Sports doctor Larry Nassar is on his way to prison for the rest of his life for molesting scores of young female athletes, but the scandal is far from over at Michigan State University in East Lansing as victims, lawmakers, and a judge demand to know why he wasn't stopped years ago.
Some are likening Michigan State to Penn State University in State College, Pa., where three senior officials, including the school's president, were sentenced to jail last year for failing to tell authorities about a sexual abuse allegation involving coach Jerry Sandusky.
Mr. Nassar, a former member of Michigan State's sports medicine staff, has admitted penetrating elite gymnasts and other athletes with his fingers while he was supposedly treating them for injuries.
Some of the more than 150 women and girls who have accused him said they complained to the sports medicine staff, a campus counselor, and the women's gymnastics coach as far back as the late 1990s.
In Michigan, it is a misdemeanor punishable by up to three months in jail and a $500 fine for certain professionals to fail to report a suspected case of child abuse.
Lou Anna Simon, who resigned under pressure Wednesday as Michigan State's president, insisted, "There is no cover-up." But the university last week asked Michigan's attorney general to conduct a review. And in sentencing Nassar to 40 to 175 years in prison Wednesday, Judge Rosemarie Aquilina called for "a massive investigation as to why there was inaction, why there was silence."
Jennifer Paine, a Michigan lawyer who specializes in child protection law and is not involved in the Nassar case, said there are probably grounds for charging some Michigan State staff members for failing to report what victims were saying.
"The obligation to report doesn't mean anything unless people enforce. That's why it's there," she said.
No one has been charged in the scandal besides Nassar.
John Manly, an attorney who represents more than 100 victims in lawsuits, said Michigan State, USA Gymnastics, and the US Olympic Committee "miserably failed children." Nassar was a team doctor at USA Gymnastics, which trains Olympians.
"They had an opportunity, instead of being Penn State, to make them a beacon of how to handle this," Mr. Manly said. "It's too late. You can't fix it now."
Penn State's former president, Graham Spanier, and two other ex-administrators, Tim Curley and Gary Schultz, were prosecuted for child endangerment for not reporting a 2001 complaint about Mr. Sandusky showering with a boy. Sandusky's arrest a decade later blew up into a scandal that brought down legendary football coach Joe Paterno.
Sandusky is serving 30 to 60 years in prison for sexually abusing 10 boys. As of last year, Penn State had paid nearly $250 million in fines, settlements, and other costs associated with the scandal.
Nassar has also been sentenced to 60 years in federal prison for child pornography. Federal prosecutors have declined to say if they are looking at any other aspects of the case.
Elsewhere, in Texas, the Walker County sheriff's office said it is investigating the Karolyi Ranch, which was a training site for Olympic gymnasts. Some gymnasts said Nassar assaulted them there.
In Washington, US senators from both parties are calling for creation of a select committee to investigate the US Olympic Committee. The NCAA said it has sent Michigan State a letter of inquiry about potential rules violations.
In the Penn State scandal, the NCAA fined the school $48 million, reduced the number of football scholarships, barred the team from postseason play, and invalidated 112 victories. Some penalties were later eased.
Kyle Stephens, who was a Nassar family friend, said he molested her for years at his Lansing, Mich.-area home. She said she told a campus counselor, Gary Stollak, about the abuse in 2004. Nassar met with Mr. Stollak and denied it, and no police report was made.
Stollak, now retired, testified in 2016 that he couldn't remember anything because of a stroke.
"He didn't report it, and he's a mandatory reporter," Ms. Stephens said, referring to those who are legally required to report sexual abuse. "Michigan State keeps saying that 'we didn't know.' Who should I have told? Tell me who I should have told so I know what I should have done... They are continuing to drag out my pain, and that is inappropriate."
A 2014 police investigation into other assault allegations ended with no charges against Nassar. The university, however, told him that he needed to have a chaperone in the room during certain exams. He was fired in 2016 for failing to do so.
Some victims say they reported Nassar to Kathie Klages, who ran camps for teen gymnasts and was Michigan State women's gymnastics coach until last February. She has denied wrongdoing.
Michigan state Sen. Margaret O'Brien (R) said college coaches should be added to Michigan's list of mandatory reporters, which includes therapists and medical professionals. In the state House, lawmakers sent a letter to Michigan State on Thursday requesting certain reports about Nassar.
This story was reported by The Associated Press.