Investigation into Larry Nassar's abuse of athletes

This independent investigation, commissioned by the U.S. Olympic Committee, examines the factors underlying the actions of former USA Gymnastics physician Larry Nassar.

Report of the
Independent Investigation

The Constellation of Factors
Underlying Larry Nassaras
Abuse of Athletes

Joan McPhee James P. Dowden
December 10, 2018

TABLE OF CONTENTS
EXECUTIVE SUMMARY .............................................................................................................1A
INVESTIGATIVE INDEPENDENCE, SCOPE AND METHODOLOGY .................................12A

I.A

II.A

III.A

A.A

Independence .........................................................................................................13A

B.A

Scope ......................................................................................................................14A

C.A

Methodology ..........................................................................................................14A
1.A

Witness Interviews .....................................................................................16A

2.A

Document Review ......................................................................................17A

WHAT HAPPENED..........................................................................................................19A
A.A

Nassaras Abuse.......................................................................................................20A

B.A

Efforts to Bring Nassar to Justice ..........................................................................24A

C.A

Legal Proceedings ..................................................................................................30A
1.A

Criminal Proceedings .................................................................................30A

2.A

Other Proceedings ......................................................................................31A

NASSARaS SYSTEM OF ABUSE ...................................................................................33A
A.A

Nassaras Career: Building a Facade and Grooming Athletes ................................34A

B.A

Nassaras Methods for Normalizing the Abuse .......................................................39A

WHO KNEW WHAT WHEN AND WHAT WAS AND WAS NOT DONE IN
RESPONSE........................................................................................................................44A
A.A

B.A

Early Reporting of Nassaras Abuse and Notice of Other Conduct ........................47A
1.A

Reports to Geddert and Klages ..................................................................48A

2.A

Reports to Coaches, Trainers and Other Adults over a Span of
Decades ......................................................................................................50A

3.A

Meridian Township Police Investigation ...................................................52A

4.A

MSU Title IX and Police Investigation .....................................................52A

5.A

Nassaras Longtime Colleagues ..................................................................55A

6.A

Notice of Other Conduct by Nassar ...........................................................56A

Reporting to USA Gymnastics...............................................................................58A
1.A

Fran Sepleras Investigation ........................................................................62A

C.A

Reporting to the United States Olympic Committee .............................................67A

D.A

Referral to the Federal Bureau of Investigation .....................................................77A

E.A

Communications with Nassar ................................................................................82A

F.A

Nassaras Quiet Retirement .....................................................................................91A
i

G.A

IV.A

1.A

FBI Investigation .......................................................................................96A

2.A

Inaction by USAG....................................................................................100A

3.A

Inaction by the USOC ..............................................................................101A

H.A

Interactions Between USAG and the FBI ............................................................101A

I.A

Further Actions by USAG ...................................................................................104A
1.A

Confidential Settlement Agreement with Survivor of Nassaras
Abuse .......................................................................................................104A

2.A

Removal of Documents from the Karolyi Ranch ....................................105A

CONTRIBUTING CULTURAL CONDITIONS ............................................................110A
A.A

Embedded Features of the Sport ..........................................................................111A

B.A

The Unique Cultural Influence of the Karolyis and the Karolyi Ranch ..............127A

C.A
V.A

Period of Inaction Following Reporting to USAG, the USOC and the FBI ..........96A

1.A

The Karolyisa Approach to Training........................................................128A

2.A

Establishing a Semi-Centralized Training System in the United
States ........................................................................................................133A

Cultural Priorities of Olympic Organizations ......................................................136A

OLYMPIC GOVERNANCE STRUCTURE AND THE DISCONNECT
BETWEEN ADOPTED POLICIES AND EFFECTIVE ACTION ................................139A
A.A

B.A

United States Olympic Committee ......................................................................139A
1.A

The Ted Stevens Act Endowed the USOC with Broad Powers and
General Purposes .....................................................................................140A

2.A

The USOCas Evolution Toward a More Traditional Corporate
Structure Corresponded with an Increased Focus on Generating
Revenue and Athlete Success and a Diminishing Voice for Athletes
in Governance ..........................................................................................142A

3.A

The USOC Adopted a Service-Oriented Governing Approach
Toward the NGBs ....................................................................................149A

4.A

The Development of SafeSport Reflected the USOCas ServiceOriented Approach ...................................................................................156A

5.A

Concerns about the Complaint Process Across Olympic Sports .............163A

United States of America Gymnastics .................................................................167A
1.A

USAG Conducted Limited Oversight of Nassar ......................................168A

2.A

USAG Failed to Exert Its Authority over Its Membership and
Adopted Practices that Served as an Impediment to Addressing
Credible Allegations of Abuse, While Maintaining a Public
Reputation as a Leader in Protecting Athletes .........................................173A

ii

a.A USAGas Efforts to Protect Gymnasts ............................................... 175A
b.A USAGas Reputation as a Leader in Protecting Athletes ................... 178A
c.A Disconnect Between USAGas Reputation and Effective Action ...... 179A
3.A

