Ex-US Olympic gymnastics team doctor Larry Nassar has been sentenced to 40 to 175 years after testimony from nearly 160 of his victims.
The judge dismissed Nassar’s attempted apology as insincere, saying he would “be in darkness the rest of his life”.
Nassar pleaded guilty to 10 counts of sexual assault against girls and young women, including Olympians.
The 54-year-old had already been sentenced to 60 years for possession of child pornography.
Judge Rosemarie Aquilina told Nassar during the sentencing: “As much as it was my honour and privilege to hear the sister survivors, it was my honour and privilege to sentence you.
“Because, sir, you do not deserve to walk outside of a prison ever again.”
She told the paedophile: “You have not owned yet what you did. I wouldn’t send my dogs to you, sir.
“I’ve just signed your death warrant”.
Following seven days of emotional testimony from Nassar’s victims, he was given an opportunity to address the court.
“What I am feeling pales in comparison to the pain, trauma, and emotional destruction that all of you are feeling,” he told the packed courtroom.
“There are no words to describe the depth and breadth of how sorry I am for what has occurred,” he added.
But Judge Aquilina revealed he had written a letter to her after his guilty plea claiming his accusers had “fabricated” allegations to gain money and fame.
Court spectators gasped as the judge read a passage in which Nassar said he had been “manipulated” into admitting his guilt.
“I was a good doctor because my treatments worked, and those patients that are now speaking out are the same ones that praised and came back over and over,” Nassar wrote.
He added in the letter: “Hell hath no fury like a woman scorned.”
As the judge finished her sentence, witnesses in the packed courtroom stood and applauded her verdict.
His sentencing follows a week of harrowing testimony from scores of women, including Olympic gold medal gymnasts Aly Raisman and Jordyn Weiber.
Their teammates, McKayla Maroney, Gabby Douglas and Simone Biles, also revealed they had been abused by Nassar.
In 2015, USA Gymnastics – the sport’s top governing body – quietly cut ties with Nassar over allegations about his professional care.
An investigation in 2014 resulted in a three-month suspension from Michigan State University (MSU), where he coached.
But he continued to see patients until he was publicly accused of abuse in a 2016 report by the Indianapolis Star newspaper.
Later that year, he was arrested and charged by Michigan officials with sexual contact with a child.
A year later, he was sentenced for child abuse images found on his computer.
Rachael Denhollander, who was one of the first women to publicly accuse Nassar, pointed the finger at MSU in court on Wednesday.
“How much is a little girl worth? How much is a young woman worth?” Ms Denhollander, now a lawyer, asked as she described the abuse that occurred when she was 15 years old.
“No one believed because they did not listen,” she said, recounting the several times victims told MSU of their allegations.
“Victims were silenced, intimidated, told they were receiving medical treatment, and at times sent back to be further abused.
“This is what it looks like when institutions create a culture when a predator can behave unabated.”
Ms Denhollander said trauma at the abuse she suffered had “cast a horrific shadow” over her medical care when she gave birth to three children, including two daughters.
As the court adjourned on Wednesday, the US Olympic Committee (USOC) announced it would hold an independent investigation into the sex abuse scandal.
“The USOC has decided to launch an investigation by an independent third party to examine how an abuse of this proportion could have gone undetected for so long,” USOC chief executive Scott Blackmun wrote in an open letter.
On Tuesday, the National Collegiate Athletic Association (NCAA) said it would investigate MSU’s original handling of the gymnasts’ abuse claims.
Hours after Nassar’s sentence was read, lawmakers in the Michigan House of Representatives overwhelmingly approved a resolution calling on the head of MSU to resign.
“We have lost confidence in the ability of President Lou Anna K Simon to lead a transparent investigation, to implement changes that will ensure it never happens again, to protect students, and to lead Michigan State University forward,” the resolution said.
The State News, the university’s student newspaper, reports that she will step down by the end of this week.
A story of survival
Rajini Vaidyanathan, BBC News, Lansing, Michigan
Throughout the seven-day hearing, the stories have been strikingly similar – the former USA Gymnastics team doctor would call the women in for treatment, but instead of taking away their pain, he stole their innocence. Some were so young they didn’t realise until years later that they had been sexually abused.
As Larry Nassar sat in his prison overalls, just metres away from them, survivor after survivor looked him in the eye and reminded him of what he’d done to them. And that’s been the most extraordinary thing about this hearing.
While the content of their testimony has been harrowing, it’s also been inspiring. For survivors of sexual abuse it’s hard to relive the experience, let alone do so in front of your attacker.
If you have been affected by child sexual abuse, sexual abuse or violence, help and support is available.
If you are in the UK, you can find links here: BBC Action Line
If you are in the US, you can contact Rainn, the national sexual abuse hotline, here, or by calling 800.656.HOPE