Larry Nassar was sentenced to 40 to 125 years in prison on Monday after pleading guilty to three counts of criminal sexual conduct in Eaton County, Michigan.
"I am not convinced that you truly understand that what you did was wrong and the devastating impact that you've had on the victims, family and friends," Judge Janice Cunningham said in delivering the sentence.
Nassar on Monday apologized to the court as part of his sentencing hearing in Eaton County, Michigan, saying that the victim impact statements had "impacted me to my innermost core."
"With that being said, I understand now that it pales in comparison to the pain, trauma and emotions that you all are feeling," he said.
Michigan Assistant Attorney General Angela Povilaitis asked that he receive 40 to 125 years in prison.
The sentence in Eaton County court was the third sentence in as many months for Nassar, the once-renowned doctor for USA Gymnastics and Michigan State University who sexually abused young girls for more than two decades.
His time in court has been notable for the passionate, righteous speeches from the survivors of his abuse. Nearly 200 girls and women -- ranging from accomplished Olympic gymnast Aly Raisman to a 12-year-old poet named Amanda on Friday -- spoke out in person or in statements about how Nassar's sexual abuse changed their lives.
"How much is a little girl worth?" Rachael Denhollander, the woman who first brought Nassar's abuse to public attention in 2016, asked the court in Eaton County on Friday.
"I am asking you to tell these little girls, tell the young women, tell the watching world, that they are worth everything," she told the judge.
The heated atmosphere over the past few weeks culminated Friday when Randall Margraves, a father of three victims, tried to attack Nassar in open court.
Nassar, meanwhile, has mostly sat quietly, occasionally shaking his head or wiping away tears. Before the sentence is delivered Monday morning, he will have a final chance to speak after the Michigan attorney general's office and his defense attorney.
That may be the last time Nassar is heard from publicly, but his impact is far from over . The stunning victim impact statements from the " army of survivors " have focused sharply critical attention on the systems of power that protected Nassar for so long.
Michigan State University, USA Gymnastics and the US Olympic Committee have denied they helped cover up the abuse. Still, the organizations have seen major leadership shake-ups and face extensive legal investigations into their inner workings to find out who knew what, when they knew it and what they did about it.
"As detectives, attorneys and survivors have previously noted, a pedophile cannot flourish in the way Larry did in an environment that is not conducive to his behavior," abuse survivor Annie Labrie said in court Wednesday.
"He was prolific because surrounding authorities allowed him to be. Because the gymnastics world allowed him to be."
How we got here
As recently as a few years ago, Nassar was widely respected in the gymnastics community and beyond for his treatment of injured athletes. For years, he claimed that his invasive " pelvic floor " treatment, in which he put his fingers into young girls' vaginas, was a cure-all that could fix any number of physical injuries.
A number of his victims said they felt violated during the procedure and complained to coaches, trainers or even police. But he was a respected doctor who treated the world's best gymnasts. Their concerns were brushed aside or otherwise dismissed, and Nassar continued to abuse his patients.
In 2014, for example, Amanda Thomashow told Michigan State Title IX investigators and MSU Police that his treatment was really sexual assault. Nassar, who told police he was known as " the body whisperer " for his close relationship with patients, said Thomashow simply didn't understand the procedure. The investigation ultimately cleared him of misconduct, and Nassar returned to abusing patients.
"I think that the way that my investigation was handled was not in a way to bring out the truth, but instead it was performed in a way to conceal and protect a pedophile," Thomashow said .
Separately, USA Gymnastics said it became aware of Nassar's sexual abuse in the summer of 2015 when three top gymnasts said he abused them. After several weeks of its own investigation, the organization reported the allegations to the FBI in late July. Nassar was no longer allowed to treat patients at USA Gymnastics, but he continued to abuse young girls at Michigan State amid a slow FBI investigation .
That abuse went on until September 2016, when The Indianapolis Star published allegations against Nassar from Rachael Denhollander and an unnamed Olympic gymnast. After that first story, more than 50 women reported similar instances of sexual abuse, and Nassar was arrested in November 2016.
The 54-year-old's life since then has been a series of guilty pleas, court hearings and prison sentences.
Nassar pleaded guilty to federal child pornography charges and was sentenced to 60 years in prison in December . He pleaded guilty to seven counts of criminal sexual conduct in Ingham County in Michigan and was sentenced to 40 to 175 years in prison two weeks ago. And he pleaded guilty to three counts of criminal sexual conduct in nearby Eaton County as well.
"I've just signed your death warrant," Ingham County Judge Rosemarie Aquilina said as she delivered the sentence.