USAGas Processing of Complaints Highlights Its Failure to
Implement Athlete-Focused Policies and Practices .................................185A

CONCLUSION ............................................................................................................................199A
APPENDIX ..................................................................................................................................234
Exhibit A
Exhibit B

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EXECUTIVE SUMMARY
Across two courtrooms, in early 2018, nearly 200 girls and women stood up to Larry Nassar.
Facing him directly, and speaking to the world, with courage, eloquence and powerful emotion,
they documented the abuse he had perpetrated, the physical and emotional suffering they had
endured, and the force they had become. With one unflinching account after the next, they brought
forth the full scope, depth and magnitude of the tragedy that had unfolded, over almost three
decades, across America and around the globe, including in the heart of elite gymnastics, at the
pinnacle of Olympic magnificence. Whether measured by the number of survivors, the tally of
abusive acts, the range of adults and institutions that failed to intervene, or the span of years over
which Nassar was able to perpetrate his crimes, the chronicle of his serial child sexual abuse is
devastating.
In all, Nassar committed thousands of sexual assaults between the early 1990s and the
summer of 2016. He abused some survivors one time, while abusing others hundreds of times
over a period of many years. Nassar carefully constructed a comprehensive system of abuse. He
cultivated a reputation and image as a highly-skilled, well-meaning and caring doctor, and he
committed almost all of his crimes under the guise of performing medical treatments. He groomed
the survivors, their families and numerous other adults into believing that he was not only a worldrenowned doctor, but also an advocate for the athletes, a physician who cared deeply about his
patientsa physical well-being and mental and emotional health. With the cover he crafted, he
became, in the words of one survivor, a awolf in sheepas clothing,a who cloaked himself in the
aguise of a loving friend and medical professional.a
In the late summer and early fall of 2016, in the wake of the Indianapolis Staras reporting
on sexual abuse in gymnastics, first one survivor of Nassaras abuse came forward, and then another
and another. With his survivors rising up en masse and law enforcement finally closing in, Nassar
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took his work laptop to a computer service store and paid to wipe all of its content. By the next
day, Nassar had placed a number of hard drives containing thousands of images of child
pornography in his trash for roadside collection. The garbage truck was late, and the police seized
the hard drives. On November 21, 2016, the State of Michigan charged Nassar with multiple
counts of first degree criminal sexual conduct, and on December 14, 2016, a federal grand jury
indicted Nassar on charges of child pornography. State and federal felony proceedings for criminal
sexual conduct, child pornography and destruction of evidence ensued in three separate courts in
Michigan.
Nassar pleaded guilty in federal court and two Michigan state courts, and he was sentenced,
cumulatively, to between 140 and 360 years in prison. During the sentencing hearings, a survivor
posed the question of what label to affix to Nassar: aA predator? A criminal? A molester? A
psychopath? A pornographer? An abuser? A thief of innocence?a The survivor concluded, aThey
all seem so inadequate because they are. And so you will be given a number.a Nassar is currently
prisoner number 21504-040, serving his sentence in United States Penitentiary Coleman II, a highsecurity federal prison in central Florida.
While Nassar bears ultimate responsibility for his decades-long abuse of girls and young
women, he did not operate in a vacuum. Instead, he acted within an ecosystem that facilitated his
criminal acts. Numerous institutions and individuals enabled his abuse and failed to stop him,
including coaches at the club and elite level, trainers and medical professionals, administrators and
coaches at Michigan State University (aMSUa), and officials at both United States of America
Gymnastics (aUSAGa) and the United States Olympic Committee (the aUSOCa).

These

institutions and individuals ignored red flags, failed to recognize textbook grooming behaviors, or
in some egregious instances, dismissed clear calls for help from girls and young women who were

2

being abused by Nassar. Multiple law enforcement agencies, in turn, failed effectively to intervene
when presented with opportunities to do so. And when survivors first began to come forward
publicly, some were shunned, shamed or disbelieved by others in their own communities. The fact
that so many different institutions and individuals failed the survivors does not excuse any of them,
but instead reflects the collective failure to protect young athletes.
Nassar found an environment in elite gymnastics and Olympic sports that proved to be
conducive to his criminal designs. With an overwhelming presence of young girls in the sport and
accepted, indeed required, intimate physical contact in the training and treatment of gymnasts, the
sport rendered athletes inherently vulnerable. In addition, there were embedded cultural norms
unique to elite gymnastics that eroded normal impediments to abuse while at the same time
reducing the likelihood that survivors would come forward. The culture was intense, severe and
unrelenting. It demanded obedience and deference to authority. It normalized intense physical
discomfort as an integral part of the path to success. Young gymnasts were largely separated from
their parents during their training programs and travel to competitions. And due to the demands
of high-performance training and competitions, gymnasts also found themselves socially isolated
a largely cut off from the world outside the four walls of the gym. These conditions, coupled with
the driving intensity of the cultural expectations to be perfect every day, and every minute of every
day, taught these young gymnasts to toe the line. They learned not to rock the boat if they were to
achieve a after years of immense personal sacrifice and tremendous commitment by their families
a the dreams they had been chasing, year in and year out, for almost the whole of their young lives.
Given these cultural conditions and features of the sport, implementation of, and rigorous
adherence to, formal structures and policies reflecting the highest standard of care were required
to protect vulnerable young athletes. Yet the USOC and USAG did not keep pace with best

