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The phone rang. It was Dr. Larry Nassar. "Hey, man, what's going on?" Dr. Steven Karageanes recalls saying. Nassar got straight to the point: "I just wanted to call and let you know that I've been accused of sexual assault." It was Thursday, Sept. 8, 2016, just four days before allegations against Nassar would be made public. Karageanes, a former president of the American Osteopathic Academy of Sports Medicine, said he took his phone into another room, away from his family. For the next 21 minutes, he listened as a fellow osteopath he had known for 25 years strongly denied the allegations of two former patients.
About this report
This article is based on 1,583 pages of victim impact statements presented in Ingham County Circuit Court in Michigan in January. More than 150 women said Larry Nassar abused them over three decades, many when they were children. USA TODAY NETWORK reporters at The Indianapolis Star, the Lansing State Journal and the Detroit Free Press conducted interviews with victims, doctors and coaches in multiple states.
Nassar asked whether Karageanes would speak to Michigan State University Police and explain pelvic medical procedures, Nassar's chosen specialty. Nassar also asked his friend to write a letter of support and help gather other doctors, trainers and therapists to fend off the women, who said he molested them during treatments when they were teenagers.
Karageanes said he would help. And it was only after additional evidence piled up that he and others realized how fully Nassar had used them.
"He groomed me for 28 years to help him commit sexual assault," Karageanes said in a statement read by a prosecutor at Nassar's sentencing in January on seven counts of criminal sexual conduct. Karageanes said he was Nassar's pawn. A means to an end. A victim of Nassar's "devious, underhanded and sickening ... machinations."
What comes through loudly in his and more than 150 other court statements -- and in interviews by USA TODAY NETWORK reporters in Michigan and Indiana -- is that the hundreds of girls Nassar molested over three decades were not the only people groomed to perpetuate his abuse. When the truth came out, parents, coaches, trainers and medical professionals felt they had been duped for years into believing in a man who had carefully cultivated a wholesome, helpful image and attained near celebrity status as the foremost medical expert in a niche sport.
People at every level failed to protect Nassar's victims.
At least 29 of the 156 survivors who gave impact statements said they told someone -- a boyfriend, fellow gymnast, parent, coach or official -- about the abuse. Yet on and on it went.
Survivors said the high-pressure culture of USA Gymnastics, the sport's national governing body, aided Nassar as he preyed on children. Other physicians were called on to defend him. The connections Nassar nurtured in sports, medicine and academia helped mask his abuses. And the institutions that gave rise to his fame failed to put sufficient checks in place to protect the children in their care.
USA Gymnastics and MSU declined to comment for this story, citing pending litigation.
When Nassar agreed last year to skip a trial and plead guilty to sexually abusing girls, any lingering doubt about him was removed.
"That's when it just like punched me in the head, you know," Karageanes said. "It means everything the last few months, oh my God, the last few years, oh my God, all these years -- I mean, it's all suspect. Everything."
'One lonely tear'
A woman identified only as Victim 125 confronted Nassar with a question that had haunted her for years.
"Who was that first girl?" she asked Nassar in Ingham County Circuit Court. "Am I her? Do you even remember? Do you even remember what we will never forget? Can you even remember, Larry, when it all began?"
She was 8 years old in 1988 when Nassar arrived at the Great Lakes Gymnastics Club in Lansing. It was there that Nassar, then in his mid-20s, teamed up with two young upstart coaches who would rise in the sport together: John Geddert, who would go on to coach an Olympic champion, and Kathie Klages, who eventually would become MSU's gymnastics coach.
In a court statement directed at Nassar, Victim 125 recalled the young medical student being at the Great Lakes gym "almost every single day for hours with your big black medical bag full of supplies over your shoulder."
Victim 125 said she was 12 when Nassar invited her to help with a flexibility study he said he was conducting on behalf of the MSU medical school. The USA TODAY NETWORK typically doesn't identify victims of sexual abuse without their consent.
