Image copyright Reuters Image caption The paedophile tried to claim his accusers "fabricated" allegations for money and fame
Ex-US Olympic gymnastics team doctor Larry Nassar has been sentenced to 40 to 175 years after testimony from nearly 160 of his victims.
The judge dismissed Nassar's attempted apology as insincere, saying he would "be in darkness the rest of his life".
Nassar pleaded guilty to 10 counts of sexual assault against girls and young women, including Olympians.
The 54-year-old had already been sentenced to 60 years for possession of child pornography.
Media playback is unsupported on your device Media caption Larry Nassar speaks as judge says 'I've signed your death warrant'
Judge Rosemarie Aquilina told Nassar during the sentencing: "As much as it was my honour and privilege to hear the sister survivors, it was my honour and privilege to sentence you.
"Because, sir, you do not deserve to walk outside of a prison ever again."
She told the paedophile: "You have not owned yet what you did. I wouldn't send my dogs to you, sir.
"I've just signed your death warrant".
Media playback is unsupported on your device Media caption What it was like to testify against Larry Nassar
Following seven days of emotional testimony from Nassar's victims, he was given an opportunity to address the court.
"What I am feeling pales in comparison to the pain, trauma, and emotional destruction that all of you are feeling," he told the packed courtroom.
"There are no words to describe the depth and breadth of how sorry I am for what has occurred," he added.
A story of survival
Rajini Vaidyanathan, BBC News, Lansing, Michigan
Throughout the seven-day hearing, the stories have been strikingly similar - the former USA Gymnastics team doctor would call the women in for treatment, but instead of taking away their pain, he stole their innocence. Some were so young they didn't realise until years later that they had been sexually abused.
As Larry Nassar sat in his prison overalls, just metres away from them, survivor after survivor looked him in the eye and reminded him of what he'd done to them. And that's been the most extraordinary thing about this hearing.
While the content of their testimony has been harrowing, it's also been inspiring. For survivors of sexual abuse it's hard to relive the experience, let alone do so in front of your attacker.
Follow @BBCRajiniV
But Judge Aquilina revealed he had written a letter to her after his guilty plea claiming his accusers had "fabricated" allegations to gain money and fame.
Court spectators gasped as the judge read a passage in which Nassar said he had been "manipulated" into admitting his guilt.
"I was a good doctor because my treatments worked, and those patients that are now speaking out are the same ones that praised and came back over and over," Nassar wrote.
He added in the letter: "Hell hath no fury like a woman scorned."
As the judge finished her sentence, witnesses in the packed courtroom stood and applauded her verdict.
His sentencing follows a week of harrowing testimony from scores of women, including Olympic gold medal gymnasts Aly Raisman and Jordyn Weiber.
Media playback is unsupported on your device Media caption Racheal Denhollander speaks at Larry Nassar trial
Their teammates, McKayla Maroney, Gabby Douglas and Simone Biles, also revealed they had been abused by Nassar.
In 2015, USA Gymnastics - the sport's top governing body - quietly cut ties with Nassar over allegations about his professional care.
An investigation in 2014 resulted in a three-month suspension from Michigan State University (MSU), where he coached.
But he continued to see patients until he was publicly accused of abuse in a 2016 report by the Indianapolis Star newspaper.
Media playback is unsupported on your device Media caption Sister survivors condemn master manipulator
Later that year, he was arrested and charged by Michigan officials with sexual contact with a child.
A year later, he was sentenced for child abuse images found on his computer.
Rachael Denhollander, who was one of the first women to publicly accuse Nassar, pointed the finger at MSU in court on Wednesday.
"How much is a little girl worth? How much is a young woman worth?" Ms Denhollander, now a lawyer, asked as she described the abuse that occurred when she was 15 years old.
Skip Twitter post by @Simone_Biles To Judge Aquilina : THANK YOU, YOU ARE MY HERO
Shout out to all of the survivors for being so brave & speaking like the queens that you are while looking at that monster. He will no longer have the power to steal our happiness or joy. I stand with every one of you 💛 pic.twitter.com/b5SMmjZgeW — Simone Biles (@Simone_Biles) January 24, 2018 Report
"No one believed because they did not listen," she said, recounting the several times victims told MSU of their allegations.
"Victims were silenced, intimidated, told they were receiving medical treatment, and at times sent back to be further abused.
"This is what it looks like when institutions create a culture when a predator can behave unabated."
Ms Denhollander said trauma at the abuse she suffered had "cast a horrific shadow" over her medical care when she gave birth to three children, including two daughters.