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practices being adopted by other youth-serving organizations. Instead, they made decisions
regarding appropriate roles and responsibilities for their respective organizations that did not
embrace a child-first approach and led to stark failures in implementing effective measures to
protect athletes from sexual and other forms of abuse. Nassaras ability to abuse athletes for nearly
three decades is a manifestation of the broader failures at USAG and the USOC to adopt
appropriate child-protective policies and procedures to ensure a culture of safety for young athletes.
Although neither organization purposefully sought to harm athletes, both adopted general
governance structures and specific policies concerning sexual abuse that had the effect of allowing
abuse to occur and continue without effective intervention.
As the USOC evolved toward a more traditional corporate governance model, it did not
meaningfully involve athletes in decisions or policy-making; nor did it provide an effective avenue
for athletes to raise and resolve complaints involving sexual misconduct matters. The complaint
process that did exist had been designed, consistent with the purposes of the Ted Stevens Olympic
and Amateur Sports Act of 1978 (the aTed Stevens Acta or the aActa), to protect athletesa rights
to compete in Olympic sports. The USOC did not have specific processes in place during the
period of Nassaras abuse that were sufficient to protect athletes from sexual abuse.
The USOC also chose to adopt a deferential, service-oriented approach to the National
Governing Bodies (aNGBsa), including USAG. In this governance model, the USOC exerted its
broad statutory authority and monetary influence over individual sports primarily for the purpose
of encouraging success at the Olympic Games, effectively outsourcing any decisions regarding
on-the-ground child-protective practices to the NGBs. As a result of this approach, the USOC was
not in a position to know whether the NGBs were implementing strong, effective policies. And
the NGBs, operating independently, enacted a wide range of policies and procedures, many of

4

which failed to conform to best practices. As a result, patterns emerged across the NGBs where
survivors of sexual and other forms of abuse encountered a complaint process that was difficult to
navigate, poorly tailored to allegations of sexual abuse, and lacking in protections against
retaliation for athletes and others who advanced allegations of misconduct against successful
coaches or other adults in positions of authority. The USOC, despite having been directly informed
by NGBs of the threat of sexual misconduct in elite sports, failed to address the risk until 2010,
and then failed to take effective action for many years, permitting NGBs to continue adhering to
inadequate and harmful policies and practices.
USAG, in particular, implemented an array of sexual misconduct policies that ranged from
the proactive and well-intentioned to the convoluted and detrimental. USAG was aware of the risk
of sexual abuse in gymnastics, took high-level steps to help protect gymnasts, and promoted itself
as a leader in athlete protection. But despite this branding, USAG repeatedly declined to respond
adequately to concrete reports of specific misconduct, and instead erected a series of procedural
obstacles to timely investigation and effective response, even in the face of serious, credible
allegations of child sexual abuse. USAGas actions in response to allegations against former
coaches Marvin Sharp, Bill McCabe and Doug Boger highlight how in the years leading up to the
revelation of Nassaras abuse, the organization ignored credible reports of abuse, and instead
required the complaining party to comply with numerous procedural requirements that operated to
block or delay effective action.
The USOCas and USAGas failure to exercise appropriate oversight to protect athletes from
sexual abuse is perhaps best exemplified by the conditions and lack of oversight at the Karolyi
Ranch. For 17 years, the Ranch was the epicenter of competitive gymnastics in the United States.
Approximately once every month, members of the Womenas Artistic Gymnastics Team (the

5

aNational Teama) and other elite female gymnasts gathered from across the country to participate
in rigorous training camps run by Bela and Martha Karolyi. The Karolyi Ranch, which was owned
and operated by the Karolyis, was both the USAG-designated Training Center for the National
Team and, beginning in 2011, a USOC-designated official Olympic Training Site.
Notwithstanding the expectation of excellence associated with the imprimatur of the USOC and
USAG brands, as well as that of the Karolyi training program, no institution or individual took any
meaningful steps to ensure that appropriate safety measures were in place to protect the young
gymnasts. And within the isolated and secluded environment of the Karolyi Ranch, atwo hours
away from nothing,a Nassar had broad latitude to commit his crimes, far from the gymnastsa
parents and unimpeded by any effective child-protective measures.
The institutional failures, however, extended beyond weak structural elements, governance
deficiencies and failures of oversight. In the summer of 2015, when the National Team member
allegations of sexual assault were squarely presented to USAG and the USOC, the two
organizations, at the direction of their respective CEOs, engaged in affirmative efforts to protect
and preserve their institutional interests a even as Nassar retired from the sport with his reputation
intact and continued to have access to girls and young women at the college, club and high school
levels. The actions of these organizations, their CEOs and other senior personnel reveal that, apart
from USAGas referral to law enforcement in the summer of 2015 and again in the spring of 2016,
USAG and the USOC took no meaningful steps to protect athletes from the danger presented by
Nassar. Rather, these organizations, each in their own way, maintained secrecy regarding the
Nassar allegations and focused on controlling the flow of information about his alleged misconduct.
Response by USAG a USAG was directly presented with credible sexual abuse allegations
by athletes against Nassar by no later than mid-June 2015. USAG responded by initiating and

