Disgraced US gymnastics team doctor Larry Nassar has been sentenced to up to 175 years in prison for sexually abusing young female gymnasts.
The sentence came after days of testimony from about 160 of his victims, including Olympic gold medalists.
"I've just signed your death warrant," Ingham County Circuit Court Judge Rosemarie Aquilina told Nassar in imposing the penalty.
"It is my honour and privilege to sentence you because you do not deserve to walk outside of a prison ever again."
Some victims dabbed their eyes after Judge Aquilina spoke, but the audience obeyed the judge's instruction to remain quiet following her pronouncement.
Four-time Olympic champion Simone Biles has said she was sexually abused by Nassar.
Nassar is serving already 60 years in prison for having child sex abuse images on his computer.
Ms Biles, who won team, all-around, vault and floor exercise gold medals at Rio 2016, recently posted a statement on Twitter that read: "Most of you know me as a happy, giggly, and energetic girl. But lately... I've felt a bit broken and the more I try to shut off the voice in my head the louder it screams.
"I am not afraid to tell my story anymore. I too am one of the many survivors that was sexually abused by Larry Nassar."
Three former US Olympians accused Nassar of sexual abuse, including Gabby Douglas, Aly Raisman and McKayla Maroney.
"I’ve just signed your death warrant," says a judge sentencing former US gymnastics doctor Larry Nassar pic.twitter.com/uOxKPDSD4V
— RTÉ News (@rtenews) January 24, 2018
Before the sentence was announced, Nassar apologised to his victims, telling them: "I will carry your words with me for the rest of my days."
But Judge Aquilina dismissed his statement as insincere, reading aloud from a letter Nassar wrote to her in which he claimed he was a good doctor who was "manipulated" into pleading guilty, drawing gasps from courtroom spectators.
Nassar also claimed his accusers fabricated claims to gain money and fame and wrote: "Hell hath no fury like a woman scorned."
"This letter tells me you still do not own what you did," Judge Aquilina said, after angrily tossing the sheet of paper aside. "I wouldn't send my dogs to you, sir."
The sentencing followed an extraordinary week-long hearing that saw a parade of Nassar victims tell their stories in raw and unflinching terms, describing how he used medical treatments and their own trust to justify his abuse.