Image copyright AFP Image caption Michigan State University President Lou Anna Simon resigned over the scandal
As the court adjourned on Wednesday, the US Olympic Committee (USOC) announced it would hold an independent investigation into the sex abuse scandal.
"The USOC has decided to launch an investigation by an independent third party to examine how an abuse of this proportion could have gone undetected for so long," USOC chief executive Scott Blackmun wrote in an open letter.
On Tuesday, the National Collegiate Athletic Association (NCAA) said it would investigate MSU's original handling of the gymnasts' abuse claims.
Late on Wednesday MSU President Lou Anna Simon resigned.
After Nassar's sentence was read, lawmakers in the Michigan House of Representatives overwhelmingly approved a resolution calling on her to resign.
"We have lost confidence in the ability of President Lou Anna K Simon to lead a transparent investigation, to implement changes that will ensure it never happens again, to protect students, and to lead Michigan State University forward," the resolution said.
Media playback is unsupported on your device Media caption What it was like to testify against Larry Nassar
Former Olympic doctor Larry Nassar has been handed a jail sentence of 175 years in Michigan for abusing female athletes he was supposed to be treating.
Here, the BBC's Rajini Vaidyanathan, who was in court, and Roland Hughes detail the extraordinary testimony given in court by the survivors of his abuse.
This article contains graphic details of sexual abuse
One hundred and fifty-six young women - mothers, sisters, daughters, Olympians.
All say they were abused by the same man: former Team USA gymnastics doctor Larry Nassar.
Over seven days, they took to the stand one by one to do what few survivors of sexual abuse ever get the chance to do - directly confront their attacker.
Nassar had already pleaded guilty to 10 counts of sexual assault for abusing young girls under the guise of medical treatment.
Women who filed criminal complaints against Nassar spoke out at his sentencing hearing in Lansing. But they were followed by close to 150 others, many of whom chose to do so without the anonymity to which they were entitled.
Kyle Stephens was the first to tell her story.
For years she was known only as Victim ZA, but last Tuesday morning, she stood before Judge Rosemarie Aquilina and calmly shared her name.
In doing so, she waived her anonymity in public just as she was about to testify to the damage her abuser had done.
"I was ready to speak," Kyle said in an interview with the BBC after her testimony. "I think it was really empowering to get up there and give my story from start to finish."
For decades, Larry Nassar abused young women. It was Kyle's call to police that led to him finally being arrested.
Unlike many of the other women who shared their stories in this case, Kyle wasn't a gymnast and a patient of Nassar's. Her parents were friends with his family.
As she stood in the small courtroom, photos of her as a smiling child were projected on to a screen. Nassar first abused her when she was six, "when I still had not lost all my baby teeth".
Image copyright Kyle Stephens Image caption Images of Kyle Stephens as a child were projected on to a screen in court
It began with him exposing himself. Later, he would masturbate before her. Then, he physically abused her - all while both their families were in the same house.
When Kyle, aged 12, told her parents that Nassar would rub his erect penis on her bare feet, he denied it. Back then, her parents did not believe her, and urged her to apologise to him.
"He forced me to grow up really fast," Kyle told the BBC after the hearing. "It was such a benign action until you grow up and realise it was a vile thing."
Image copyright AFP/Getty Images Image caption Kyle Stephens addressed Nassar (foreground) in court
Seven minutes into her testimony last Tuesday, delivered alongside her mother, Kyle looked up at Judge Rosemarie Aquilina and politely asked if she could address Nassar directly.
She reminded him of how her parents invited him round to their home after she had accused him. Sitting in her living room, he had denied abusing her and had said that if she was ever really abused, she should remember to report it.
"Well Larry, I'm here," she told him in court. "Not to tell someone, but to tell everyone.
"Perhaps you have figured it out by now, but little girls don't stay little forever. They grow into strong women who return to destroy your world."
In her teens, Kyle was asked to babysit Nassar's two daughters. Doing so helped her protect them, she told the court, and allowed her to save enough money to pay for counselling.
Having reached a point where she had started to question whether the abuse had indeed occurred, she tried again to explain to her parents what had happened.
This time, they believed her.
Nassar, 54, graduated from the University of Michigan in 1985 and joined the medical staff of the US national gymnastics team based in Indianapolis a year later.
In 1997, alongside his work with the national gym team, he began working as a team physician at Michigan State University (MSU). He began abusing Kyle Stephens a year later.
He worked for the US gymnastics team in four Olympic Games, regularly rushing to the help of gymnasts who might have fallen awkwardly.
