One of the first women to publicly accuse former sports doctor Larry Nassar of sexual abuse says victims are now focusing on “institutional dynamics” that allowed the abuse to occur.

Nassar was sentenced Monday to between 40 and 125 years in prison for sexually abusing patients at Twistars, an elite gymnastics club in Michigan. But more than 260 women and girls say he abused them, including while he worked at Michigan State University and USA Gymnastics.

Rachael Denhollander said after Monday’s sentencing that victims “wouldn’t be here had the adults and authorities done what they should have done 20 years ago.”

She says victims are now turning their attention “with even greater force to the institutional dynamics that led to the greatest sexual assault scandal in history.”

Denhollander is a Kentucky lawyer who came forward after reading a 2016 Indianapolis Star investigation of how USA Gymnastics handled sexual abuse allegations against coaches.

The judge who sentenced former doctor Larry Nassar to decades in prison for sexually abusing patients at an elite gymnastics club says the depth of his crimes is “incomprehensible.”

Judge Janice Cunningham sentenced Nassar on Monday to between 40 and 125 years in prison. The case focused on sexual assaults at Twistars, a gym for elite gymnasts in Eaton County, Michigan.

But more than 260 women and girls say Nassar sexually abused them under the guise of medical treatment while he worked with Twistars, Michigan State University and USA Gymnastics.

Some victims say the abuse occurred decades ago.

Cunningham says Nassar’s conduct “spans the country and the world.” She told Nassar she didn’t believe “there is a likelihood that you could be reformed.”

Nassar told the court: “It’s impossible to convey the breadth and depth of how sorry I am to each and everyone.”