In the summer of 2015, nearly a year before the Larry Nassar sexual assault scandal erupted publicly, former USA Gymnastics president and CEO Steve Penny had detailed and disturbing notes about the team doctor's alleged sexual assault of Olympian McKayla Maroney, according to a new book by ESPN investigative reporters Dan Murphy and John Barr.

Notes and email exchanges from the summer and fall of 2015, obtained by the authors and published Tuesday in the book "Start by Believing," are among a series of previously unreported documents and interviews that help reveal the extent to which USA Gymnastics' former leader and others were willing to go to contain the emerging scandal. Those documents show Penny was aware that Maroney had said she "felt no therapeutic effect but felt [Nassar] was getting sexual gratification" by penetrating her with his fingers on several occasions. Even though he was aware of that detail, Penny passed up a chance to warn Nassar's full-time employer, Michigan State, and the public about the alleged misconduct.

USA Gymnastics' attorneys Dan Connolly and Scott Himsel presented Penny with a clear-cut choice in September 2015 as to whether they should share what they knew, months after he learned about Maroney's complaints.

"We can tell the full story of what we've learned thus far," the attorneys wrote in an email obtained by the authors. "We think it is highly likely that would become a media story and prompt Larry to sue for defamation. ... Neither Dr. Nassar nor USAG wants the attendant negative publicity at this time."

Penny, who is awaiting trial on evidence-tampering charges for a separate incident related to the Nassar case, opted to stay silent. Nassar continued to see patients at Michigan State University for nearly another year. Dozens of women and girls who visited Nassar during that time period said he assaulted them.

Penny became president and CEO of USA Gymnastics in 2005 and resigned in March 2017. Mark J. Rebilas/USA TODAY Sports

Penny, an experienced marketing and public relations expert, had worked to contain and control the story of Nassar's abuse from the first time he learned of concerns about the then-renowned team physician. In June 2015, Penny and others at USAG had learned that several prominent national team gymnasts were uncomfortable with the way Nassar had touched them during treatment sessions. Rather than alerting authorities as was required by Indiana law, Penny first hired consultant and workplace harassment investigator Fran Sepler to investigate the complaints. Sepler interviewed gymnasts Aly Raisman and Maroney, two members of the Olympic gold-medal-winning 2012 team, and Maggie Nichols, whose bid to make the 2016 Olympic team was hampered by a knee injury.

According to bullet-point notes Penny had in late July 2015 that were obtained by the authors, he was aware that Maroney told Sepler that she had seen Nassar hundreds of times. "Much more troubling, she [Maroney] reported digital penetration three times -- in Japan 2011, London 2012, Belgium 2013," the notes said. Those same notes mention Nassar sending her gifts and buying her coffee, and noted that he was "rougher" in subsequent exams.

On July 28, 2015, more than a month after first hearing of complaints about Nassar, Penny reported the findings of USAG's internal investigation of Nassar to the FBI's Indianapolis field office. Days before that meeting with the FBI, Himsel and Connolly, USAG's attorneys, directed Nassar to skip an upcoming gymnastics competition. Nassar had not yet been dismissed from his job or charged with a crime, and the attorneys allowed him to say he was sick to explain why he wasn't at the meet. Nassar's absence at the upcoming 2015 world championships in October, however, would be conspicuous and not easily explained away with lies about dealing with a sickness. So as that meet approached, Himsel and Connolly sent their email to Penny about what might happen if he told the full story. In the same email, they suggested an alternative.

"Have us call back Dr. Nassar's lawyer," they wrote. "Tell him that a replacement will handle the World Championships and we can work on the messaging regarding that." Penny followed Connolly and Himsel's advice, which cleared the way for Nassar to announce in a lengthy Facebook post in late September 2015 that he was stepping away from his duties with USA Gymnastics of his own volition.

Penny, in his first extensive public comments about the scandal, told the authors he chose not to share the disturbing details about Nassar with Michigan State because the FBI warned him not to do anything that might impede an ongoing investigation. Through a written response sent via his personal attorneys, Penny said he interpreted the FBI's warning to mean he should not speak to anyone about the complaints. His attorneys also said that they did not consider anything Penny learned in 2015 to be an "unambiguous claim of sexual assault."

"We expected that law enforcement would take all necessary actions regarding Nassar, including removing him from Michigan State University if deemed necessary," Penny told the authors.

The authors found that at least one high-ranking USAG official has said under oath that the FBI never explicitly told the organization it shouldn't share what it had learned about Nassar with Michigan State. Former USAG vice chairman Paul Parilla said in a lawsuit deposition that the FBI didn't give specific instructions but rather warned USAG officials multiple times "not to take action that would interfere with the investigation."

