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Hundreds of female gymnasts who were sexually abused by Larry Nassar, a former team doctor for the U.S. national gymnastics team, have agreed to a $380 million settlement with USA Gymnastics and the U.S. Olympic & Paralympic Committee (USOPC), ending the latest dark chapter in one of the biggest child-molestation cases in history.

The settlement, announced Monday during USA Gymnastics’ bankruptcy proceedings in U.S. Bankruptcy Court for the Southern District of Indiana, is among the largest ever for a sexual abuse case. The funds would seek to compensate more than 500 victims of abuse, including Olympic gold medalists such as Simone Biles, McKayla Maroney and Aly Raisman.

“No amount of money will ever repair the damage that has been done and what these women have been through,” said Rachael Denhollander, a Nassar survivor and member of a survivors committee involved in the settlement negotiations. “But at some point, the negotiations have to end because these women need help — and they need it right now.”

Many of the girls and women abused by Nassar have battled mental health issues, including anxiety, depression and post-traumatic stress disorder, and some have attempted suicide because of the abuse — which Nassar perpetrated under the guise of medical treatment.

Denhollander, a lawyer, said it was unclear how much money each survivor would receive from the settlement because an independent mediator would consider many factors, including the length of time and the severity of the abuse, when calculating a dollar amount per person.

USA Gymnastics and USOPC officials applauded the settlement, which — along with the gymnastics federation’s reorganization plan — was approved Monday by Judge Robyn Moberly of the bankruptcy court. The approval means that USA Gymnastics should emerge from bankruptcy by the end of the year.

The Olympic officials commended the survivors for their bravery and apologized to them.

“USA Gymnastics is deeply sorry for the trauma and pain that survivors have endured as a result of this organization’s actions and inactions,” Li Li Leung, president and CEO of USA Gymnastics, said in a statement, adding that the reorganization plan reflected the federation’s “accountability to the past and our commitment to the future.”

Sarah Hirshland, CEO of the USOPC, said in a statement that the committee had made many changes to protect athletes going forward. “We recognize our role in failing to protect these athletes, and we are sorry for the profound hurt they have endured,” she said.

The Nassar case, which forced the recognition of young athletes’ vulnerability in gymnastics and other sports, revealed how organizations such as USA Gymnastics and the USOPC had failed to protect its athletes and appeared to prize medals over athletes’ safety. There have been numerous congressional hearings about the issue, and one result was that lawmakers strengthened protections for athletes in Olympic sports.

In one hearing, FBI Director Christopher Wray apologized for the agency’s mismanagement of the case. In heart-wrenching testimony in September, Biles, Maroney, Raisman and former national team member Maggie Nichols described how the FBI turned a blind eye to Nassar’s abuse while the investigation stalled and children suffered.

One legacy of the case will be how it empowered victims to speak about their sexual abuse and face their accusers. At Nassar’s sentencing hearings in early 2018, more than 100 girls and women he abused, including some of his patients at Michigan State University, stood in front of him and gave witness statements about how he had hurt them. Their statements were often defiant and told of how they had persevered despite the abuse.

Because of the Nassar case, sports organizations became aware of their culpability when athletes are abused on their watch. Steve Penny, former USA Gymnastics president and CEO, was fired from the federation and faces a felony charge of evidence tampering in the case. Scott Blackmun resigned under pressure as CEO of the USOPC.

“The settlement shows that there was injustice absolutely going on here,” said John Manly, a lawyer representing many of the victims. “But if you really want to stop people who enable child molesters, you have to start sending people to jail.”

Manly added that the only person in the case serving time in prison is Nassar, and said Nassar’s enablers — including the sports, university and law enforcement officials who heard complaints about him but never followed up — should be in prison, too. Manly said he had mixed feelings about the settlement: It stings, he said, that it has been five years since he filed his first suit in the case.

“For the life of me, I don’t know why five years had to go by and hundreds of millions of dollars had to be spent on corporate lawyers for us to get to this point,” he said.

The first significant payout to Nassar’s victims was announced in 2018, when Michigan State promised to give $500 million to survivors of the doctor’s abuse. It was believed to be the largest settlement reached in a sexual abuse case involving a U.S. university.

In Monday’s announced settlement, insurers of USA Gymnastics and the USOPC would pay the bulk of the $380 million, but the USOPC also agreed to pay $34 million of its own money and give USA Gymnastics a loan of about $6 million. That contribution represents a stunning turnaround for the organization, which had argued that it should not be held responsible for Nassar’s crimes or be named in Nassar-related abuse suits, partly because the doctor was not an employee of the Olympic committee.

Under an avalanche of Nassar lawsuits filed against USA Gymnastics, the gymnastics federation lost all of its major sponsors and filed for bankruptcy protection in late 2018, the same year Nassar was sentenced to what amounted to life in prison for multiple sex crimes.

The $380 million settlement now will help the federation emerge from bankruptcy after years of uncertainty. Another benefit for the federation is that it will keep the USOPC from decertifying USA Gymnastics as an Olympic organization, a possibility that had loomed over it since it was basically placed on probation in 2018.

In August, USA Gymnastics and Nassar’s abuse victims agreed on a $425 million proposed settlement, but it had yet to be fully funded because several insurance companies had not agreed to contribute the money they were asked to.

Another lingering issue was how much money the USOPC should, and would, contribute. That settlement proposal and the current one, though, both included a list of nonmonetary provisions, which survivors such as Denhollander view as crucial to rebuilding the sport and keeping its athletes safe.

One provision would be that at least one Nassar survivor would serve on the federation’s board of directors. Another provision would be that there would be an independent accounting of what went wrong in the Nassar case and how it went wrong, Denhollander said.

“To move forward, we have to make sure that this never happens again — on the Olympic team or at the lowest-level gyms,” she said, noting that only a small percentage — maybe less than 10% — of the 500 victims in the settlement were elite gymnasts. “I think we owe it to the survivors, but also to the future gymnasts, to do the best that we can do to protect them.”

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