6

conducting an internal investigation of the athlete complaints over a five-week period. In late July,
USAG referred the matter to the Federal Bureau of Investigation (aFBIa), at the recommendation
of the outside investigator USAG had retained to assess the athlete complaints. USAG acted
almost immediately to provide false excuses for Nassaras non-attendance at USAG events, thereby
keeping the gymnastics community in the dark about the complaints of Nassaras sexual abuse.
USAG thereafter allowed Nassar to quietly retire under the pretense of a long and illustrious career.
These actions by USAG, notwithstanding its well-founded fear that Nassar had serially abused
athletes, permitted Nassar to continue to have access to young athletes and girls for another 14
months, including at other youth-serving organizations with which Nassar was known to be
affiliated: MSU (Nassaras employer); Twistars USA Gymnastics Club (aTwistarsa) (where Nassar
routinely treated gymnasts); and Holt High School (where Nassar served as a team doctor).
After the Indianapolis Staras public exposure of Nassar in September 2016, USAG
continued to take steps to control the flow of information regarding his abuse of athletes. In
November of 2016, two months after the Indianapolis Star reported on Nassaras abuse, and
immediately following a visit to the Karolyi Ranch by Texas Rangers in search of evidence,
USAGas then-CEO, Steve Penny, directed an immediate effort to urgently retrieve all medical
forms and all documents that pertained to Nassar. All such records were collected, removed and
returned to USAGas offices in Indianapolis on an urgent basis. Mr. Penny has since been indicted
by a grand jury in Texas for obstructing the Texas Rangersa investigation by atampering with
evidence,a a third-degree felony. Moreover, one month following the removal of records from the
Karolyi Ranch, USAG entered into a confidential settlement agreement with a survivor of Nassaras
abuse. In the agreement, USAG conditioned its settlement of her claims a against the organization
for its role in her years-long abuse by Nassar a on her agreement to sign a non-disclosure

7

agreement, a practice that many youth-oriented organizations had stopped a decade earlier. The
non-disclosure agreement purported to prohibit the gymnast from speaking publicly not merely
about the terms of the settlement, but also about Nassaras abuse.
Response by the USOC a In July 2015, Mr. Penny directly notified Scott Blackmun, thenCEO of the USOC, that National Team members had lodged sexual abuse allegations against
USAGas National Team doctor. Mr. Penny also shared certain information with Alan Ashley,
Chief of Sport Performance for the USOC, about the sexual abuse allegations.

Neither

Mr. Blackmun nor Mr. Ashley shared the information received from Mr. Penny with others in the
organization, and the USOC took no action between July 2015 and the date the Indianapolis Star
published its account of Nassaras child sexual abuse in September 2016. Specifically, after
Mr. Penny advised Mr. Blackmun that USAG had received disturbing allegations about the
gymnastics team doctor, Mr. Blackmun did not inform anyone else at the USOC of the allegations,
including any member of the USOC Board of Directors or any member of the USOC SafeSport
team. Mr. Ashley likewise took no action in response to the information that Mr. Penny had shared
with him. Nor did Mr. Blackmun initiate any internal review or other assessment to gather facts
regarding Nassar, the athlete concerns, the scope of the alleged misconduct or Nassaras ability to
gain access to athletes at USOC-owned and operated facilities, such as the U.S. Olympic Training
Center in Colorado Springs, Colorado. Nor did he alert other youth-serving organizations with
which Nassar was affiliated to the ongoing risk of harm. And when Larry Buendorf, the USOCas
then-Chief Security Officer, reported to Mr. Blackmun that he had learned from Mr. Penny that
athletes had raised concerns about a doctoras atechniquea and that USAG had made a report to the
FBI, Mr. Blackmun told Mr. Buendorf that he was already aware of the issue and neither asked

8

any questions nor sought any guidance from his Chief of Security on appropriate child-protective
measures.
Mr. Blackmun and Mr. Ashley also each deleted from their respective email accounts the
one email referencing Nassar by name that Mr. Penny had sent to the two of them in September
2015. Further, in early 2018 a long after the Indianapolis Star had publicly exposed Nassar a
Susanne Lyons, then a board member at the USOC and soon to become the organizationas acting
CEO, sent an email to Mr. Blackmun conveying her understanding that, prior to publication of the
Indianapolis Star article, Mr. Buendorf was the only person at the USOC who had known that
Nassar was the alleged perpetrator.

