Megan Halicek went to Dr. Larry Nassar as a 15-year-old gymnast suffering from a fractured spine. But during what was supposed to be a routine appointment, Nassar assaulted her: “Again and again and again,” Halicek testified in court in January, “he abused me, all the while telling me stories about his Olympic journey.”

“I closed my eyes tight, I held my breath, and I wanted to puke,” she recalled. “To this day, those feelings are still there.”

Halicek is one of more than 150 women who came forward with harrowing testimony at the sentencing hearing for Nassar, a former doctor for USA Gymnastics and sports medicine physician at Michigan State University who has pleaded guilty to charges of criminal sexual conduct and federal child pornography charges.

A judge sentenced Nassar to up to 175 years in prison for his crimes in January, saying “I just signed your death warrant.” The former doctor has already been sentenced to 60 years on federal child pornography charges.

Among Nassar’s alleged victims are decorated US Olympians, including Aly Raisman, Gabby Douglas, Simone Biles, and McKayla Maroney. Maroney said Nassar molested her “every time I saw him.” It amounted to “hundreds” of times she told NBC’s Savannah Guthrie, in a Dateline interview set to air Sunday.

But the majority were not famous competitors. They were students and young female athletes — gymnasts, dancers, and volleyball players. Nassar’s reputation as a well-connected, talented doctor won their trust. It also helped secure their silence.

The ongoing reckoning with the Nassar case comes amid a larger outpouring of stories about sexual assault and harassment in all arenas, from Hollywood to hotel rooms — and the people in power negligent or complicit in protecting those perpetrators.

Even given the headlines of the past few months, the Nassar case is shocking. First, there’s the number of known victims: More than 260 women and one male athlete have now come forward, which, as HuffPost’s Alanna Vagianos writes, represents “nearly as many victims as the Jerry Sandusky, Bill Cosby, and Harvey Weinstein scandals combined.”

Many of the victims were minors, sometimes abused with their parents in the room while they were medically examined. There is evidence that Michigan State University and USA Gymnastics, the two elite institutions associated with Nassar, were slow to act on reports that he was abusing girls and young women.

Here’s what we know about the case against Nassar, where it stands now, and why elite gymnasts may have ended up particularly vulnerable.

Who is Larry Nassar?

The sex abuse scandal surrounding USA Gymnastics team doctor Larry Nassar, explained

Nassar practiced at the very top tier with some of the most elite American gymnasts. In 1986, he began working with USA Gymnastics, the governing body that selects Olympic teams, as an athletic trainer. After he went to medical school at Michigan State University, he became the chief medical coordinator for USA Gymnastics in 1996. At photos taken at the 1996 Olympics, he’s pictured next to American gymnast Kerri Strug after her famous ankle injury, and he attended the games in Sydney in 2000, Beijing in 2008, and London in 2012.

He was also part of the faculty at Michigan State, where he had taught and practiced medicine since 1997 — meaning he wasn’t only a renowned sports physician but also part of an academic institution.

Then in September 2015, Nassar abruptly retired from USA Gymnastics with little fanfare. (He’d stepped down from his chief medical coordinator position but had originally planned to stay on as the team doctor for the 2016 Olympics.)

A year later, a flood of sexual assault allegations began to explain why.

More than 260 people have accused Nassar of sexual abuse

The sex abuse scandal surrounding USA Gymnastics team doctor Larry Nassar, explained

In 2016, the Indianapolis Star ran a scathing exposé on USA Gymnastics’ systematic failure to protect young athletes from sexual abuse and to report allegations against coaches to authorities. It opened the floodgates and eventually led to dozens of allegations against the physician.

The initial article focused on coaches and did not name Nassar, but Rachael Denhollander of Louisville, Kentucky, reached out to the publication with her own story of abuse and filed a criminal complaint with the Michigan State University police. In it, she alleged that Nassar had sexually abused her in 2000, when she was 15.

Denhollander had sought treatment from Nassar for lower back pain at his sports treatment clinic at MSU, and she alleged that the doctor, without gloves, digitally penetrated her vagina and anus, and at another visit unhooked her bra and massaged her bare breasts with a “visible erection.”

“He’s the type of person who knows how to make you want to trust him,” Denhollander told the Indy Star in the September 2016 story. “There’s a reason he’s risen to this place of prominence. And honestly, part of what grieves me so much is that he has everything he needs to be an incredible leader. He has the personality, he has the skill, he has the knowledge, and he’s using that to prey on people. What a waste.”

Around the same time, “Jane Doe” (who later identified herself as Jamie Dantzscher, who competed with Team USA in 2000 at the Sydney Games), filed a civil suit in California against Nassar, alleging that he abused her repeatedly between 1994 and 2000.

Dozens of allegations followed, all similar, about a trusted doctor who offered relief only to molest them under the guise of treatment.

“For years, Mr. Nassar convinced me that he was the only person who could help me recover from multiple serious injuries. To me, he was like a knight [in] shining armor,” Alexis Moore, who said Nassar molested her starting when she was 9, said in court in January. “But alas, that shine blinded me from the abuse. He betrayed my trust, took advantage of my youth and sexually abused me hundreds of times.”

Eventually, 125 women filed criminal complaints with police, and as many as 260 people have filed civil suits against the doctor and the institutions that employed him for so long, most notably USA Gymnastics and Michigan State University. Some of the victims say coaches and administrators were aware of complaints against Nassar, but no actions were taken against him.

The victims, all women, include notable US Olympians. Aly Raisman, Gabby Douglas, and McKayla Maroney, Jordyn Wieber, four members of the “Fierce Five” 2012 gold medal-winning team stated publicly that Nassar sexually abused them. Wieber came forward for the first time during Nassar’s sentencing. Simone Biles, one of the most decorated gymnasts of all time, has said that Nassar abused her too.

Nassar’s victims said the doctor cannily won over their trust, making them feel special or privileged because of his position with USA Gymnastics. He operated in a sport where injuries can end careers, and young athletes deferred to his authority. Even Olympic athletes were told to feel grateful for Nassar’s care; Raisman said an official with USA Gymnastics told her she should feel lucky for his treatment because he was such a good doctor.

Victims testified that he gave them gifts, offering trinkets from his Olympic travels. Maroney, in her interview with Guthrie, said Nassar would bring her food, and that used the intense, pressure-filled culture to his advantage. “I would’ve starved at the Olympics if I didn’t have him bring me food,” she said.

Nassar was also outwardly supportive, and kind to many of those he abused. “He was always, always, always on my side,” Raisman told Time magazine. “He was always that person who would stick up for me and make me feel like he had my back. The more I think about it, the more I realize how twisted he was, how he manipulated me to make me think that he had my back when he didn’t.”

Nassar, after initially denying the allegations of abuse and defending vaginal penetration as part of his medical treatment, pleaded guilty in two Michigan counties to a total of 10 counts of criminal sexual assault. The victims are primarily women or girls; the first male athlete came forward in March. Almost all were assaulted by Nassar during the course of a medical examination, except one girl — a family friend of Nassar’s whom he abused for six years, between the ages of 6 and 12.

In addition to the charges in Michigan, federal prosecutors charged Nassar in December 2016 with possession of child pornography, saying that the doctor had about 37,000 explicit images in his possession. Investigators discovered this cache while executing a search warrant related to an investigation into sex abuse allegations against Nassar, which stemmed from his work with USA Gymnastics.

Nassar ultimately agreed to plead guilty in July to the possession of child porn, but as part of the deal, he avoided the more serious federal sex abuse charges, which ESPN reported included allegations that he molested children in his home, i