"My mother was out of town but granted permission for me to go to your house, because not only did she love and trust you but because I was supposed to be one of several subjects participating in your Michigan State study," Victim 125 recalled in court.
A neighbor drove her to Nassar's apartment. When she got there, it was just her and Nassar. There were no other subjects for his supposed study. Trusting Nassar, the preteen girl followed his direction.
He told her to take a bath in his tub, which would help relax her muscles, she said in court. Then he lay her, naked, on a treatment table in his living room.
She reminded Nassar in court: "You massaged the entirety of my 12-year-old body, suggesting that I relax as you slipped your adult fingers in and out and in and out of my body. That was one of the many, many times that your hands were in me, on me, over the next many years."
Victim 125 said in an interview last month that Nassar's "study" left her confused.
"I knew when I left there that something had happened," Victim 125 said. "I didn't know I was sexually abused. I just knew that I felt really uncomfortable and that something had gone on, but I didn't know what."
A self-made specialist
Nassar received his medical degree in 1993 and later positioned himself as an expert on pelvic floor treatments.
He became adept at relieving pain caused by the rigors of gymnastics, but he also took liberties with girls that went far beyond their medical needs, according to statements from numerous survivors. He sometimes groped their breasts. And, no matter what their ailment, whether a sore neck or ankle, some said, Nassar's treatment often involved penetration of their vaginas.
To disguise what he was doing, Nassar would describe his treatment in different ways to different people, presenting it as non-invasive to the medical world while penetrating the vaginas and rectums of gymnasts under the guise of healing them. Many of his victims were so young, naïve and trusting that they didn't realize they were being abused.
For decades, the difference between what Nassar said and did -- and the deference of patients, parents and other doctors -- would create confusion that allowed him to continue molesting girls.
USA Gymnastics was so confident in its doctor back in 2000 that it sent out the following message to gymnasts attending its National Talent Opportunity Program Training Camp: "If you or anyone in your room has a problem at night (or any time), please call Dr. Larry Nassar, Debbie Van Horn or a USA Gymnastics staff person. Please do not call your personal coach."
The Olympic organization failed to prevent Nassar from treating girls alone in hotel rooms and in dorm rooms at its national training center in Texas, known as the Karolyi Ranch. Many of the women who spoke in court at Nassar's sentencing described the center as an environment ripe for abuse.
The girls in Nassar's orbit were taught from a young age what it takes to be an elite gymnast: discipline, obedience and a high tolerance for pain. Withstanding the pain meant keeping quiet, which cultivated a mind-set among the young athletes that their voices didn't matter.
"From the beginning, we are taught to soldier on through intense training sessions, through the emotional roller coaster of competition, through injury and fatigue, through pain," former gymnast Chelsea Williams said.
When gymnasts were injured, they were sometimes required to see Nassar.
The number of victims rose.
In 2013, USA Gymnastics made Nassar a "core member" of a medical task force established to review the organization's "practices, procedures and protocols regarding athlete care." Among its responsibilities: develop best practices for medical team members, including "ethical obligations for addressing or reporting significant issues."
A year later, former USA Gymnastics president Steve Penny praised Nassar as "instrumental to the success of USA Gymnastics at many levels, both on and off the field of play."
In the process, many gymnasts were led to believe that Nassar using his fingers to penetrate their vaginas and rectums was a necessary, and routine, part of their osteopathic care.
"Who was I to question his treatments or, even more, risk my chance at making the Olympic team or being chosen to compete nationally? And, after all, he was recommended by the national team staff and he treated us monthly at all of our national team camps," 2012 Olympic gold medalist Jordyn Wieber said at a court hearing.
'All the girls loved Larry'
Like many sexual predators, Nassar positioned himself as a helpful "nice guy."
"Every Monday he would come to the gym and everyone was always so happy to see him," Brooke Hylek said in a statement at Nassar's sentencing. "All the girls loved Larry and trusted him."
