(CNN) - Larry Nassar has effectively been condemned to life in prison after the sports physician admitted to abusing sexually abusing girls under the guise of medical treatment.
But the heat on institutions linked to him is nowhere near finished.
For about two decades, the doctor worked with the US Olympic women's gymnastics teams, athletes at Michigan State University and girls at Michigan's Twistars gymnastics club. Several women said they reported his abuse to people at USA Gymnastics and Michigan State, but that their claims were ignored or improperly investigated.
The reactions changed after The Indianapolis Star published a gymnast's accusations in 2016, and Nassar pleaded guilty to 10 counts of criminal sexual conduct in two Michigan counties.
The fallout from the abuse scandal may span years, involving investigations, civil lawsuits and an overhaul of at least one sports governing body. On January 27, Michigan Attorney General Bill Schuette said a special prosecutor will investigate "every corner" of Michigan State to determine school officials' culpability.
"We're not going to heal all the way until we know exactly who knew what, when and how they're going to fix it," former Michigan State gymnast Lindsey Lemke said after one of Nassar's sentencings in late January. She was one of more than 150 accusers who had confronted Nassar in court over his abuse.
Here's what's happening:
Michigan State and USA Gymnastics are among the defendants in a number of civil lawsuits by more than 100 accusers.
USA Gymnastics, which selects and trains US teams competing for Olympic and world championships in the sport, counted Nassar as part of its medical staff or as national team doctor through four Olympic cycles.
Nassar also was a Michigan State sports physician from 1997 to 2016.
Allegations in the lawsuits include negligent failure to warn or protect, and intentional infliction of emotional distress.
• In one suit, 2012 Olympics medalist McKayla Maroney alleged USA Gymnastics paid her to be quiet about Nassar's abuse of her, which she said began when she was 13. The US Olympic Committee, Michigan State and Nassar also are named as defendants.
• In another suit, gymnast Larissa Boyce alleges she told then-Michigan State gymnastics coach Kathie Klages in the late 1990s that Nassar abused her. Boyce recalls Klages telling her that she could not imagine Nassar "doing anything questionable," then discouraging her from filing a formal complaint, according to the lawsuit.
• Former Michigan State softball player Tiffany Thomas-Lopez says in a lawsuit Nassar abused her in the late 1990s, and that at least three university trainers listened to her accusations but did nothing about them.
USA Gymnastics, the US Olympic Committee and Michigan State have denied wrongdoing, and USA Gymnastics said it reported the sexual abuse allegations to authorities when it learned about them.
Michigan State maintains that no official there believed Nassar committed sexual abuse until newspapers began reporting on the allegations in the summer of 2016. Any suggestion that the university engaged in a coverup is "simply false," the school asserted in January.
Klages' attorney, Steve F. Stapleton, told CNN his firm is representing the former coach in federal civil litigation surrounding Nassar and will not comment on pending litigation.
Michigan attorney general names special prosecutor
A number of investigations also have been announced -- with Michigan State as one of the targets.
Schuette, the state attorney general, said January 27 that a special prosecutor will investigate the school "from the president's office down."
"No individual and no department at Michigan State University is off-limits," Schuette said.
What will the investigation look for?
The special prosecutor, William Forsyth, said he will determine:
• How Nassar was allowed to abuse patients for nearly 20 years without being stopped.
• Who at Michigan State was aware of his actions.
• What university officials did when they became aware.
The Detroit News recently reported that misconduct allegations against Nassar reached at least 14 Michigan State representatives in the two decades before his arrest.
The university received a Title IX complaint of sexual misconduct against Nassar in 2014, but the investigation concluded that Nassar's conduct was not of a sexual nature and he was cleared of any Title IX violations, the News reported. Title IX is a federal law that protects people from sexual discrimination in education or other programs receiving federal aid.
With investigations underway, there have been several shakeups:
• Michigan State President Lou Anna Simon resigned in late January after outcries that the school's response wasn't good enough. The school's trustees named former Michigan Gov. John Engler as interim president.
• Michigan State Athletic Director Mark Hollis said on January 26 he is retiring.
• Michigan State physician Brooke Lemmen resigned last year after she allegedly removed "several boxes of confidential treatment records" from the school at Nassar's request, and allegedly didn't tell school officials that Nassar had told her in 2015 that USA Gymnastics was investigating him, the Lansing State Journal reported.
