“This letter tells me you have not yet owned what you did,” she said. “You still think somehow you are right, you’re a doctor, that you’re entitled, so you don’t have to listen. That you did ‘treatment.’ I wouldn’t send my dogs to you, sir.”
Dr. Nassar, 54, was accused of molesting girls for years under the guise of giving them examinations or 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 child pornography convictions.
The case and its ramifications are far from over. It has ignited outrage in the sports world and beyond, leading to the resignation this week of the chairman and several board members of the governing body for gymnastics in the United States, U.S.A. Gymnastics. Last week, the organization cut ties with the private training center at a remote Texas ranch where some of the abuse occurred.
And at Michigan State, where Dr. Nassar spent years on the faculty and treated many of its athletes, an outpouring of political pressure led to the resignation of the university’s president, Lou Anna K. Simon, late Wednesday.
Ms. Simon’s resignation may have just been the beginning at Michigan State, as the N.C.A.A. on Tuesday formally opened an investigation into the university’s conduct.
The United States Olympic Committee, which some of the young women condemned for not doing enough to protect them when they joined the team and had to continue to see Dr. Nassar, said on Wednesday it was now taking action.
Moments after the judge delivered her sentence, the Olympic committee issued a statement calling on the entire U.S.A. Gymnastics board to resign and promising additional steps to investigate Dr. Nassar’s conduct and ensure athletes are not harmed in the future. The Olympic committee’s chief executive, Scott Blackmun, also apologized for not attending the hearing, after gymnasts pointedly condemned the U.S.O.C. for lack of support.
A number of civil lawsuits have also been filed.
The sentencing hearing itself, streamed live on the internet, captured national attention for extending several days to allow for victim impact statements from girls and women who said they were molested by Dr. Nassar over the years. Many of the victims had not previously identified themselves. Initial plans to conclude after four days were altered as more women came forward.
Among those who have accused him are the Olympic gold medalists Aly Raisman, McKayla Maroney, Gabby Douglas, Jordyn Wieber and Simone Biles.
The final three victims spoke on Wednesday. Rachael Denhollander, who was one of the first women to come forward with public accusations against Dr. Nassar, was the last to speak at his sentencing hearing. “Larry is the most dangerous type of abuser,” she said. “One who is capable of manipulating his victims through coldly calculated grooming methodologies, presenting the most wholesome and caring external persona as a deliberate means to ensure a steady stream of young children to assault.”
Judge Aquilina praised Ms. Denhollander for opening the floodgates. “You are the bravest person I have ever had in my courtroom,” she said.
The sentence carries a minimum 40 years imprisonment, adhering to the terms of the plea agreement, but the judge advised that should Dr. Nassar improbably live longer than any human has, and come up for parole after serving the federal and state sentences, his time in state prison should extend to 175 years.
Nassar also pleaded guilty in November on three sexual abuse counts in a neighboring county. That sentencing is later this month.
The statements by the young women in the past week were forceful and at times anguished.
“Imagine feeling like you have no power and no voice,” Ms. Raisman said in court last Friday. “Well, you know what, Larry? I have both power and voice, and I am only just beginning 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 spent replaying the words delivered by this powerful army of survivors.”
As part of a lawsuit settlement, Ms. Maroney had signed a nondisclosure agreement with U.S.A. Gymnastics that would have caused her to be fined more than $100,000 for speaking 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,” she said. “He in fact is, was, and forever shall be a child molester, and a monster of a human being.”
In the end, though, Judge Aquilina had the final words.
“Your decision to assault was precise, calculated, manipulative, devious, despicable,” she told Dr. Nassar in part. “I don’t have to add words because your survivors have said all of that and I don’t want to repeat it. You can’t give them back their innocence, their youth.”