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Could Lawrence Nassar have been prevented from assaulting dozens of athletes?

Lawrence Nassar is accused of assaulting over 80 athletes during his 20 years are a doctor for USA Gymnastics and at the Michigan State Sports Clinic. Why wasn't he stopped?

More than eighty athletes have come forward, all with similar allegations about Dr. Lawrence Nassar—that he touched them inappropriately while treating them for injuries. Some of the allegations date to the late 1990s, others are as recent as last year. Nassar, 53, is incarcerated, facing 25 counts of criminal sexual conduct and two federal child pornography charges. Matthew Newburg, Nassar's attorney, has declined comment.

After all the cases are decided, Nassar may spend his life in prison, but the questions will remain: Who knew what and when? How many assaults could have been prevented?

Nassar was a doctor for USA Gymnastics from 1986 until he was fired by the organization in July 2015. He worked at Michigan State's College of Osteopathic Medicine and at the MSU Sports Clinic from 1996 until being fired in September 2016. In his work with the clinic he treated girls as young as nine.

According to a suit filed against Nassar and MSU, two gymnasts, both then minors, came forward with concerns about Nassar in 1997, speaking with then Michigan State women's gymnastics coach Kathie Klages. In the suit, one accuser, then 16, says that Klages told her that she was "misunderstanding" what Nassar was doing to treat her. The "treatment" employed by Nassar was intravaginal manipulation.

A spokeswoman for the American Osteopathic Association said last week, "It has become abundantly clear that this is not an 'osteopathic' procedure—which Dr. Nassar's defense attorney has contended—but a relatively rare treatment that is more often performed by MDs and physical therapists, typically for pelvic floor pain."

In a statement, Klages's attorney, Shirlee Bobryk, said her client had trusted Nassar to "competently and ethically" treat the gymnasts. Bobryk added, "Had [Klages] ever received any information to cast doubt on the appropriateness of that trust in Dr. Nassar, she would have reacted immediately to protect her gymnasts."

College coaches are, according to Title IX, required to pass along allegations to law enforcement. Klages "took no action," according to the suit, and told one accuser that while she could "file something" it would result in "serious consequences" for the accuser and for Nassar.

The suit also alleges that Klages called Nassar before the girl's next appointment, which occurred later that day. Nassar told the patient that she "was not understanding a proper medical treatment" and assaulted her again during the appointment. Klages told the second accuser, then 15, according to the patient's attorney, Mick Grewal, that "there was no reason to bring up the conduct of Nassar."

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There was another complaint to MSU around 1999 and another around 2000. According to a suit filed this year, an 18-year-old softball player was told in 2000 by a trainer that Nassar "was a world-renowned doctor" and that the intravaginal procedure was a "legitimate medical treatment." Upon reporting the treatment to a higher ranking trainer, she was told it "sounded unusual," but a third trainer told her that it "was not sexual abuse" and that she "was not to discuss what happened with Nassar."

The university received another complaint, in 2014, which was reported to Ingham County prosecutors, who declined to charge him. During the school's investigation of that case, four medical professionals concluded that Nassar's intravaginal procedure, while rare, was legitimate. All four were Nassar's colleagues at the MSU Sports Clinic.

In July 2014, William Strampel, the dean of the MSU College of Osteopathy, wrote this to Nassar in an email: "We will have another person, [resident, nurse, etc] in the room whenever we are approaching a patient to preform (sic) procedures of anything close to a sensitive area," and "the procedure ... will be modified ... to be sure that there is little to no skin to skin contact when in these regions.... I am happy to have you back in full practice." Strampel, who is still dean, couldn't be reached for comment.

So what did USA Gymnastics know?

Jamie Dantzscher, a former national team member and an Olympic bronze medalist in 2000, alleges that Nassar abused her from 1995 through the 2000 Olympics. She and two other national team members, Jeannette Antolin and Jessica Howard, detailed their allegations on 60 Minutes on Feb. 19.

USA Gymnastics says it reported Nassar to law enforcement on July 27, 2015, after a five-week internal investigation. "The information gleaned in the interviews provided the information needed to go to law enforcement, and USA Gymnastics contacted the FBI the next business day after it received that report," a USA Gymnastics spokeswoman said.

Dominique Moceanu, who, at 14, was the youngest gymnast on the 1996 Olympic team, questions how the organization could not have known about Nassar earlier. "I am unaware of what USAG knew prior to 2015," Moceanu says. "What I do know is at camp they knew what we ate, when we slept, what time we trained, what time we had physical therapy, and who ate an extra roll at lunch. So it seems odd that nobody knew about Nassar's behavior over a nearly 30-year period."

USA Gymnastics maintains a list of people, mostly coaches, who are banned from participating in the sport, for committing sexual offenses or for violating laws designed to protect minors. There are 115 names on the list. Nassar's name was never on it; he had not been convicted of a crime. So the Nassar case raises one more question: How many other sexual predators are not on the list?