Mr. Blackmun failed to correct Ms. Lyonsas clear

misunderstanding. He failed to explain to Ms. Lyons not only that he and Mr. Ashley had been
the first to know of the allegations, but also that Mr. Buendorf, promptly after learning of the
allegations from Mr. Penny, had dutifully reported those allegations to Mr. Blackmun.
USAGas and the USOCas inaction and concealment had consequences: dozens of girls and
young women were abused during the year-long period between the summer of 2015 and
September 2016.
***
This Report sets forth in detail the factual findings of the Independent Investigation.
Part I provides a high-level overview of what happened, from the start to the finish of
Nassaras criminal career a from his earliest reported abuse of children in the early 1990s through
late 2016, when an overwhelming number of survivor complaints finally brought him to justice.
This Part addresses the courageous accounts that hundreds of survivors have publicly provided.

9

Part II examines the manner and means of Nassaras comprehensive system of abuse,
including his grooming of athletes, the facade he created for himself, and the methods he employed
to anormalizea his conduct and cover for his crimes.
Part III sets forth who knew what when with regard to Nassaras abuse, and what was and
was not done in response. This Part looks at both individuals and institutions and tracks the early
reports of Nassaras abuse to coaches, trainers and other adults, as well as early warning signs of
Nassaras predation. It chronicles complaints to institutions and law enforcement that led to Title
IX and law enforcement investigations a investigations that proved to be ineffective and allowed
Nassar to slip from the grasp of direct, credible survivor reports of criminal sexual assault. This
Part also identifies individual enablers and examines institutional failures that contributed to
Nassaras abuse. This Part looks in depth at the actions of USAG and the USOC and their senior
leadership, and also examines deficiencies at other institutions, including, in particular, the Karolyi
Ranch, where Nassar abused elite gymnasts, and the FBI, which did not move expeditiously to
investigate the serious, credible allegations of Nassaras abuse.
Part IV looks at the embedded culture in elite gymnastics and Olympic sport. While the
culture fosters many positive values a including teamwork, patriotism and the pursuit of excellence
a it also makes the sport of gymnastics inherently attractive to child sexual predators, erodes
normal impediments to abuse and reduces the likelihood that survivors will raise complaints. In
this unique and extreme environment, Nassaras sexual misconduct was able to proliferate and
metastasize. Without strong, affirmative child-protective measures, there was little to stand
between these brave and committed young girls and the predator in their midst.
Part V analyzes the Olympic governance structure and the complex systemic factors that
contributed to Nassaras system of abuse and to his uninterrupted, decades-long run of criminal

10

misconduct. This Part reviews the choices that the USOC and USAG made to adopt self-limiting
governance structures, which led to a marked disconnect at both institutions between adopted
policies and effective action. This disconnect in turn permitted the unchecked growth of policies,
practices and cultural norms that were not reflective of a child-first approach and led to the absence
of effective, on-the-ground protective measures.

The effects of the USOCas self-limiting

governance structure extended beyond USAG, and likewise permitted other NGBs to implement
policies and practices that failed adequately to address the risk of athlete abuse, resulting in patterns
of deficiencies in complaint processes across Olympic sports.
Nassar thrived in this loose governance model. The USOC had minimal interactions with
him and deferred to USAG, which in turn permitted Nassar to create a personal fiefdom where he
wrote the rules and set the tone for the medical treatment of the womenas gymnastics program for
close to 20 years a overseeing medical care at USAG events, serving as the point person for
approval of any outside medical providers, and participating in drafting rules governing sexual
misconduct by the medical staff. USAG engaged in essentially no oversight of Nassar throughout
the lengthy period of his serial sexual assault of gymnasts.

11

INVESTIGATIVE INDEPENDENCE, SCOPE AND METHODOLOGY
On February 2, 2018, a subcommittee of the Board of Directors (aBoarda) of the USOC
engaged Ropes & Gray LLP (aRopes & Graya) to conduct an independent investigation
(aIndependent Investigationa) ainto the decades-long abuse by Larry Nassar to determine when
individuals affiliated with USA Gymnastics or the USOC first became aware of any evidence of
Nassaras abuse of athletes, what that evidence was and what they did with it.a This mandate was
subsequently clarified to explicitly encompass not only awho knew what whena and what was and
was not done in response, but also the circumstances that contributed to and allowed for Nassaras
abuse to continue for such an extended period of time, including systemic deficiencies, failures of
oversight and contributing cultural conditions across Olympic sports.
The team of independent investigators (aIndependent Investigatorsa) was led by former
federal prosecutors Joan McPhee and James Dowden.