Image copyright IOP/AFP/Getty Images Image caption Many of Nassar's victims cited the moment he helped injured gymnast Kerri Strug at the 1996 Olympics, a moment that boosted his reputation as a caring, well-respected doctor
Carrie Hogan, a former softball player at MSU, told the court it was seen as a "privilege" to be treated by Nassar. Successful treatment could make a difference to the university's stars on the brink of a sports career.
"I was very aware of the signed photographs of the Olympic gymnasts he had treated," she said. "He was the best of the best." Others said he was seen as a "god" in the gymnastics world.
In an episode of a gymnastics podcast broadcast in December 2013, Nassar spoke about how important it was to look after young athletes.
"Not just physically but mentally, you have to protect your athletes," he told GymCastic, speaking uncharacteristically slowly. "You have to let them know they will be cared [for]."
He also warned of the danger of mental injury to athletes, saying "the physical injuries almost always they can recover from. The mental injury leaves the scars that keep coming back and haunt them later."
Many of the women who spoke in court said that after he abused them, they were intimidated by his powerful status.
Reporting the offence - if they understood that they had been subject to an offence at all - felt almost impossible.
Nassar had a strikingly similar pattern of how he abused young women, the vast majority of whom were gymnasts.
They came to him often in pain, looking for help.
At their most vulnerable moment, he tried to convince them what he was doing was normal - even talking about everyday life and joking as he touched them.
Media playback is unsupported on your device Media caption Former gymnast Jeanette Antolin: 'You made me believe you were my friend'
By projecting a sense of normality from his position of authority, Nassar made his victims feel they were wrong to believe this was abuse, and that they would be in the wrong if they complained.
"I remember having the option of keeping my spandex on, which I was very grateful for and chose," said Jennifer Rood Bedford, a volleyball player at MSU between 2000 and 2003.
"He had me lay down face down on the medical table. When he started treatment, I remember him saying his treatment relied upon applying pressure to areas around the pelvis and that this was normal.
"So when he went down there, I just told myself it was normal, that he knows what he's doing and don't be a baby.
"I remember laying there and thinking 'Is this OK? This doesn't seem right'."
Rachael Denhollander, a former gymnast from Michigan, was the first victim to speak up publicly in 2016.
She told the BBC that Nassar abused her during every visit she made to his clinic over a year after she turned 15.
Nassar would position Rachael's mother at the head of the table so she was not able to see what he was doing.
With one hand, he would carry out sports massage. With the other, covered by a towel, he would insert his fingers into Rachael's vagina or anus. In one of their last sessions, he unhooked her bra and fondled her breast - the only time Rachael said she knew she was definitely being assaulted and not treated.
Media playback is unsupported on your device Media caption Nassar reacts as former gymnast Gwen Anderson testifies
Many of the women said their trust in male relatives, partners, doctors, strangers, friends and teachers was destroyed as a result of Nassar's actions.
"My first reaction was to question myself, to blame myself," said Jennifer Rood Bedford.
"I wanted to believe the best in people, but no matter how much I rationalised - he's a doctor, he's treating you, he didn't mean for that to happen - I couldn't shake the voice in my head that something wasn't right."
If you have been affected by child sexual abuse, sexual abuse or violence, help and support is available.
If you are in the UK, you can find links here: BBC Action Line
If you are in the US, you can contact Rainn, the national sexual abuse hotline, here, or by calling 800.656.HOPE
For Gwen Anderson, a former gymnast who competed for her state of Michigan, the abuse began when she was just 12.
Now, as a teacher to girls of the same age, she says she sees Nassar's actions in an even starker light.
"I teach 12, 13, 14-year-olds every day," she told the court. "And every single day, when I look at them, I am faced with the reality of how young and defenceless we were when you molested us.
"I look at them every single day and I think to myself 'I am their safe place. I am their protector. I am their encouragement. I am their motivator. I am their rock'."
It is unclear when and how Nassar's abuse of his patients started, though the first allegations date to 1994.
In August 2016, the Indianapolis Star published a story detailing allegations of sexual abuse committed by coaches working for USA Gymnastics. It claimed that the sporting body did not report allegations of abuse to relevant authorities.
The initial article did not name Nassar. But after it was published, Rachael Denhollander realised this was her chance to speak up.
The newspaper published allegations against him from two named former gymnasts, including Rachael, a month later.
"I knew this was how it was going to have to be done," she told the BBC outside court. "When you have a predator who is surrounded by two very powerful institutions, one anonymous voice is never going to be enough.
"When you have a predator who is manipulative, gregarious and as engaging as Larry is, you have to be willing to meet him where he is the most comfortable - on very public ground. And never flinch."
Media playback is unsupported on your device Media caption Gold medallists Raisman and Wieber face their abuser
Rachael's bravery helped encourage other women to come forward. In the corridors outside the sentencing hearing, countless women cited Rachael's actions as inspiration for their own decision to speak up.
