An emotional seven-day sentencing hearing for former gymnastics doctor Larry Nassar is over, but the fallout from the case could take years to resolve.
Nassar, 54, was sentenced in Ingham County, Michigan, on Wednesday to between 40 and 175 years for molesting seven girls — a small fraction of his accusers.
Here's what to expect next:
Nassar faces a third sentencing
Nassar will be sentenced in Eaton County, Michigan, for molesting three more minors. His plea agreement calls for a minimum of 25 to 40 years in prison. Victims will be allowed to testify, but the numbers are likely to be lower than they were in Ingham County.
Nassar has already been given 60 years in federal prison for child pornography found on his computers; his attorneys plan to appeal the punishment, which involves three consecutive 20-year sentences.
There's a mountain of civil suits
More than 150 lawsuits have been filed by Nassar's accusers in federal court in Michigan and state court in California, variously naming the convicted doctor; USA Gymnastics, where he was team physician; Michigan State University, where he had his medical practice; the U.S. Olympic Committee; the Twistars gymnastics club; and famed coaches Bela and Marta Karolyi.
The accusation in all the suits is essentially the same: The institutions and people that should have been protecting Nassar's patients failed miserably, allowing him unfettered access to his victims and ignoring red flags for years that he was a serial predator.
USA Gymnastics and MSU have recently asked for the suits to be dismissed. The state university says it has immunity and that officials didn't learn of allegations against Nassar until 2016; anyone who received a complaint was not a mandatory reporter, the school argued. USA Gymnastics contends the statute of limitations has expired and that it did enough by alerting the FBI to an athlete's complaint.
Attorneys for gold-medalist McKayla Maroney have also asked the court to invalidate a non-disclosure agreement she signed as part of a settlement with the gymnastics federation — but the organization has already said it won't enforce it.
Reform in the gymnastics world?
The sentencing hearing was still underway when USA Gymnastics made its biggest moves since President Steve Penny was ousted last year — announcing the resignations of three board executives and cutting ties with the Karolyi Ranch, where some gymnasts say they were sexually assaulted or otherwise abused.
But many said that didn't go far enough. And on Wednesday, the U.S. Olympic Committee said it was launching an independent, third-party investigation into how the abuse could have gone on so long that would examine both the USOC and USAG and result in a public report.
The Olympic Committee said it "strongly considered" decertifying USA Gymnastics as the national governing body for the sport but decided against it. Instead, it demanded that all current board members must resign and the organization must overhaul its structure.
The NCAA is involved
The NCAA has sent a letter of inquiry to Michigan State "regarding potential NCAA rules violations related to the assaults Larry Nassar perpetrated against girls and young women, including some student-athletes at Michigan State."
The collegiate athletic association offered no further comment, and it isn't clear which NCAA bylaws the association is looking at for possible violations.
But some experts say the letter of inquiry to Michigan State may be little more than a PR move after the NCAA was criticized for how it handled another sexual abuse scandal back in 2012: the Penn State case involving assistant football coach Jerry Sandusky.
"The NCAA is confused about image," said B. David Ridpath, an associate professor of sports business at Ohio University and president of the Drake Group, which promotes intercollegiate reform efforts. "They almost feel like they're forced to do something, or else they'll have to come out and say what they did at Penn State was an overreach."
Marc Edelman, a Baruch College law professor and attorney, said it's impossible to know what punishment, if any, the NCAA will hand down.
"The NCAA decided to punish Penn State primarily through its football team because Sandusky was a football coach. It would be a sad irony if the current women's gymnasts at Michigan State were punished for Nassar's behavior. This would seem to create a double whammy."
Michigan State is on the defensive
Accusers say more than a dozen current or former MSU officials were notified of Nassar's abuse as far back as 1997, but the complaints were brushed off. The university hired an outside lawyer who concluded that no school officials "believed" Nassar was abusive until he was exposed by a newspaper investigation in 2016.
But that hasn't stopped the clamor for heads to roll at the Big Ten school. And on Wednesday, MSU President Lou Anna Simon announced she would resign.
"As tragedies are politicized, blame is inevitable," Simon said in a written statement. "As president, it is only natural that I am the focus of this anger."
Simon's resignation came ahead of a planned vote by faculty representatives on whether to initiate a vote of no-confidence in Simon, who had been backed by all but one member of the Board of Trustees.
Simon was castigated for skipping the first day of Nassar's sentencing hearing; a trustee who supports her created a furor by saying she shouldn't lose her job over "this Nassar thing"; and one of the victims at the hearing revealed she's still getting billed for appointments where she was molested.
Reluctantly, MSU asked Michigan Attorney General Bill Schuette to review the university's handling of the matter. If Schuette finds evidence of a cover-up, he could charge the school or top officials. Simon said in her statement Wednesday that she backs the investigation and would fully cooperate.
Coming soon to a TV near you?
Judge Rosemarie Aquilina, who sentenced Nassar to up to 175 years and told him, "I just signed your death warrant," captivated the public during the marathon hearing. There's no indicated the former Army lawyer and moonlighting crime novelist wants to give up her seat on the bench, but if she does, Twitter already has some ideas about her next gig.