The mission of the Independent

Investigators was to collect the facts and publicly issue a comprehensive report that addresses both
the underlying facts and individual and institutional accountability.
We interviewed over 100 individuals, including more than 60 current and former
employees of the USOC and USAG, ranging from the most senior leadership throughout the
relevant time period to junior employees with potentially relevant information. We had access to
over 1.3 million documents, including hard copy material, reports and files, emails,
contemporaneous notes-to-self, text messages and cell phone data. In addition, we reviewed
publicly available material, including transcripts from Nassaras criminal proceedings, social media
and news coverage spanning the relevant period, topical books and biographies and various other
sources, to assist our understanding of the relevant facts.
This report (the aIndependent Reporta or the aReporta) is the culmination of ten months of
investigative efforts and reflects our distilled conclusions based on a detailed review of the factual
12

record. We recognize that many interviewees shared highly personal experiences and opinions,
and by necessity the Report directly references only some of them. This should not be taken as a
rejection of the material that is not referenced, but rather as our attempt to distill a large volume of
information.

Every single interview was an integral part of the investigative process and

contributed to the findings contained in the Report. In particular, we would like to thank the
survivors of sexual and other abuse in elite and Olympic sports who shared their stories with us.
We are, and remain, deeply thankful to these survivors, whose voices contributed greatly to our
understanding of the issues at the heart of the investigation.
A.

Independence

Before we agreed to accept the role of Independent Investigators for this matter, we
confirmed with the USOC the following:
i*

We would not be providing legal advice to any individual or organization.

i*

We would not be acting as lawyers to any individual or organization.

i*

Attorney-client privilege would not prevent us from releasing our factual findings.

i*

Our complete report would be made available to the public upon the completion of the
investigation.

i*

No one at the USOC, USAG or any other organization would have authority to direct or
guide our fact-finding or the content of our report.

i*

Ropes & Gray verified that it had not previously represented the USOC or USAG and
committed that it would not represent either organization in any separate matter, however
unrelated, for an extended period of years following completion of the Independent
Investigation.

Consistent with our expectations and requirements of full independence, no party has influenced
or attempted to influence the findings in this Independent Report.

13

B.

Scope

As noted above, the scope of our investigation included not only awho knew what whena
and what was and was not done in response, but also any systemic deficiencies, failures of
oversight, cultural conditions or other factors contributing to Nassaras serial sexual abuse of
gymnasts over an extended period of time. We also were afforded latitude to look across elite
athletics and Olympic sports to identify relevant facts and circumstances and any patterns across
NGBs to inform our assessment of contributing factors and conditions. Our mandate did not
include offering recommendations for reform.
We established at the outset that our investigative team would have broad access to
witnesses, documents and other information from the USOC and USAG, as well as cooperation
from both entities. We also confirmed the following:
i*

We would have the authority, in our sole discretion, to determine what information and
material was relevant to the investigation.

i*

The investigation would include interviews of officers, directors, employees and agents, as
well as a review of emails, internal communications, central files and other records at the
USOC and USAG.

i*

If any individual or organization asserted that any requested information was privileged,
confidential or not relevant and declined to provide access, we could so state in our public
report.

i*

The investigation would not be narrowly limited to issues related to awho knew what whena
about Nassaras abuse of athletes and what was and was not done in response, but more
broadly would encompass all relevant contributing conditions and factors.

Both the USOC and USAG, consistent with their commitments, cooperated extensively in our
investigation.
C.

Methodology

At the outset of the engagement, we established a dedicated email address and toll-free
telephone hotline to receive information and advertised the availability of these resources to the

14

public in various forums. In mid-September, we issued an Open Letter to the survivor community,
which ran as a full page advertisement in USA Today and as a banner in the online edition of
Inside Gymnastics, inviting survivors to contact us. i Where individuals expressed privacy
concerns, we agreed to take steps to help protect their identities from disclosure. We also reached
out to individuals known to have potentially relevant information to request their participation in
the Independent Investigation.
At the outset of our outreach effort, the Independent Investigation team participated in a
training led by the Rape Abuse & Incest National Network (aRAINNa) to reinforce our
understanding of survivor-centered considerations. Out of respect for their privacy, we did not
directly contact survivors of abuse, although we did engage in continuous indirect outreach efforts
to ensure that any survivors who wished to participate in the Independent Investigation would have
the opportunity to do so. In particular, we made a concerted effort from the earliest days of the
investigation to speak with the community of survivors of Nassaras abuse, including by reaching
out to numerous lawyers who represent survivors. The survivors of Nassaras abuse elected not to
speak with us due to lingering concerns about our independence from the USOC and their
understandable distrust of the organizations at the center of this investigation. We understand and
respect their decision. Because, however, the Independent Investigation and Report would not be
complete without reflecting the voices of the survivors of Nassaras abuse, we reviewed the
voluminous publicly available statements of survivors, including the impact statements provided
during the Michigan sentencing hearings in January and February 2018. While the Report is
heavily sourced and footnoted, the Report does not attribute any quotation to any specific survivor,

i

A copy of the Open Letter is appended hereto as Exhibit A.

