LANSING, Mich. — Two decades after she first spoke up about Dr. Larry Nassar, two decades after she told a Michigan State gymnastics coach about treatment that felt more like sexual assault than a medical procedure, Larissa Boyce stood in a courtroom not far from the sprawling Big Ten campus.

This was late November and Nassar was there to plead guilty to seven counts of first-degree criminal sexual conduct. It represented a small fraction of the 125 women who, like Boyce, contacted state police in recent months alleging molestation at the hands of the now 54-year-old doctor. In early December, he would enter a similar plea in state court over in Grand Rapids. Last week, he was sentenced to 60 years in prison on separate federal child pornography charges.

This flurry of reckoning delivered only partial relief. It assured Nassar would spend his life in prison. It ended his reign of terror that began here in Mid-Michigan and extended, via his work with USA Gymnastics, through the country and to the highest levels of the sport.

Yet as Boyce, now a 36-year-old mother of four, looked around Judge Rosemarie E. Aquilina’s courtroom last month and saw all the other victims and their families who came to witness Nassar’s plea, the scope of the scandal was reaffirmed.

Almost all of them were younger than her. Almost all of them were abused after she initially spoke up. All of them, she believed, were victims of not just Larry Nassar, but the adults, organizations and institutions who could have, and should have, stopped him.

Most notably, Michigan State University, where Nassar worked daily for decades.

“This behavior,” Boyce said, “was known.”

*****

In 1997, at the age of 16, Boyce was part of an elite youth gymnastics club, Spartan Youth Gymnastics, that often met at Jenison Fieldhouse on Michigan State’s campus. It was under the direction of Kathie Klages, MSU’s gymnastics coach. One day Boyce fell and injured her lower back. She was referred to Nassar for treatment. The then young doctor was highly acclaimed due to his work with not just the Spartans, but the U.S. Olympic Gymnastics team, where just a year prior he treated Kerri Strug’s ankle before her iconic, gold-medal winning vault.

Soon, Boyce said, her treatment for a back injury included Nassar penetrating her vaginally and anally as she lay on a medical table. She was confused.

Boyce said she eventually told Klages, who Boyce alleges Klages said Nassar had a sterling reputation and wondered if it was part of a proper medical procedure. Klages brought Boyce’s teammates in and, in front of Boyce, asked if they had any similar concerns. Boyce said she felt embarrassed, shamed and singled-out. According to Boyce, one raised their hand, although that girl, now known in legal documents under the alias Jane B8 Doe, later decided not to continue with the allegation. Boyce said Klages told her she could report the abuse, but it would have “serious consequences” for both Nassar and Boyce.

Boyce decided to drop it. She soon quit gymnastics, giving up on a sport she loved and was projected to compete in at the college level. She told no one why. For nearly 20 years, she assumed she really had been confused by the treatment.

Then in 2016, two gymnasts came forward to the Indianapolis Star claiming Nassar had sexually abused them. Boyce realized she wasn’t alone. Then other victims stepped forward. The state police set up a hotline to take complaints.

In February, a day after MSU placed her on suspension for downplaying concerns about Nassar, Klages retired after 27 years leading the Spartans. She denied any wrongdoing and promised to cooperate with any investigation. “Although [Klages] is not a named defendant in any lawsuit, she is extremely distressed by the accusations that have been made about her creating any sort of impediment to gymnasts reporting complaints of criminal sexual conduct or sexually inappropriate behavior,” according to a statement from her attorney.

Boyce saw it differently. And her anger only rose as she learned that she was not the only one to speak up. At least six other women say they raised suspicions of Nassar from between 1997 and 2015.

One, former Michigan State softball player Tiffany Lopez, alleges in a lawsuit she told three different MSU trainers about concerns she had of Nassar between 1998 and 2000. They were not acted on. Meanwhile, Nassar was investigated in 2004 by police in nearby Meridian Township for assault but the case was not sent to prosecutors. In 2014, a complaint to campus police was referred to the district attorney, but Nassar was not charged. On both occasions the doctor said his actions were legitimate medical treatments.

Then there was a 2014 Title IX investigation by the school that cleared Nassar. However, the dean of the school’s College of Osteopathic Medicine, under which Nassar worked, placed restrictions on him, including prohibiting him from seeing underage patients alone and requiring he wear medical gloves for any procedure.

Victims argue that if Michigan State didn’t think anything was wrong, then why assign sanctions? It is a de facto admission of guilt.

Worse, only Nassar was told of the prohibitions. No one notified his patients, their parents or even the nurses who worked in Nassar’s office. He was allowed to operate on the honor system.

Through it all the victims piled up, one injured young athlete after the next, believing they were lucky to be seen by such a prominent doctor, who cloaked himself in Olympic red, white and blue and Spartan green and white, with pictures of he and famous gymnasts lining the wall of his office.

“They didn’t listen,” said Jennifer Jones, who in 2011 took her then 11-year-old daughter to Nassar for treatment. Nassar pled guilty in November of molesting her, known as Victim B in criminal counts.

“There were many people who came forward through the years,” Jones continued. “And if anybody had listened to them … ”

She didn’t need to finish. An entire courtroom of tearful young woman told the story for her.

*****

More than 150 women have joined lawsuits against Michigan State, USA Gymnastics and the locally prominent Twistars Gymnastics Club. There are likely more who either haven’t come forward yet or will choose to remain private.

