Lansing — The truth about what happened at Michigan State University when Larry Nassar sexually assaulted hundreds of young women may never fully be known — because the university has repeatedly stonewalled investigators trying to find out, a state investigator said in a scathing report released Friday.

The report, issued by Michigan Attorney General special independent counsel William Forsyth, depicts MSU as indifferent to sexual assault and steeped in protectionism, lacking transparency and valuing financial and legal considerations over victims and public interest.

"MSU stonewalls the very investigation it pledged to support," the report says, adding later: "An institution truly interested in the truth would not have acted as MSU has."

The report comes as the Board of Trustees embarks on the search for the university's next president. In a statement, MSU spokeswoman Emily Guerrant said the university "is extraordinarily sorry that Larry Nassar was on our campus and has hurt so many people."

MSU is carrying out "an intense reform and cultural change effort" in response to the scandal, she said.

"Today’s announcement shows that the attorney general’s office has found no criminal conduct beyond those formerly charged, even after reviewing more than a half million documents and interviewing 500 people," Guerrant said. "We appreciate the attorney general’s investigation and the hard work of the many people involved.""

But Forsyth, who discussed the report's findings at a news conference in Lansing, said that until there is "top-down culture change," many would be skeptical of any policies that Michigan State enacts in the wake of the scandal.

When asked what he would say to Nassar's victims, Forsyth spoke softly.

"I'm sorry that this happened to them," he said. "It continues to happen to them in the sense that they will never know what happened."

Sterling Riethman, one of Nassar's victims, reacted on Twitter, saying Michigan State continues to fail her and others.

"I find it interesting to watch how many people have sincerely apologized to us with visible emotion, pain and sorrow, when it’s those same people who have nothing to apologize for," Riethman tweeted. "Yet the institution who can and should take responsibility only continues to hurt us more."

Bill Funk, an expert in presidential searches, said the report could limit the pool of potential candidates as the university seeks a permanent replacement for Interim President John Engler.

"Given the history here, there would be a wariness on the part of candidates," said Funk, founder and President of R. William Funk & Associates, a Dallas-based executive search firm that has helped numerous universities hire presidents.

"It would seem to me the best candidates would want to come into the situation knowing that all of the things that happened over the past couple of years were cleaned up and they could start with a fresh slate ... Engler should be cleaning it up."

Continued publicity of MSU's troubles is going to heighten the university's challenge to find the best candidates, Funk said.

At the same time, he said some people who love a challenge and higher education has turnaround specialists, though not many.

"Culture is one of those things you can't change quickly," Funk said. "It’s a tough one. Certainly people will know what they are getting into."

The report cites numerous MSU actions during the investigation, and even beforehand, to support its statement that the full truth of Nassar may never be known.

Among them:

--MSU hired former federal prosecutor Patrick Fitzgerald, saying he would investigate the university's handling of Nassar, when his real mission was "to prepare and protect the institution in forthcoming litigation."

--University officials discussed in emails how to keep information secret.

--MSU insisted that its attorneys attend witness interviews in a "veiled attempt ... to blunt the candor of witnesses and otherwise prevent them from sharing certain details regarding MSU's knowledge and handling of the Nassar matter."

--The university sent reams of "irrelevant documents" to investigators including policies on bed bugs and tornadoes.

"Both then and now, MSU has fostered a culture of indifference toward sexual assault, motivated by its desire to protect its reputation," the report says.

Michigan State promised cooperation when it asked the attorney general for an investigation in January so that it could understand how Nassar was able to flourish for decades as a staff doctor who sexually assaulted patients under the guise of medical treatment,the report says. That same month, a Detroit News investigation revealed that at least 14 MSU staff members had received reports about Nassar, including then-President Lou Anna Simon.

But the university continued to withhold information that is critical to the attorney general's investigation, citing attorney-client privilege, the report says.

"Rather than 'ready cooperation' as the board promised, the university has largely circled the wagons," it says.

"For as long as MSU frustrates the search for the truth," the report adds, "we will never be fully confident that we have it."

Reclaim MSU, the activist group that has worked to promote culture change in the wake of Nassar, issued a statement saying the report confirms what the group has been saying for a year about the university's accountability and transparency.

"Michigan State University has a toxic culture of concealment and secrecy," the statement says. "The higher administration and the Board of Trustees have failed us repeatedly. This is a top-down problem that has continued following President Simon's resignation and through Interim President Engler's tenure in office."

