergoing tests or receiving medical treatment. Some were as young as 6. Many of them were Olympic gymnasts. In November, he pleaded guilty to sexually abusing seven girls. He had already been sentenced to 60 years in federal prison for convictions for child pornography.
The case and its ramifications are far from over. It has ignited indignation in the world of sports and beyond, which has led to the resignation this week of the president and several board members of the governing body of gymnastics in the United States, U.S.A. Gymnastics. Last week, the organization cut ties with the private training center on a remote ranch in Texas where some of the abuses occurred.
And at Michigan State, where Dr. Nassar spent years on the faculty and treated many of his athletes, an outpouring of political pressure led to the resignation of the university's president, Lou Anna K. Simon, to last Wednesday hour.
Mrs. Simon's resignation may have just been the beginning in the State of Michigan, such as N.C.A.A. on Tuesday formally opened an investigation into the conduct of the university.
The US Olympic Committee, which some of the young women condemned for not doing enough to protect them when they joined the team and had to keep seeing Dr. Nassar, said Wednesday that he was now taking measurements. .
Moments after the judge gave his ruling, the Olympic committee issued a statement asking the board of directors of USA Gymnastics to resign and promise additional steps to investigate the conduct of Dr. Nassar and ensure that the athletes do not suffer damages in the future. The executive chairman of the Olympic Committee, Scott Blackmun, also apologized for not attending the hearing, after the gymnasts deliberately condemned the USS.C. for lack of support.
A series of civil suits have also been filed.
The sentencing hearing, broadcast live over the Internet, captured national attention for extending several days to allow impact statements from victims of girls and women who said they had been molested by Dr. Nassar over the years. Many of the victims had not previously been identified. The initial plans to conclude after four days were altered as more women showed up.
Among those who accused him are the Olympic gold medalists Aly Raisman, McKayla Maroney, Gabby Douglas, Jordyn Wieber and Simone Biles.
The three finalists the victims spoke on Wednesday. Rachael Denhollander, who was one of the first women to file public accusations against Dr. Nassar, was the last to speak at her sentencing hearing. "Larry is the most dangerous type of abuser," he said. "One who is able to manipulate his victims through coldly calculated grooming methodologies, presenting the most healthy and understanding external person as a deliberate means to ensure a steady flow of young children to attack."
Judge Aquilina commended Ms. Denhollander for opening the floodgates. "You're the bravest person I've had in my court," he said.
The sentence carries a minimum of 40 years in prison, adhering to the terms of the plea agreement, but the judge warned that if Dr. Nassar lived improbably longer than any human being, and leave on parole after serving Federal and state convictions, your time in state prison should extend to 175 years.
Nassar also pleaded guilty in November to three counts of sexual abuse in a neighboring county. That sentence is later this month.
The statements of the young women in the last week were strong and sometimes distressed.
"Imagine that you feel you have no power or voice," said Ms. Raisman in Friday's court. "Well, you know what, Larry, I have the power and the voice, and I'm just starting to use them, all these brave women have power, and we will use our voices to make sure you get what you deserve: a life of suffering by reciting the words of this powerful army of survivors. "
As part of a judicial settlement, Ms. Maroney had signed a non-disclosure agreement with USA Gymnastics that would have caused her to be fined more than $ 100,000 for talking about the abuse. After several celebrities offered to pay the fine, the organization said it would not fine her.
"Dr. Nassar was not a doctor," he said. "In fact, it is, it was and always will be a child molester and a monster of a human being."
In the end, however, Judge Aquilina had the last words.
"Your assault decision was accurate, calculated, manipulative, tortuous, despicable," he told Dr. Nassar in part. "I do not have to add words because their survivors have said all that and I do not want to repeat it, they can not be returned their innocence, their youth."
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