Last Updated Jan 24, 2018 6:51 PM EST
"It is my honor and privilege to sentence you," Judge Rosemarie Aquilina told former USA Gymnastics Dr. Larry Nassar on Wednesday in Lansing, Michigan.
With that, theup to 175 years in prison for sexually abusing young female athletes.
Following days of searing testimony, the judge told Nassar he doesn't deserve to walk outside a prison ever again.
"I just signed your death warrant," Aquilina said. After 156 victims had addressed their abuser, Aquilina got her turn.
"Your decision to assault was precise, calculated, manipulative," she said.
Before Aquilina handed down the sentence, Nassar addressed her and his victims.
"There are no words that can describe the depth and breadth of how sorry I am for what has occurred," Nassar said.
Aquilina did not buy Nassar's apology, reading aloud parts of the letter he had written to her last week.
"'What I did in the state cases was medical, not sexual,'" she quoted the letter as saying. "'The media convinced them that everything I did was wrong and bad. They feel I broke their trust. Hell hath no fury like a woman scorned.'"
The judge told Nassar his treatments were not medical, and reminded him he had admitted wrongdoing in his plea deal.
"Because you are guilty, aren't you?" she said.
As the procession of victims came to a close, Rachael Denhollander called for the maximum sentence.
"So I ask, how much is a little girl worth?" she said Wednesday. "I submit to you that these children are worth everything."
She was the first to publicly accuse Nassar of sexual abuse in a 2016 Indianapolis Star article.
"You started a tidal wave," Aquilina said. "You are the bravest person I have ever had in my courtroom."
Kaylee Lorincz says she was only 13 years old when Nassar first abused her.
"You need to look at me and listen. I only hope that when you get a chance to speak, you tell us who knew what, and when they knew it," Lorincz said.
Nassar's abuse did not occur in a vacuum. There was a culture in place where children were afraid to say "no" to a grown up, and where complaints were not taken seriously. As Aquilina said Wednesday, a massive investigation will be needed to find out how this happened.