Nassar sought deeper connections, too, as the girls' close friend and confidant. He texted them, sent them messages on Facebook, gave them nicknames and shared adult details about himself, such as his preferred beer.
He played on their desire for Olympic greatness, hanging pictures of top athletes in his office. Some women remembered looking up at the images as he assaulted them.
Gift-giving is considered a possible warning sign of pedophilia, especially when only certain children receive them, and is banned from some gyms, but no one appears to have stopped Nassar.
He gifted Kassie Powell, a track athlete, an Olympic sweatshirt she wore around the house for weeks. Emily Morales, a gymnast, got an autographed towel from the London Olympics. Alexis Alvarado was given autographed photos of famous gymnasts. Others received Olympic pins and one girl was given a practice leotard.
For Isabell Hutchins, the gifts were even more personal -- 1996 Olympics swag featuring the event's mascot, Izzy.
Isabell was gifted figurines and playing cards.
"And there were Izzy Band-Aids for Izzy boo-boos because of all the injuries I had had," Hutchins said at Nassar's sentencing. "He even wrote me a letter and he said: 'Dear Izzy, I am so proud of you having such an awesome season this year. Did you know that the 1996 Olympic mascot was Izzy? Well, enjoy. And, of course, I have a pair of Izzy socks from the 2000 Aussie Olympics.
"Love you, girl. Larry.'"
But the trust Hutchins, Hylek, Powell, Morales, Alvarado and hundreds of other girls put in Nassar was betrayed. They were all assaulted.
Hutchins brought the Izzy figurines into the courtroom during Nassar's sentencing. After her statement, she dropped them in the trash.
'I was humiliated'
Some girls did complain. Former gymnast Larissa Boyce told the court she raised concerns to MSU coach Kathie Klages about Nassar's treatments as early as 1997. According to a lawsuit, Klages asked other gymnasts in the Spartan Youth program whether Nassar had done anything to them.
A second gymnast spoke up.
But rather than calling police or MSU officials, Boyce said Klages went to Nassar. "Instead of being protected," Boyce said in court, "I was humiliated. I was in trouble, and brainwashed into believing that I was the problem. This MSU employee then fed me back to you, the wolf, to continue to be devoured."
Klages' attorney declined to comment, citing a pending lawsuit. In 2017, Klages told police she did not remember Boyce coming to her.
One of the women who met Nassar at Great Lakes in the 1980s said a very close friend came to her in 1997. "I think Larry did something bad to me," the friend told Gonczar.
"I asked her what he had done," Gonczar said in court. "She explained he vaginally manipulated her. I calmed her down and explained to her what happened to her was completely OK as it happened to me all the time."
That conversation upset Gonczar when she eventually realized the treatment she and her friend had received was actually sexual abuse. Gonczar said she has sought counseling.
Michigan police departments twice investigated Nassar before his arrest in 2016, once in 2004 and again in 2014. The first investigation was never sent to prosecutors. The second one was, but no charges were filed.
In early 2014, MSU graduate Amanda Thomashow reported that Nassar massaged her breast and vagina after sending out the only other person present during an exam at MSU. She told him to stop, but he did not until she physically removed his hand from her. The university started a Title IX investigation, and its police department started a separate criminal investigation.
The investigation relied on the medical opinions of four MSU employees who had close ties to Nassar. They determined that Thomashow received an appropriate medical procedure and probably misinterpreted it as sexual assault because she wasn't familiar with osteopathic medicine and wouldn't know the "nuanced difference."
"As I see it, Amanda was abused twice," Suzanne Thomashow said of the Title IX process, specifically pointing to the "nuanced difference" line that said her daughter didn't understand what happened.
Suzanne Thomashow, a doctor, said she was furious when Amanda told her what Nassar did. Suzanne Thomashow knew it was a sexual assault, but she thought it was an isolated incident. She stopped referring patients to Nassar after that and didn't send any of her daughters back to see him.
Suzanne Thomashow would later learn that one of her other daughters, Jessica, had been sexually assaulted by Nassar years before.
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