As a result, instead of 90 survivors sharing their stories of abuse over four days - as had been expected at the start of the hearing - 156 women and girls ended up doing so over seven days.
The feeling in the courtroom throughout was one of collective empowerment and solidarity built through a shared experience of horror.
Last week, four-time Rio Olympic champion Simone Biles issued a statement to say she too had been abused by Nassar. On Friday, Olympic gold medallists Aly Raisman and Jordyn Wieber came to court to detail what he did to them during the 2012 Games in London.
Nassar was eventually arrested on 21 November, 2016.
He was sentenced to 60 years in jail a year later for three counts relating to child sex abuse images on his computer.
He then pleaded guilty to molesting females at his home, at a gymnastics club and in his MSU office, a plea that led to the 156 pre-sentence testimonies.
"I realise what I am feeling pales in comparison to the pain, trauma and emotional disturbance that I have wreaked," Nassar told the survivors as the hearings drew to a close.
"There are no words that can describe the depth and breadth of how sorry I am for what has occurred.
"I will carry your words with me for the rest of my days."
At the start of the hearings, Nassar had stared blankly down at his hands, avoiding eye contact with all those who came forward to speak.
But on Wednesday, his former colleague, gym coach Tom Brennan, stood alongside Gwen Anderson while she was testifying. "Look at her," he yelled at the man he called his former mentor, ordering him to pay attention to the women as they testified.
After that, Nassar appeared to look up and listen to the survivors with greater frequency.
The question of how repentant he was remained unanswered at the end of the hearings, however: Judge Aquilina read excerpts of a letter he sent her, saying he was a good doctor, and that the media had convinced the young women to believe he had acted wrongly.
Media playback is unsupported on your device Media caption Judge Aquilina: 'I have just signed your death warrant'
Judge Aquilina's role in this case was crucial. Almost every testimony began with survivors thanking her for her support and encouragement.
Given that Nassar had admitted his guilt months before, Judge Aquilina had no obligation to be impartial. As she took on the role of therapist, advocate and friend to the women who stood before her, she condemned his actions.
"The monster who took advantage of you is going to wither, much like the scene in the 'Wizard of Oz' where the water gets poured on the witch and the witch withers away," she told one woman after her testimony.
She also encouraged a number of the abuse survivors not to kill themselves when they said they had considered suicide - taking their own lives would hand Nassar victory, she said.
"I know you're a little nervous, pretend you're talking to me and your mum," she told another woman as she prepared to deliver her testimony.
A crime writer in her spare time, Judge Aquilina's words were a powerful force throughout the hearing. She described the women as "sister survivors" and "warriors" who had demonstrated "superwoman steel."
"I didn't want even one victim to lose their voice," she told the court, as she explained why she was prepared to let the hearing go on for as long as it took to hear all of the survivors who wanted to speak.
The survivors, in turn, responded. One after the other waived their anonymity and came to realise this was a chance to take charge of their own story.
Media playback is unsupported on your device Media caption Tiffany Thomas Lopez: "You created an army when you violated us"
Not all the women knew each other, but many acknowledged the invisible bond between them, and the strength they had gained from the others who had spoken in court.
One former MSU softball player, Tiffany Thomas Lopez, told Nassar she was part of "the army you created when you violated us", going on to say: "Your actions have had me by the throat for years. I'm ready to be released from your clench."
As the hearings went on past the four days that were initially scheduled, anger gradually built towards the institutions where Nassar worked.
Aly Raisman, part of the gold medal-winning gymnastics team in the 2012 Olympics, demanded an independent investigation into how Nassar was allowed to continue abusing girls even after complaints were made.
She attacked both USA Gymnastics - an organisation she said was "rotting from the inside" - and the US Olympic Committee for their lack of support. Three senior USA Gymnastics board members subsequently quit.
The focus has now shifted on to who knew what, and when.
Image copyright Reuters Image caption Rachael Denhollander, "the five-star general in the army of survivors"
The Lansing State Journal newspaper reports that seven women or girls made complaints about Nassar to coaches, trainers, police or university officials between 1997 and 2015.
In 2014, an investigation by MSU even cleared Nassar of wrongdoing after a recent graduate accused him of molesting her. Two years later, he was under arrest.
The university has put aside $10m (£7.2m) to reimburse former students for counselling, but is being sued by about 140 women.
On Friday, MSU's board of trustees asked the Michigan attorney general's office to conduct an outside review into how it handled the allegations. There is also growing pressure on MSU President Lou Anna Simon.
