Photo: Carlos Osorio (AP)

Members of the Michigan House of Representatives released a letter today that summarized the findings of an inquiry into Michigan State’s handling of Larry Nassar, who sexually abused hundreds of patients while working as a doctor for both MSU and USA Gymnastics. Their findings lay out multiple areas where Michigan State failed to stop a predator in their employ, and several reasons why Nassar was able to get away with his abuse for so long.

In addition to noting the specific issues with MSU’s 2014 Title IX investigation of Nassar—which put Nassar back to work before the campus police investigation was finished and imposed new guidelines on him that would only go unenforced—the letter also describes a larger problem of both ignorance and policy loopholes that allowed Nassar to get away with his abuse for so long.

“There are clear gaps in current law, regulations, and policies that help enable an environment which, unfortunately, has proven ripe for abuse,” the letter said. “While MSU has made many positive changes to its policies addressing these gaps, the Legislature must now act to correct these deficiencies on a broader scale to the greatest extent it can.”

Among those “gaps” is the fact that, according to the letter, medical records were not kept for many of Nassar’s treatments/assaults, and many that were kept did not reference the full nature of his methods, which included vaginal and rectal penetration with his ungloved hand. That failure allowed Nassar to argue to investigators that he did not penetrate his patients.

Other failures in MSU policy outlined in the letter include the fact that the school did not require chaperones in the exam room while Nassar was treating minors. MSU also did not have a strong enough informed consent policy in place, which eventually allowed Nassar to abuse his patients without even providing a medical excuse. From the letter:

When Nassar starting performing his treatments in the 1990s, it appears he took careful steps so they would be perceived as medically appropriate, such as by explaining the procedure to the patient with a pelvic model demonstration and providing informational materials prior to treatment. The evidence reviewed demonstrates that his conduct shifted over time as he became more aware of what he could get away with. By the late 1990s and early 2000s, it appears he occasionally would only mention that he was going to adjust the pelvic bone, for example, without fully explaining the procedure. By 2014, he seems to have felt confident enough to abuse his patients without any prior notice or explanation whatsoever of the purported medical treatment. By 2016, he was self-assured enough to readily admit to investigators that he “does not get written consent from the patient before treatment” and even testified that “unless the patient stops him, he is assuming the patient understands.”

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Nassar also did not ask for or receive payments from patients or their insurers for many of his treatments, which the letter says should have raised questions sooner than it did. Nassar’s former boss, William Strampel, was charged with criminal sexual misconduct in March.

According to the letter, 243 survivors to date have reported abuse from Nassar to the MSU Police Department. The full letter, which includes a detailed Q&A between the representatives and an MSU attorney, is embedded below.