Lansing - Disgraced former USA Gymnastics doctor Larry Nassar was sentenced to 40 to 175 years in prison on Wednesday after a week of raw emotional testimony by scores of women he sexually abused for years under the guise of medical treatment.
"I've just signed your death warrant," Judge Rosemarie Aquilina said as she handed down what amounts to a life sentence to the 54-year-old Nassar in a tense Lansing, Michigan, courtroom.
"You do not deserve to walk outside of a prison ever again," the judge said as Nassar, dressed in a blue prison jumpsuit, stood expressionless before her flanked by two defence attorneys.
"You're a danger, you remain a danger," Aquilina said. "Anywhere you walk destruction will occur to those most vulnerable."
Minutes ahead of the sentencing, Nassar apologised in court to his victims, who included Olympic gold-medal winning gymnasts Simone Biles, Aly Raisman, Gabby Douglas and McKayla Maroney but also scores of female athletes at Michigan State University, where he worked.
"What I am feeling pales in comparison to the pain, trauma, and emotional destruction that all of you are feeling," Nassar said, turning at several points to face his victims in court.
"There are no words to describe the depth and breadth of how sorry I am for what has occurred," he said.
Judge Aquilina scoffed at his apology, however, and read from a letter in which Nassar, despite his guilty plea, once again claimed to have been providing legitimate medical treatment.
"It was not treatment. It was not medical," the judge said. "I wouldn't send my dogs to you, sir."
In extraordinary scenes over the past week, around 160 women appeared in court or testified anonymously to the emotional pain they continue to experience because of the sexual abuse by Nassar.
The slight, bespectacled Nassar looked down or occasionally wiped his eyes with a tissue as woman after woman delivered gut-wrenching statements about the impact of his abuse.
Already sentenced to 60 years in prison on federal child pornography charges, Nassar pleaded guilty to 10 counts of criminal sexual conduct.
He was sentenced on Wednesday on seven of those counts, with a final additional sentence to be handed down later this month.
The final woman to deliver a statement in court was Rachael Denhollander, the first to publicly accuse Nassar of abuse and file a police report against him.
Calling for the maximum sentence, she asked the judge: "How much is a little girl worth? How much is a young woman worth."
Denhollander said Nassar's "brazen sexual assault" occurred when she was 15 years old, and was carried out "with my own mother in the room," unaware of what was going on.
"I assured myself it must be fine because I could trust the adults around me," Denhollander said.
"I pray you experience the soul-crushing weight of guilt," she told Nassar.
Judge Aquilina congratulated Denhollander for coming forward and building "an army of survivors."
"You are the bravest person I have ever had in my courtroom," the judge said.
Another abuse victim, Sterling Riethman, told Nassar - but also the authorities at USA Gymnastics (USAG), the US Olympic Committee (USOC) and Michigan State University (MSU) - "this army isn't going anywhere."
"We are here to show you," said the 25-year-old, "there is no white flag to wave when it comes to protecting little girls and their futures."
Riethman and others thanked Judge Aquilina for opening up the sentencing hearings to anyone who wished to share their experiences - in what turned into a cathartic experience for many survivors.
Parents spoke of the anguish of failing to protect their children from a predator, and women spoke of post-traumatic stress and deep emotional scars.
Raisman, the Olympic gold medallist, confronting Nassar on Friday, echoed the feelings of many athletes.
"You are so sick. I can't even comprehend how angry I feel when I think of you," she said.
As victim after victim detailed Nassar's actions, they also slammed a lack of accountability among sporting institutions.
Shortly after the sentence was handed down, the USOC announced an independent probe into USA Gymnastics and the Olympic Committee itself, to establish "who knew what and when" and how "abuse of this proportion could have gone undetected for so long."
Three top officials of USA Gymnastics' board of directors resigned this week but USOC is demanding an entire overhaul of the board.
USAG also severed ties with the famed Karolyi Ranch - the Texas training facility once considered a breeding ground of champions, where Nassar reportedly had unfettered access to young girls.
Michigan's state House on Wednesday passed a resolution by a 96-11 vote, calling on MSU's president Lou Anna Simon to resign.
Simon announced the same day that she was tendering her resignation, and the university's board of trustees said it would accept.
Nassar remained employed at the university until September 2016, when allegations against him were first made public by a newspaper.
The body overseeing US collegiate sports, the NCAA, has opened an investigation of MSU's handling of the case.