It’s why just having Nassar put away isn’t enough.

“I am grateful that Larry Nassar has pled guilty,” said Rachael Denhollander, the first victim to come forward publicly in the Indianapolis Star story. “I’m grateful that truth is known … but we have yet to hear the truth from MSU, USAG and the USOC. Officials that kept Larry in power for decades. Officials who ignored repeated reports of sexual assault. Officials who brushed victims off as unable to tell the difference between a medical exam and sexual violation.

“Each and every time, MSU officials silenced these victims,” Denhollander continued. “Larry continued to have access to little girls for decades.”

“MSU unequivocally denies this accusation,” school spokesman Jason Cody said. “Moreover, MSU and its external counsel have consistently promised if it were to find any employee knew of and acquiesced in Nassar’s misconduct, it would immediately be reported to law enforcement.”

Victims say Michigan State has been elusive and complain about the lack of a serious investigation into the school.

MSU says the FBI and the campus police conducted a “joint investigation” earlier this year. The results were sent to the U.S. Attorney for the Western District of Michigan, which citing departmental policy declined comment on the situation. No criminal charges have been brought.

MSU also conducted an internal review run by a former U.S. Attorney, but there is skepticism of that investigation because no victims, including Boyce and others who say they alerted MSU employees, were questioned.

“How can you do an investigation when not a single victim has been interviewed?” said Mick Grewal, who represents numerous victims including Boyce. “How can you do an investigation into whether the complaints were ignored when you don’t interview the people who did the complaining? That’s the first thing you do. They are just playing games.”

*****

The Nassar case has similarities to the Jerry Sandusky scandal that engulfed Penn State earlier this decade. In 2012, Sandusky, a former Penn State defensive coordinator, was convicted on 45 counts of sexual molestation and sentenced to up to 60 years in prison. Like with Nassar, the criminal case was handled by the state’s attorney general’s office. However, in that case, Pennsylvania prosecutors also aggressively investigated whether school administrators knew of Sandusky’s actions. It led to convictions for Penn State’s president, vice president and athletic director, each of whom were sentenced to jail time.

The office of Michigan’s attorney general, Bill Schuette, handled Nassar’s plea deals but has not similarly pursued MSU. Schuette is running for governor of Michigan in 2018. Only last week, after relentless complaints from victims and families, did his office request Michigan State turn over the findings of an internal review run by a former U.S. Attorney the school hired.

The university, however, said no notes were taken during the review and no final report was produced.

That revelation “appalled” Tom Leonard, a former state prosecutor who is now the Speaker of the House in Michigan. “Not once was there ever a situation where we had an investigation and a report wasn’t produced,” Leonard told the Detroit News, citing his experience as a district attorney. “There were often times that a report didn’t produce charges, but there was always a report.”

Leonard joined the Lansing State Journal in calling for the resignation of university president Lou Anna K. Simon, who has been at the school since 1993 and in her current role since 2004. He also echoed current Michigan gubernatorial candidate Gretchen Whitmer and attorney general candidate Pat Miles in calling for an independent investigation. Each has promised to order one if elected next year.

“We owe it to the victims of these heinous crimes … to find out who knew what, and when,” Whitmer said last week.

*****

At stake isn’t just the truth and possible widening of the criminal investigation, but potentially hundreds of millions of dollars in civil litigation.

Penn State has reached settlements with about 33 Sandusky victims and paid out some $109 million, according to recent university financial documents. That’s an average of about $3.3 million per victim.

For Michigan State, potential liability rests on the number of victims (hundreds), the egregiousness of Nassar’s actions (significant) and whether a jury believes the allegations from Boyce and the others of alerting officials, which would then leave the university responsible for Nassar (to be determined).

“The number of victims who have come forward far exceed that of the Sandusky matter,” said Benjamin Andreozzi, a Harrisburg, Pennsylvania, attorney who represented a dozen Sandusky victims. “As for the nature of the misconduct, the claims which involve allegations of any form of penetration will command very significant financial value – possibly seven figure cases.

“The final factor is probably the most difficult to gauge because until lawsuits are filed and the internal documents from MSU and USA Gymnastics are on the table, we don’t know exactly what they knew and when they knew it,” Andreozzi continued. “If these documents reveal that the institutions knew about his misconduct very early and turned a blind eye to his behavior, a jury is likely to apportion more fault to the institutions and less fault to the perpetrator.”

Until Nassar pled guilty and a gag order on the case was lifted, little was done in pursuing that truth. Civil discovery has yet to begin in earnest. Neither the AG’s office nor anyone else has started an independent investigation. President Simon, among others, are still employed and enjoy the expressed confidence of the MSU Board of Directors. The Board will meet again Friday in East Lansing, where another student protest demanding action is planned.

The school has not, as Penn State did with former FBI director Louis Freeh, commissioned a widespread investigation and publicly release an exhaustive report on what they found.

The focus has been almost exclusively on Nassar, not who could have stopped him.

“Michigan State needs to be transparent,” Boyce said. “Multiple people at MSU were told about it or knew about it. … It wasn’t just him. MSU is trying to push the blame just on him.”

Larry Nassar is thankfully behind bars. That won’t ever change.

In courtroom after courtroom these past few weeks though, it’s clear that should be the beginning of this case, not the end.

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