For Raisman and the scores of other women gymnasts who say Nassar sexually molested them when they were children, that reckoning was long overdue. The sports medicine "guru"—whose abuse included a "special treatment" that involved him sticking his fingers in his patients' vaginas, sometimes with his bare hands for extended amounts of time—pled guilty to 10 counts of first-degree criminal sexual conduct last November. In December, he was sentenced to 60 years in federal prison for child-pornography charges, and on Wednesday—after seven days of impact statements from survivors—he was sentenced to 40 to 175 years for sexual abuse. These court developments are the culmination of complaints about Nassar that, according to lawsuits, victims and their family members started voicing back in the mid-1990s.

But the women who spoke out in court, along with their supporters, asserted that they were victimized by others, too—that Nassar’s abuse, of gymnasts and other young athletes alike, could not have flourished without a network of enablers. According to the women, these enablers were authority figures at USAG, Michigan State University (MSU), the United States Olympic Committee, and the Twistars Gymnastics training center, among other entities, who repeatedly ignored, downplayed, or disregarded allegations against him. Despite Monday’s resignations at USAG, very few of these authority figures have faced formal repercussions.

The apparent lack of accountability is particularly stark at Michigan State, where Nassar worked from 1997 through 2016 as a team physician and assistant professor. Numerous women gymnasts contend they reported Nassar’s behavior to athletic trainers or coaches, only to be met with skepticism and insistence that they continue seeing him. In the spring of 2014, Nassar was briefly suspended while the school’s Title IX department investigated a complaint by a student who alleged he’d sexually abused her, but was reinstated after a panel of medical experts, all of whom had close ties to the sports doctor, said there was nothing sexual about Nassar’s treatments. He continued to see—and, according to police reports, continued to abuse—patients at MSU despite remaining under criminal investigation for the same allegation that sparked the Title IX probe.

William Strampel, the former College of Osteopathic Medicine dean who supervised Nassar, told him in an July 2014 email that he was “happy” the Title IX situation had been resolved, according to correspondence published by ESPN—even though the police investigation into Nassar was still active. Yet while Strampel stepped down as dean last month citing “medical reasons,” he remains on faculty at the College of Osteopathic Medicine. Kristine Moore, the university administrator who conducted the Title IX investigation, is still at the institution, too, as are Lianna Hadden and Destiny Teachnor-Hauk, trainers whom according to at least two victims were told of Nassar’s behavior but failed to report it.