15

and likewise, narrative descriptions that rely on these statements are derived from a composite of
unattributed material.
1.

Witness Interviews

We spoke with a diverse group of over 100 people, ranging from individuals who reached
out to the hotline with information in the first few days of the investigation, to former Olympians
and competitive gymnasts, to survivors of sexual misconduct in gymnastics and other sports. We
also spoke with several individual athlete advocates and advocacy organizations whose thoughts
contributed substantially to our research and reporting.
We also directly requested the opportunity to speak with employees and board members of
the USOC, USAG and the U.S. Center for SafeSport (aCenter for SafeSporta).

These

organizations made available every current employee and board member with whom an interview
was requested. In all, we interviewed more than 60 individuals at the USOC and USAG, from the
most senior leadership to junior employees. We likewise requested to speak with certain former
employees and board members of the USOC and USAG, and in particular, Scott Blackmun and
Steve Penny.

Both Mr. Blackmun and Mr. Penny agreed to participate in the Independent

Investigation, and they answered all questions during their interviews with the exception of
information protected by the attorney-client privilege. Also on privilege grounds, Mr. Penny,
through counsel, declined to answer any questions regarding the removal of documents from the
Karolyi Ranch.
We also made numerous efforts to interview other individuals with potentially relevant
information, including Martha and Bela Karolyi, Fran Sepler, former USAG employees Deborah
Van Horn and Gary Warren, former USAG board member Jay Binder, former MSU employee
Brooke Lemmen, former outside counsel for USAG Scott Himsel, Daniel Connolly and Jack
Swarbrick, retired Special Agent Jay Abbott with the FBI, Larry Nassar and others. These
16

individuals either declined or did not respond to requests to be interviewed. Fran Sepler submitted
a written statement, but otherwise declined to participate in the investigation.
2.

Document Review

We requested documents from: the USOC; USAG; Twistars; MSU; each of the other NGBs
and Paralympic Sports Organizations; the U.S. Center for SafeSport; Baker Tilly, an auditing firm
that conducted an audit of NGB compliance with SafeSport in 2017; the Karolyi Ranch; and the
FBI. Each of the above entities produced documents in response to our requests, with the exception
of three NGBs, the Karolyi Ranch and the FBI. ii The following NGBs declined to provide
documents: USA Diving, USA Pentathlon and USA Surfing. Mr. and Ms. Karolyi also declined
to produce any documents relating to the Karolyi Ranch. And the FBI responded that the requested
material was exempt from disclosure under applicable law. We also received documents directly
from several witnesses who voluntarily provided documents to us through our dedicated email
address or during the course of interviews.
Given the voluminous relevant material at the USOC and USAG, we drafted a list of broad
search terms to identify relevant documents in specified email accounts and other central files.
After applying these broad search terms, the USOC produced a total of almost 30,000 documents,
which we reviewed. USAG produced a total of approximately 1.3 million documents. In accord
with best practices, we reviewed these documents by utilizing advanced technologies, both
conceptual analytics and algorithmic prioritization, to identify relevant documents. We also
requested and received information from personal mobile phones and computers of certain former
employees of USAG.

ii

The U.S. Center for SafeSport also declined to produce documents, asserting, among other reasons, that it is an
independent entity and the requested materials could not be disclosed pursuant to its confidentiality policy. Letter
from Joseph Zonies, Counsel to the U.S. Center for SafeSport, to Independent Investigators (Feb. 22, 2018), on file
with the Independent Investigators.

17

Finally, as addressed in Part III.C, upon our discovery that a particular email had not been
produced to the Independent Investigation by the USOC, the USOC engaged a computer forensics
firm to conduct a complete review of the USOCas electronic database to determine the
circumstances and timing of the deletion of the specified relevant email. The firm was unable to
reach a definitive conclusion about the deletion of the specified email, but provided a report
detailing the most likely deletion scenarios, which is attached to this Report as Exhibit B.
The Independent Investigators would like to thank each person who contributed time and
shared valuable experiences with our team.iii We hope that the Report provides a meaningful
contribution to the understanding of the institutional and individual factors that allowed for a
tragedy of this magnitude to unfold uninterrupted over such an extended period of time. It is also
our sincere hope that the Report will help to protect young athletes from such devastating harm in
the future.

iii

We also would like to thank Helen Gugel, Ezra Geggel and the entire team of lawyers, paralegals and staff at Ropes
& Gray who showed tremendous dedication and commitment to the Independent Investigation and to the accuracy
and completeness of this Report. Their contributions were extensive and materially advanced the investigation and
reporting of our factual findings.

18

I.

