Larry Nassar, the former USA gymnastics coach who sexually abused young athletes under the guise of medical treatment, was sentenced to 40 to 175 years behind bars on Wednesday.
“I just signed your death warrant,” Judge Rosemarie Aquilina said. "You do not deserve to walk outside of a prison ever again."
Nassar pleaded guilty in November to 10 counts of first-degree criminal sexual abuse for molesting young athletes. He has already been sentenced to 60 years in federal prison on child pornography charges.
Aquilina handed down her sentence — met with applause when court adjourned — at the end of a powerful seven-day hearing where 168 people emotionally confronted Nassar about his abuse of mostly young, teenage girls.
Many who came forward were training as high-level gymnasts. Some were Olympic gold medal winners. Others were tearful family members, devastated coaches, and advocates for survivors of sexual abuse. Most used their names publicly, while several dozen chose to remain anonymous.
The last day of the hearing at the Ingham County Courthouse in Michigan was filled with moving statements, a gripping monologue by the judge, and comments from Nassar himself. At times, people in the courtroom gasped in shock or shouted at the disgraced doctor, wearing a blue prison jumpsuit.
The final survivor to speak on Wednesday was Rachael Denhollander, the person who first spoke out about Nassar's abuse in a 2016 IndyStar investigation.
Denhollander requested the judge to give Nassar the maximum sentence, asking, "How much is a little girl worth?"
Nassar tried to pause and turn away from the judge several times during his address, but she ordered him to continue.
"Your words these past several days have had a significant emotional effect on myself and has shaken me to my core," he said to his dozens of victims. "I will carry your words with me for the rest of my days."
Aquilina questioned the sincerity of Nassar's statement by reading from a letter he submitted to the court last week saying he wasn't sure he could mentally handle the number of victim impact statements.
Aquilina read a section of the letter in which Nassar wrote he is a good doctor because his patients came back to him repeatedly for treatment.
"The media convinced them everything I did was wrong," he wrote in his letter.
"Hell hath no fury like a woman scorned," the letter continued as people in the courtroom burst into disbelieving laughter.
Aquilina tossed Nassar's letter in disgust, asking him if he wanted to withdraw his plea before continuing with sentencing, telling Nassar that what he did was not a medical treatment.
"You have not yet owned what you did," she said. "You still think somehow you are right, that you are a doctor, that you don't have to listen, and that you did treatment? I wouldn't send my dogs to you, sir."
More than 140 women, including Olympic medalists McKayla Maroney, Simone Biles, Gabby Douglas, and Aly Raisman, have accused Nassar of abuse.
The women accused Nassar of inserting ungloved fingers into their vaginas and rectums while they believed they were being treated for sports injuries and pains.
"He abused my trust, he abused my body, and he left scars on my psyche that will never go away," Maroney said in a statement provided to the court during sentencing. "It all started when I was 13 or 14 years old. It didn't end until I left the sport."
Raisman, a six-time Olympic medalist, used her impact statement to slam USA Gymnastics, saying the organization is "rotting from the inside" for empowering and enabling Nassar's sexually abusive behavior.
"I will not rest until every last trace of your influence on this sport has been destroyed like the cancer it is,” Raisman said in court.
Denhollander, who was 15 years old when Nassar first abused her in 2000, also used her statement to detail times when girls and women spoke up about Nassar only to not be believed.
"Nobody 'knew' because nobody handled the reports properly," she said. "The victims were silenced."
"I wondered almost daily if there was any chance that my voice would ever be heard," she added.
Denhollander became the first person to publicly speak out against Nassar's abuse in an interview with the IndyStar in 2016.
"No matter the cost, it was right," she said about her decision to come forward.
Aqulina praised Denhollander from the bench for speaking out, calling her the "five-star general" of the "army of survivors."
"You started the tidal wave," Aquilina told Denhollander. "You made all of this happen. You made all of these voices matter. Your sister survivors and I thank you."
Several athletes criticized USA Gymnastics and Michigan State University, saying they reported Nassar but nothing was done to stop his abusive behavior.
According to a Detroit News investigation, at least 14 people at Michigan State University received reports about Nassar's behavior in the 20 years before his arrest. The National Collegiate Athletic Association on Wednesday sent a letter of inquiry into how Michigan State University handled reports of Nassar's abuse.
After a survivor said she was abused by Nassar at her high school, Holt Public Schools Superintendent David Hornack issued a statement saying, "We are in the process of identifying next steps to investigate and take appropriate remedial action."
Additionally, authorities are investigating the Karolyi Ranch, the Texas training facility where several gymnasts, including Raisman, Biles, and Maggie Nichols, said they were sexually abused.
USA Gymnastics announced last week that it will no longer use the facility for training purposes. The ranch has been the most important training facility for US gymnastics for the past 16 years.