As Nassar starts his jail sentence - brought about by a team of female investigators, prosecutors and judges - the battle to seek answers from the authorities is only just starting. Why did they not listen to survivors' stories sooner?
Rachael Denhollander, now a mother of three and a lawyer, was the last to give her testimony on Wednesday. Judge Aquilina called her "the five-star general in the army of survivors".
For Rachael, the sentence has been a vindication of her decision to speak out publicly 16 months ago.
"I'm so deeply grateful for where we are," she told the BBC. "But it's absolutely heartbreaking to me.
"To know that the vast majority of those little girls could have been saved from what they went through is devastating."
If you have been affected by child sexual abuse, sexual abuse or violence, help and support is available.
If you are in the UK, you can find links here: BBC Action Line
If you are in the US, you can contact Rainn, the national sexual abuse hotline, here, or by calling 800.656.HOPE
Larry Nassar was sentenced to 175 years in prison on Wednesday after a highly emotional seven-day sentencing hearing in a Michigan courtroom.
'I just signed your death warrant,' said Judge Rosemarie Aquilinia, referencing the fact that Nassar would never again be a free man and die in prison.
Nassar had agreed to serve a minimum sentence of 40 years as part of a plea deal, with that prison time coming after he completes his 60-year federal sentence for child pornography charges.
He was expected to get a maximum of 125 years in prison, but Judge Aquilina went well beyond that mark.
Prior to that, the pedophile doctor addressed his victims in a brief statement, choosing to turn and face the women as he made his remarks.
'Your words these past several days, your words, have had a significant emotional effect on myself and has shaken me to my core,' he mumbled through tears.
'I also realize what I'm feeling pales in comparison.'
He then added: 'I will carry you words with me for the rest of my days.'
Those tearful words were revealed to be completely hollow however by Judge Rosemarie Aquilina, who proved that point by reading from the letter that Nassar submitted to the court last week.
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Going away: Larry Nassar (above) was sentenced to 175 years in prison by Judge Rosemarie Aquilina on Wednesday after a seven-day hearing in Ingham County Court
Dry those eyes: That tearful apology was quickly revealed to be an act, with Judge Aquilina (above) reading the letter that Nassar wrote last week
A long road: Rachael Denhollander (above) smiles as Nassar is sentenced on Wednesday, almost two years after she filed her report against the doctor and set the case in motion
The final moments: A young woman tensely waits for Judge Aquilina to hand down her sentence on Wednesday in court
Primal fear: Judge Aquilina reads from the letter (above) that Nassar submitted in court last week while complaining about the state of his mental health
'What I did in the state cases was medical, not sexual, but because of the [federal porn conviction] I lost all credibility,' read Judge Aquilina from the letter.
'As much as it was my honor and privilege to hear the sister survivors, it is my honor and privilege to sentence you. Because, sir, you do not deserve to walk outside of a prison ever again. -Judge Aquilina to Nassar, Day 7 (Jan. 24)
'So I'm trying to avoid a trial to save the stress to my community, my family. But look what's happening. It's wrong.'
He then wrote about his victims in words that were a far cry from the statement he had made moments earlier in court.
'I was a good doctor, because my treatments worked and those patients that are now speaking out were the same ones that praised and came back over and over,' wrote Nassar.
'The media convinced them that it was wrong and bad.'
The crowd gasped as the letter then read: 'Hell hath no fury like a woman scorned.'
It was a shocking moment, and it seemed as if Judge Aquilina might be considering revoking the plea at one point.
Those gasps quickly turned to laughter however when Judge Aquilina read a subsequent line in Nassar's letter in which he painted himself to be a martyr.
'I was so manipulated by the Attorney General and now Aquilina, and all I wanted was to minimize stress to everyone,' wrote Nassar.
It is my privilege - on counts 1, 2, 5, 8, 10 and 18 and 24 - to sentence you to 40 years. I'm going to look at my cheat sheet. Forty years, just so you know and you can count it off your calendar, is 480 months. The tail end, because I need to send a message to the parole board in the event somehow God is gracious and I know he is -- and you survive the 60 years in federal court first and then you start on my 40 years. You've gone off the page here as to what I'm doing. My page only goes to 100 years. Sir, I'm giving you 175 years, which is 2100 months. I've just signed your death warrant. -Judge Aquilina to Nassar Day 7 (Jan. 24)
There were few laughs, however, when he made his next point in the letter, with Judge Aquilina reading: 'Now [the victims] are seeking the media attention and financial reward.'
Judge Aquilina had reached her breaking point by then, and reminded Nassar of his plea agreement.
'Would you like to withdraw your guilty plea?', she asked the doctor.