It added that "the validity of the presidential search is in serious question."

"We have called on all eight Trustees who presided over this corrupt system to resign," the statement said. "Two did not attempt reelection and one resigned. The five remaining trustees must resign," the statement said.

The report emphasized that the scope of its investigation was limited and did not include an inquiry into Geddert's Twistars USA, USA Gymnastics and the US Olympic Committee — institutions that young athletes also accused of not protecting them from Nassar's sexual assaults.

But Forsyth was open about the tenor of MSU during the investigation, pointing to lawyers in MSU's legal department as responsible for stonewalling, but added that he didn't think that Engler, also a lawyer, played a role.He pointed to Robert Young, MSU's general counsel, whom he said in June had been blocking the probe.

Though many people at MSU have been forthcoming, said Assistant Attorney General Christina Grossi, every member of the Board of Trustees "toed the line" including members who publicly say they support victims of Nassar.

Forsyth called the situation "very frustrating."

The 16-page report comes as Attorney General-elect Dana Nessel prepares to take office in January, replacing Bill Schuette, whose office brought 10 criminal sexual conduct charges against Nassar that led judges to sentence him to two prison sentences of 40-175 years and 40-125 years. A federal judge also gave him 60 years for possessing 37,000 images of child pornography, essentially incarcerating him for life.

In a statement, Nessel expressed anger at MSU's conduct.

"The findings in this report are deeply, deeply disturbing and the stories of the survivors are heartbreaking — but the callous disregard Michigan State University continued to show the victims and this special investigator absolutely infuriates me," she said. "The culture of indifference the University has displayed throughout this investigation is a pervasive poison that appears to have seeped into every corner of that campus."

Nessel pledged, "I am committed to using my role as Michigan’s Attorney General to do whatever we must to bring justice and honor to the survivors, which includes continuing any aspects of the investigation which require further action."

The report, which comes at the end of Forsyth's appointment, overviews the nearly year-long investigation and includes interviews of 550 people, a review of nearly half a million pages of documents and led to charges against three former MSU officials: Kathie Klages, the former, longtime head gymnastics coach; William Strampel, the former dean of the College of Osteopathic Medicine and Nassar's ex-boss and Simon, who resigned three days before the attorney general's investigation began.

The report is not final, said attorney general spokeswoman Megan Hawthorne, in part because of those three ongoing prosecutions. Grossi added that more than 15,000 pages of documents still need to be reviewed along with nearly 200 emails from MSU that a judge recently ruled must be released to the Attorney General's Office.

"This report is a horrific case history of an institution that tried to cover up the crimes of a serial child predator for more than two decades," said Rachael Denhollander, the first woman to publicly accuse Nassar of sexual assault, leading to his demise.

"Investigators executed search warrants, seized MSU computers, interviewed witnesses under oath and have indicted top university officials including former president Lou Anna Simon."

The report ends by saying investigators found no proof to substantiate an allegation against former Trustee George Perles, accused in a lawsuit filed by Erika Davis of covering up an alleged rape by Nassar in the early 1990s.

"As part of our review of MSU, we investigated Ms. Davis' allegations and found no credible evidence to support them," the report says.

The bulk of the report details the work of more than two dozen officials from the Attorney General's Office and Michigan State Police that included a consultation with an expert in pelvic floor therapy plus interviews with 280 victims, the Board of Trustees, other MSU officials and Nassar himself.

It also details the disinterest displayed at MSU when 13 young women reported Nassar to 11 MSU representatives, including doctors, athletic trainers and coaches, between 1997 and 2015. Of those, two athletic trainers are still at MSU.

"[T]he MSU employees who allegedly received reports of Nassar's sexual assault or improper medical treatment ... downplayed its seriousness or affirmatively discouraged the survivors from proceeding with their allegation," the report says.

"That so many survivors independently disclosed to so many different MSU employees over so many years, each time with no success, reveals a problems that cannot be explained as mere isolated, individual failures; it is evidence of a larger cultural problem at MSU Sports Medicine Clinic and MSU more broadly."

"For as varied as the details of survivors' accounts are, there is a common thread through each: the tendency of MSU employees to give the benefit of the doubt to Nassar, not the young women who came forward," the report continues.