• Klages, the gymnastics coach, retired in 2017.
NCAA investigating Michigan State
The NCAA, too, is looking into Michigan State's handling of allegations against Nassar.
The collegiate athletics governing body said January 24 it wants to see whether the university violated any NCAA rules.
Other actions involving MSU
• Michigan House Speaker Tom Leonard was asking House attorneys in January to advise him on constitutional avenues to remove Michigan State's board of trustees, MLive.com reported. The request came not only as general criticism grew over how the university handled the Nassar scandal but also after trustees publicly supported Simon before she resigned.
• The trustees in late January said they were trying to get an "independent third-party" to produce recommendations for improving life at the university. An independent investigator would review "all our processes relating to health and safety, in every area of the university, and ... provide recommendations that we will implement to change the culture of MSU," trustee board Chairman Brian Breslin wrote.
US Olympic Committee wants an investigation ...
The US Olympic Committee -- itself a focus of victims' ire -- has called for an investigation by an "independent third party to examine how an abuse of this proportion could have gone undetected for so long."
"We need to know when complaints were brought forward and to who," USOC Chief Executive Scott Blackmun said in an open letter.
"This investigation will include both USAG (USA Gymnastics) and the USOC, and we believe USAG will cooperate fully. We will make the results public," Blackmun wrote.
... and demands resignations at USA Gymnastics
The remaining board members of USA Gymnastics stepped down January 31 at the demand of Blackmun, who had threatened to decertify the sport's governing body if they didn't.
Turnover at the board began days earlier, when three top USA Gymnastics board members resigned January 22. Blackmun acknowledged that move but said it wasn't enough.
The Indianapolis-based organization's 18 other board members then resigned.
Blackmun said an interim board must be in place by February 28.
The demand for resignations was not based "on any knowledge that any individual USAG staff or board members had a role in fostering or obscuring Nassar's actions," Blackmun wrote in a letter CNN obtained. "Our position comes from a clear sense that USAG culture needs fundamental rebuilding."
Sorting USA Gymnastics' future
USA Gymnastics already was undergoing an overhaul. The group asked former federal prosecutor Deborah Daniels in late 2016 to review its policies on handling sexual misconduct -- and in June she released a report highlighting numerous shortcomings.
USA Gymnastics said it would implement Daniels' 70 recommendations, including:
• Requiring members to report suspected sexual misconduct to legal authorities and the US Center for SafeSport.
• Implementing an abuse prevention training plan for members, parents and athletes.
• Removing the "athlete representative," tasked with ensuring the welfare of gymnasts at the training center, from the Olympic selection committee so athletes can feel more comfortable reporting abuse to him or her
USA Gymnastics needs to sort other parts of its immediate future, too.
It was once scheduled to hold a training camp in late January at the Karolyi Ranch in Texas. The ranch had been the official US Women's National Team Training Center since 2001.
But USA Gymnastics cut ties with the ranch January 18 after several gymnasts said Nassar abused them there. The organization is exploring alternative sites to host camps until it finds a permanent location.
USA Gymnastics also suspended coach John Geddert, the owner of Michigan's Twistars gymnastics club, one of the locations where Nassar admitted to sexually abusing athletes. Geddert also was 2011 US world team and 2012 US Olympic team head coach.
Twistars did not respond to CNN's request for comment. Geddert's attorney, Chris Bergstrom, said in an email that "at this time, Mr. Geddert only wishes to convey his heart-felt sympathy to all victims of Larry Nassar's abuse."
USA Gymnastics also is under financial pressure. AT&T said in January it was suspending its sponsorship of the organization "until it is rebuilt and we know that the athletes are in a safe environment."
Nassar's time in prison
Nassar essentially is facing life in prison after three sets of guilty pleas:
• In December, a federal judge sentenced him to 60 years in prison after Nassar pleaded guilty to child pornography charges.
• In January, a Michigan judge sentenced Nassar to 40 to 175 years in prison -- to be served after the federal sentence -- after Nassar pleaded guilty to seven counts of criminal sexual conduct in Ingham County, the home of Michigan State.
• In February, a Michigan judge will sentence Nassar for his guilty plea to three counts of criminal sexual conduct in Eaton County, where Twistars is located.
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