When Nassar declined she quickly pushed back however, not wanting to let this point rest after 156 victims had shared statements with the court.
'Because you are guilty, correct?' asked Aquilina.
Nassar then responded by mumbling: 'I've said my plea.'
Given his uncooperative state, Judge Aquilina decided at that point to speak for Nassar.
"You, sir, decided on a plea because there was no medical treatment. You did this for your own pleasure,' she told the defendant, who was flanked by his shell-shocked defense attorneys.
'This letter tells me you have still not owned what it is that you did. That you still think you're right, a doctor.'
Judge Aquilina then declared: 'I wouldn't send my dogs to you, sir.'
She then questioned why Nassar never sought treatment for what was clearly a lifelong perversion.
'Aside from the letter that you wrote, a couple months after your plea, which tells me you still don't get it, there's still something I don't understand,' said Judge Aquilina.
'Sir, you knew you had a problem. That's clear to me. You knew you had a problem from a very young age. You could have taken yourself away from temptation and you did not. Worse yet, there isn’t a survivor that didn’t come in and say how world-renowned you were.'
Face the music: 'Your words these past several days, your words, have had a significant emotional effect on myself and has shaken me to my core,' Nassar mumbled through tears (above with his defense team)
False prophet: 'What I did in the state cases was medical, not sexual, but because of the [federal porn conviction] I lost all credibility,' read Judge Aquilina from the letter (Nassar above on Wednesday)
Champions: Prosecutor Angela Povilaitis embraces other members of the prosecution team after the sentence was announced on Wednesday (above)
Last looks: Mattie Larson (left in white shirt on Wednesday watching Nassar being escorted away) told the pedophile doctor on Tuesday, 'I f***ing hate you'
Some closure: Nassar's sentencing provided some of the women with a sense of closure they said outside the courtroom (victim Chelsea Williams above with tissue on Friday)
Long week: Prosecuting attorney Povilaitis wipes a tear from her eye while listening to Denhollander speak in court on Wednesday
Those women were now dealing with the price they have been forced to pay for Nassar's untreated predilections.
'You can’t give them back their innocence, their youth,' said Acquilina of the victims, all of whom she had allowed to receive restitution.
'You can’t give a father back his life.'
Our Constitution does not allow for cruel and unusual punishment. If it did, I have to say, I might allow what he did to all of these beautiful souls - these young women in their childhood - I would allow some or many people to do to him what he did to others. -Judge Aquilina to Nassar, Day 1 (Jan. 16)
Judge Aquilina then took the letter and tossed it towards the defendant, washing her hands of it for good.
'I find that you don't get it, that you're a danger. That you remain a danger,' said Judge Aquilina, citing Nassar's letter as an example of his inability to be accountable for his actions.
She then stated: 'Inaction is an action. Silence is indifference. Justice requires action and a voice. And that is what has happened here in this court.'
Then it was time to hand down the news.
'As much as it was my honor and privilege to hear the sister survivors, it is my honor and privilege to sentence you,' said Judge Aquilina.
'Because, sir, you do not deserve to walk outside of a prison ever again.'
She then noted: 'If you are ever out, which is doubtful, you'll be required to register as a sex offender.'
Time's up: 'I find that you don't get it, that you're a danger. That you remain a danger,' said Judge Aquilina, citing Nassar's letter as an example of his inability to be accountable for his actions (Kyle Stephens above)
Good guy: Jacob Denhollander (above on Wednesday with Rachael) posted on Twitter after his wife spoke, writing: 'I've always known how amazing Rachael Denhollander is. Now you do, too'
To be safe: Judge Aquilina (above on Wednesday) noted: 'If you are ever out, which is doubtful, you'll be required to register as a sex offender'
The letter: Nassar and his defense attorney Matt Newberg (above on Friday) react to Judge Aquilina's decision to read from his letter
Pay up: 'You can’t give them back their innocence, their youth,' said Acquilina of the victims, all of whom she informed would be able to receive restitution (Assistant Attorney General Angela Povilaitis hugs a member of her team as victim Kyle Stephens looks on)
With the prison time set and the sex offender registry note taken care of, Judge Acquilina moved on to the issue of restitution.
That is often seen as an afterthought in these trials, but Judge Aquilina made a point of informing every single woman she was entitled to receive money.
'You will pay restitution based on whatever amounts are submitted,' Judge Aquilina told Nassar, later adding that his attorneys could ask for a hearing.
You have not yet owned what you did. You think somehow you are right, that you are a doctor, that you don’t have to listen, and that you did a treatment!? I wouldn’t send my dogs to you, sir. Judge Aquilina to Nassar on Day 7
His attorneys were quick to point out, however, that there was no money.