"When faced with accusations of digital penetration during routine medical treatments — serious allegations that amount to criminal wrongdoing — the MSU employees discounted the young woman's story and deferred to Nassar, the world-renowned sports medicine doctor."

One of the first people interviewed by investigators was Nassar, but the report said he offered "no helpful information."

"In fact, it immediately became clear that his statements of remorse in the courtroom were a farce," according to the report. "Among other things, he stated that he did nothing wrong in regard to Amanda Thomashow — the survivor at the center of MSU’s 2014 Title IX investigation into Nassar."

Nassar also told investigators that the criminal case against him "should have been handled as a medical malpractice case," according to the report.

"Nassar claimed that he only pleaded guilty because he lost support from the medical community and his patients after the police discovered reams of child pornography in his possession," the report said. "Finally, and contrary to his sworn statement at the time he pleaded guilty, he was adamant that all of his 'treatment' was done for a medical purpose, not for his own pleasure."

But Dr. Kenneth Lossing — an expert in osteopathic manipulative medicine in the pelvic area, including the “sacrotuberous ligament release,” which Nassar often referred to using — debunked Nassar's assertions.

"[C]ontrary to Nassar’s practice, Dr. Lossing advised that intravaginal treatment should typically be utilized only if a patient presents with a trauma-induced history of infertility, irregular menstruation, incontinence, or pelvic pain, and only after external treatment is ineffective," the report said.

"When performing such a sensitive procedure, he said, clear and informed consent is paramount," the report continued. "If the patient is not of legal age, informed consent from the patient’s parent or legal guardian is required. And when conducting intravaginal treatment on a patient of the opposite sex, a chaperone is standard procedure."

Lossing, past president of the American Academy of Osteopathy, also noted to investigators that certain parameters of the treatment, including whether an internal approach was used, should be documented in a patient’s medical records.

"The accounts from survivors reveal that Nassar showed no regard for these basic medical protocols," the report says.

The investigators' consultation with Lossing prompted the Attorney General's Office to have two lawyers who are also medical doctors review every medical record obtained during Nassar's prosecution to find warnings signs that might have been overlooked.

The medical records themselves did not raise any obvious issues, the report found. However, in cases where a victim had reported abuse to MSU, the lawyer/doctors found discrepancies between the patient's medical records and the statements made to police.

"Specifically, the documentation did not match the police statements as to intensity, duration, and invasiveness of the treatments," according to the report. "A peer reviewer would have or should have questioned the treatments and procedures employed by Nassar if the treatment sessions had been completely documented as to duration and method.

"In short," the report said, "it appears that Nassar disguised the 'treatments' he performed by not documenting the conduct that would have raised red flags."

The report singles out MSU sports medicine Dr. Jeffrey Kovan as the only MSU employee who properly reported a complaint about Nassar by Thomashow in 2014 to MSU's Title IX office, But it shows that the investigators in that office failed Thomashow.

It noted that Kristine Moore, who investigated the complaint, failed to consult neutral and objective medical experts with no ties to Nassar or the MSU osteopathic college when trying to determine if Nassar's treatment was legitimate. Instead, she interviewed Nassar's colleagues, Drs. Brooke Lemmen, Lisa DeStefano and Jennifer Gilmore.

"All three either studied, worked or taught with Nassar," the report said. "During her investigation, Moore either downplayed the witnesses' connection with Nassar or failed to consider how their personal opinions of Nassar as a man of character affected their professional judgement."

Lemmen's bias was especially "troubling," the report said. Evidence showed that she had such a close personal relationship outside the office that she knew of Thomashow's allegations before Moore formally interviewed Thomashow on May 29, 2014.

"Three days before that ... Nassar emailed Lemmen about the allegations, providing Lemmen background on his treatment technique and how he had previously and without objection performed techniques similar to the allegations he claimed Thomashow was making," according to the report.

Nassar also tried to taint Lemmen's perception of Thomashow's allegations, the report said, by misrepresenting them to Lemmen and also implying that Thomashow had motivation to falsely accuse him because he had liked a photo of her on social media

He also claimed during an interview with Moore that Thomashow had a "psych history" and questioned whether she had been sexually abused in the past.

"Nassar's efforts to manipulate the investigation appears to have had a significant effect," the report said. "Following her interview with Nassar, Moore focused her attention on the legitimacy of the technique that Nassar claimed he performed."