The FBI's investigation of Nassar was passed between field offices in Indianapolis, Detroit and Los Angeles. The case "dragged on" for more than a year while Nassar continued to sexually assault his patients, according to a congressional report that found the FBI was among the institutions that "fundamentally failed" in the Nassar case.

"My heart aches for anyone who was subjected to any mistreatment by Larry Nassar," Penny said via his attorneys. "... It horrifies me, as more information has become known, that Nassar was able to conceal his conduct for so long and I cannot understand why our report to the FBI did not result in more immediate actions against Nassar."

The Department of Justice's Office of the Inspector General is reviewing the FBI's handling of the Nassar case. The office completed its review in the spring of 2019 but has yet to release its findings and has not answered questions from survivors, attorneys and members of Congress who want to know why it hasn't shared a final report.

"Our investigation found that the FBI was one of many institutions that enabled Larry Nassar's abuse," said Sen. Richard Blumenthal (D-Conn.), who helped lead an investigation into the Nassar scandal and co-authored a pending bill aimed at reforming the way Olympic sports governance handles abuse claims. "It is past time to see the Inspector General's investigation into federal law enforcement's failures. The survivors deserve answers."

That report is one of many offshoots from the sprawling Nassar case that remain unresolved years after the former doctor was sent to prison.

This week marks the two-year anniversary of Nassar's first state sentencing hearing in Lansing, Michigan, where 156 women provided searing impact statements that shed devastating light on his crimes and the institutions that enabled him. Their words led to an effective life sentence for Nassar and widespread calls for reform at those institutions.

But two years later, survivors fear the original outrage has fizzled without bringing needed change.

Rachael Denhollander became one of the first women to publicly accuse Nassar of assault in 2016 through a story in The Indianapolis Star. AP Photo/Carlos Osorio

"It doesn't matter enough. That's the honest reality. If it mattered enough, they would have done something," said Rachael Denhollander, who was the first to publicly speak about Nassar's sexual abuse more than three years ago. "A lot of people like to talk and say big things when something is popular. People like to think of their lives as an epic battle between good and evil. Very few people realize that battle doesn't look epic. It looks like daily, small sacrifices."

Penny is one of four people awaiting trial for criminal charges related to the Nassar case.

Penny was indicted in September 2018 by a Walker County, Texas, grand jury on charges of evidence tampering for allegedly ordering another USAG employee to remove Nassar's medical files from Karolyi Ranch -- the longtime training facility of Team USA gymnasts -- before law enforcement gained access to search the site.

Debbie Van Horn, Nassar's longtime colleague on the USAG athletic training staff, was indicted in June 2018 on charges of sexual assault of a child. Former Michigan State president Lou Anna Simon and former gymnastics coach Kathie Klages have been charged with lying to police.

All four have pleaded not guilty. Only one of the four cases has a scheduled trial date (Klages' trial is set to begin Feb. 10). Penny received a $1 million severance package, according to The Wall Street Journal, when he resigned from USAG in March 2017. Simon, who stepped down from president into an emeritus position in 2018, agreed to a $2.45 million payout when she retired from the university in August 2019.

Former national team head coach John Geddert has been the subject of an open police investigation for more than a year.

The major institutions that oversaw Nassar remain locked in legal stalemates.

Michigan State University has been in a dispute with the state attorney general's office since December 2018 over the school's refusal to release roughly 6,000 pages of documents relating to the Nassar case. The school's board of trustees, which originally asked the attorney general's office to conduct its comprehensive investigation to provide unbiased answers to the public, maintains the documents in question are protected under attorney-client privilege.

The debate has caused a rift among trustees. Trustee Nancy Schlichting resigned in October -- less than a year after she was appointed to replace an outgoing board member as a rare outsider -- due to frustration with some of her colleagues; she believes they failed to make good on their promise to be transparent.

"It has become very clear to me that my commitment to have an independent review of the Nassar situation, and to waive privilege so the truth can come out, is not shared by the MSU board chair, legacy board members and some newer trustees," Schlichting said in a statement at the time.

USA Gymnastics filed for bankruptcy in December 2018 -- a move that USAG board members said was done to expedite the civil court claims made by more than 500 gymnasts suing the organization for its role in allowing Nassar's abuse to persist. More than a year later, lawsuits against USAG and the U.S. Olympic and Paralympic Committee remain in a holding pattern until bankruptcy court proceedings reach a conclusion.

Denhollander said when she first came forward in September 2016 that she was prepared to face five to seven years of those small, painful battles before Nassar's trial and appeals were over. In one sense, she said, they're further ahead than she thought they would be.

"We've gotten answers that most survivors never get," she said. "But that's not nearly enough."