'The victims deserve the money,' Judge Aquilina told the defense.
'The county will survive one way or another.'
There were just a few more things to take care of at that point, with Judge Aquilina making sure that Nassar understood his sentence and informing him he had 21 days to appeal.
She also reminded Nassar he was no longer a doctor in response to an article she read that said he was providing inmates with medical treatment behind bars.
His defense team, meanwhile, spoke of how hard the trial has been on them, noting that they have received death threats directed at their children.
Attorney Matt Newburg pointed out that the Constitution affords Nassar to a 'zealous defense,' a notion that was backed up by the judge.
'Please respect their job. It's a difficult one. I know, I've been in their shoes,' Judge Aquilina told those in attendance.
Judge Aquilina took some time to praise the victims once more as well in court, and issue a warning to the media that she would not be giving interviews because this is not her story.
Hugs: Judge Aquilina made sure that Nassar understood his sentence and informing him he had 21 days to appeal (Michigan State University Department of Police and Public Safety Chief and Director Jim Dunlap hugs Denhollander)
No go: Judge Aquilina also reminded Nassar he was no longer a doctor in response to an article she read that said he was providing inmates with medical treatment behind bars
Gather round: Judge Aquilina took some time to praise the victims once more as well in court, and issue a warning to the media that she would not be giving interviews because this is not her story
Rapt audience: Nassar's defense spoke of how hard the trial has been on them, noting that they have received death threats directed at their children
Devastated daughter: 'You can’t give a father back his life,' Judge Aquilina said a reference to the death of Kyle Stephens' father who killed himself over the abuse (Stephens above on Friday with Chief Dunlap)
'His practiced and perfected abuse spanned over 25 years and included countless victims,' said Assistant Attorney General Povilaitis in her final remarks on Wednesday.
'But we know his access to children and young women and his abuse did not end until an investigative news report and one brave woman came public to stop him.
Inaction is inaction. Silence is indifference. Justice requires an action and a voice and that’s what happened in this court. 168 buckets of water were placed on your so-called match that got out of control. There has to be a massive investigation as to why there was inaction. Why there was silence. Justice requires more than what I can do on this bench. -Judge Aquilina to Nassar on Day 7
She then noted how that every other time he was accused of an assault or a woman made an allegation of abuse, nothing had happened to Nassar.
'His lies worked,' explained Povilaitis.
'With each time that he got away, he was empowered to continue, to perfect, and to abuse even more.'
She went on to describe the perfect storm of events that had to take place in order to get Nassar charged with a crime.
'It shouldn't take investigative journalists to expose predators' said Povilaitis, along with 'one brave woman put into the unenviable position and choice to go public with her name and be the only public person for months.'
She then gave special credit to the writers from the Indy Star who broke the story on Nassar's abuse, stating: 'But thank God we have these journalists, and that they exposed the truth and that they continue to cover this story.'
Simone Biles was among those who weighed in after the case, with the Nassar victim and Gold-medal winning athlete writing: 'To Judge Aquilina : THANK YOU, YOU ARE MY HERO & Shout out to all of the survivors for being so brave & speaking like the queens that you are while looking at that monster. He will no longer have the power to steal our happiness or joy. I stand with every one of you.'
Progress: 'You were never the problem, but you are so much the solution. You are unstoppable. You are part of an unstoppable growing force, an unstoppable, strong, loud voice. The effects of your voice are far-reaching. It's not just in this courtroom, but worldwide.' Judge Aquilina told Aly Raisman last week (Aquilina above on Wednesday)
Horror: 'Larry meticulously groomed me for the purpose of exploiting me for his sexual pleasure,' Denhollander (above on Wednesday) informed the court
Predator: 'His practiced and perfected abuse spanned over 25 years and included countless victims,' said Assistant Attorney General Povilaitis in her final remarks on Wednesday (Povilaitis speaks to Kaylee Lorincz on Wednesday)
Difficult moment: Kaylee Lorincz (above) wipes away tears as she confronts |Nassar, as the second-to-last victim to speak
Sisterhood: Megan Halicek and another victim of Larry Nassar embrace in the courtroom on Wednesday after the verdict
Grateful: Simone Biles (above) praised Judge Aquilina and all the survivors who spoke in court over the past seven days
The woman who built the 'army of survivors' and started the case against Nassar was fittingly the last to speak in the pedophile doctor's seven-day sentencing hearing on Wednesday.
Rachael Denhollander was 15 when she was sexually assaulted, and she began her remarks by stating: 'The sentence rendered today will send a message across this country. And so I ask, how much is a little girl worth? How much is a young women worth?'
