LANSING, MI (WLNS) – Judge Rosemarie Aquilina sentenced Larry Nassar to 40 to 175 years on the seven sexual assault charges he pleaded guilty to last year.

This brings an end to the week-long sentencing hearing in Ingham County, where 156 women and girls made victim impact statements. The judge wanted to make sure their voices were heard, telling Nassar he does not deserve to look outside of prison ever again.

“I just signed your death warrant,” Judge Aquilina said.

Nassar, 54, will spend at least 40 years in prison for sexually abusing dozens of women and girls under the guise of medical treatment.

“Your decision to assault was precise, calculated, manipulated, devious, despicable,” Judge Aquilina said.

She told the former MSU and USA Gymnastics doctor his fate after seven days of listening to more than 150 of his victims, their parents and coaches make impact statements about how the abuse has affected their lives.

“You played on everyone’s vulnerability,” Judge Aquilina said.

But before the judge handed down the sentence, Nassar had the chance to speak.

“Your words these past several days, your words, your words, have had a significant emotional effect on myself and shaken me to my core,” Nassar said.

Twice, the once famed Olympic doctor turned to the court gallery.

“I’ve also realized that what I feel pales in comparison to the pain, trauma, and emotional destruction, there are no words that describe the depth and breath of how sorry I am for what has occurred,” he said. “An acceptable apology is impossible to convey, I will carry your words with me for the rest of my days.”

The room packed with his victims, their families and attorneys.

What happened in this court room Wednesday, is something the Michigan Attorney General’s office hopes will be viewed as a “turning point” in how our community looks at sexual abuse.

“The world has witnessed what happens when victims are treated with respect, dignity, empathy, compassion, and are truly supported by police, prosecutors, and the criminal justice system in courts,” Angela Povilaitis said.

But before she sentenced the former doctor, Judge Rosemarie Aquilina once again brought up a letter that Nassar wrote before his week-long sentencing hearing started.

She read portions of it to the court.

“What I did in the state cases was medical not sexual, but because of the porn, I lost all support, thus another reason for this guilty plea,” Nassar wrote.

Because the letter was written after Nassar admitted guilt, it led the judge to question whether he knew what he did was wrong.

Aquilina: “Would you like to withdraw your plea?”

Nassar: “No your honor.”

Aquilina: “Because you are guilty aren’t you? Are you guilty sir?”

Nassar: “I’ve said my plea exactly.”

Even though Wednesday wraps up the case in Ingham County, Nassar will still have to be sentenced in Eaton county, where he pleaded guilty to three sexual assault charges. That’s set to happen on Jan. 31st.

Before he can serve time in the state cases, the former doctor will have to serve his 60-year prison sentence on three child pornography charges.