Then mother-of-two then outlined the many reasons why Nassar deserved the maximum sentence, and why Michigan State University, USA Gymnastics and the United States Olympic Committee needed to be put under investigation.
She also shared a few shocking stories that spoke to the depraved behavior of Nassar's defense team, MSU staff and the man she succeeded in sending to prison.
You started the tidal wave. You made all of this happen. You made all of these voices matter. Your sister survivors and I thank you. You are the bravest person I have ever had in my courtroom. -Judge Aquilina to Denhollander on Day 7
'I held my first born, and then my two daughters, and each time Larry I remembered the day you brought Caroline in so I could hold her,' recalled Denhollander at one point, recounting a visit from her abuser and his newborn child.
'You knew how much I loved children and you used your own daughter to manipulate me.'
Denhollander, who has sat in the courtroom every day, approached the podium on Wednesday after a brief introduction from Michigan Assistant Attorney General Angela Povilaitis.
'I knew after meeting her we would be here at some point,' she told the court of the woman whose 2016 report put multiple cases against Nassar in motion.
'I knew there was no doubt that she would carry this case and the world would believe her.'
She was composed and calm throughout her statement, keeping a even tone and never once bursting into tears or raising her voice.
'Larry meticulously groomed me for the purpose of exploiting me for his sexual pleasure,' Denhollander informed the court.
It was then revealed to the court how this happens, with the victim explaining that because no adult questioned Nassar's practices or motives, she assumed his penetration of her was normal medical practice.
'As Larry abused me, I assured myself it was just fine because I thought I could trust the adults around me,' said Denhollander.
'And so I lay still.'
Proud DA: 'I knew after meeting her we would be here at some point,'Povilaitis told the court of the woman whose 2016 report put multiple cases against Nassar in motion
Reason to smile: Bailey Lorencen has a big grin on her face while meeting with reporters on Wednesday after the verdict
Support system: A group of women show their support for the women outside the courthouse on Wednesday (above)
Great idea: The women were from the Michigan based victim advocacy groups End Violent Encounters and Firecracker Foundation, and cheered for women as they left the courthouse
Don't stop believing: 'May the horror expressed in this courtroom over the past seven days be motivation for anyone and everyone, no matter the context, to take responsibility if they have erred in protecting a child,' said Denhollander
She now knows, however, that it was not a medical treatment but sexual assault, and she called out the number of times places like MSU ignored reports and complaints and allegations about Nassar's practices.
Things then got worse when she went public, with Denhollander noting: 'My sexual assault was wielded like a weapon against me.'
Nassar's defense team went after Denhollander and questioned her credibility, she said, all while making it seem as though she were out for money.
Denhollander, who is not asking for any restitution in the case, then noted that it was Nassar's defense attorney Susan Smith that was frequently mugging for the camera in court while being paid.
Keep your voice up. Rachel's [Denhollander] voice hopefully will raise these numbers of reports in all of your voices, but that statistic does not include children 12 and under. -Judge Aquilina to victims on Day 7 (Jan. 24)
She also spoke about the fact that she had to turn over a diary as part of discovery, meaning Nassar got to see her innermost thoughts about her abuse.
The other person who sat in the courtroom for the past seven days, Denhollander's husband Jacob, also had some words to share on Wednesday.
He posted on Twitter after his wife spoke, writing: 'I've always known how amazing Rachael Denhollander is. Now you do, too.'
Denhollander spoke for 36 minutes in the end, leaving those listening in tears and earning a standing ovation when she returned to her seat.
'May the horror expressed in this courtroom over the past seven days be motivation for anyone and everyone, no matter the context, to take responsibility if they have erred in protecting a child, to understand the incredible failures that led to this week and to do it better the next time,' stated Denhollander.
But before she could leave, the most anticipated speaker of the week was asked to do a bit of listening, with Judge Aquilina saying a few words.
'You started the tidal wave,' she told Denhollander, labeling her the 'five-star general' of this incredible army.
'You made all of this happen. You made all of these voices matter. Your sister survivors and I thank you. You are the greatest person I've ever had in my courtroom.'
Outside the courthouse though she said that this might not be the end after all, and could be just the beginning of her quest to make sure all those involved are held accountable.
The two-time Olympic gymnast Aly Raisman confronted the former USA gymnastics doctor Larry Nassar in court during his sentencing hearing. More than 100 girls and women – including Raisman and her fellow Olympic champions Simone Biles, Gabby Douglas and McKayla Maroney – came forward to describe the impact of his abuse. 'Abusers, your time is up,' said Raisman.