WHAT HAPPENED

A
A

A

A

A

A

SELECTEDA FINDINGSA

A

iSS

NassarA sexuallyA assaultedA hundredsA ofA girlsA andA youngA womenA overA aA spanA ofA
almostA threeA decades.A A HeA abusedA someA ofA themA onceA andA othersA hundredsA ofA
times.A A NassarA generallyA assaultedA youngA femaleA athletesA underA theA guiseA ofA
performingA medicalA treatments,A butA heA alsoA abusedA theA daughterA ofA hisA familyA
friends,A startingA whenA sheA wasA sixA yearsA old,A andA atA leastA oneA youngA maleA
gymnast.A A TheA earliestA publicA reportsA ofA abuseA dateA toA theA earlyA 1990s;A theA latestA
toA theA summerA ofA 2016.A

iSS

TheA IndianapolisA StarasA AugustA 4,A 2016A articleA concerningA USAGasA failureA toA alertA
authoritiesA toA allegationsA ofA sexualA abuseA causedA severalA formerA gymnastsA toA
comeA forwardA toA theA newspaperA andA theA policeA aboutA NassarasA abuse.A A ThisA initialA
outreachA promptedA MSUA toA suspendA andA laterA terminateA Nassar,A resultedA inA aA civilA
lawsuitA inA earlyA SeptemberA andA ledA theA IndianapolisA StarA toA publishA anA articleA withA
accusationsA againstA NassarA onA SeptemberA 12,A 2016.A A Thereafter,A dozensA ofA
athletesA andA formerA athletesA cameA forwardA toA theA mediaA andA theA authoritiesA toA
reportA abuseA byA Nassar.A

A

iSS

ThroughoutA theA fallA ofA 2016,A NassarA defiantlyA maintainedA hisA innocenceA andA
receivedA supportA fromA longtimeA friendsA andA colleagues,A asA wellA asA fromA theA largerA
gymnasticsA community.A A ManyA survivorsA initiallyA facedA resistanceA andA criticism.A A
OverA time,A theA weightA ofA theirA numbers,A NassarasA arrestA inA NovemberA and,A finally,A
theA discoveryA ofA thousandsA ofA imagesA ofA childA pornographyA causedA supportA forA
NassarA toA allA butA evaporate.A

A

iSS

InA JulyA andA NovemberA 2017,A NassarA wasA convictedA inA federalA andA stateA courts.A A
AfterA nearlyA 200A survivorsA testifiedA duringA hisA sentencingA hearings,A heA wasA
sentencedA cumulativelyA toA betweenA 140A andA 360A yearsA inA prison.A

A

iSS

InA additionA toA theA criminalA consequencesA forA Nassar,A formerA employeesA ofA USAGA
andA MSUA faceA criminalA proceedingsA forA eventsA relatedA toA NassarasA abuse.A A FederalA
andA stateA legislaturesA andA agenciesA haveA alsoA launchedA investigationsA intoA USAG,A
theA USOC,A certainA NGBs,A MSU,A theA FBIA andA others.A

A

19

A

Over the course of approximately 30 years, Larry Nassar sexually abused well over 400
children and young adults, some once and some dozens and even hundreds of times.1 iv In all,
Nassar committed thousands of sexual assaults between the early 1990s and 2016. He abused
famous Olympians in hotel rooms across the globe; elementary-school-aged gymnasts in local
Michigan gyms and in the basement of his familyas home; athletes from MSU in his clinicas office;
and the daughter of his family friends, starting when she was six years old.2 Nassar abused almost
all of these girls and young women under the guise of performing medical treatments. He
presented himself as a doctor to Olympic champions who, at the same time, was their humble
friend and caring confidant. He groomed the survivors, their families and numerous other adults
into believing that he was an exceptional doctor who tirelessly devoted himself to the health and
well-being of others. Under that cover, Nassar engaged in crime after crime.3
A.

Nassaras Abuse

Athletes vividly described the initial excitement of an appointment with Nassar. He was
the doctor to Olympic heroes, whose pictures and personal thank you notes adorned his exam room
walls.4 Club-level athletes afelt so privileged, so speciala;5 v an appointment with Nassar awas
more like the feeling of going to see a celebrity.a6 The Olympians and National Team members
likewise felt grateful for all of the small ways in which Nassar provided them with comfort and a
sympathetic ear in the demanding environment of competitive gymnastics.7 Nassar always seemed

iv

A complete accounting of the number of survivors cannot be determined with precision. The estimate referenced
here almost certainly reflects the lower end of the likely number of survivors and is based on a May 16, 2018 statement
in which MSU announced that it had agreed to settle claims by 332 survivors for $425 million, and set aside an
additional $75 million to compensate additional survivors who may bring future claims. Amy Held, Michigan State
University Reaches $500 Million Settlement With Nassar Abuse Victims, NPR (May 16, 2018),
https://www.npr.org/sections/thetwo-way/2018/05/16/611624047/michigan-state-university-reaches-500-millionsettlement-with-nassar-abuse-victims. As of September 10, 2018, an additional 167 claimants have come forward.
Catherine Shaffer, Number of Nassar accusers approaches 500, MICH. RADIO (Oct. 19, 2018),
http://www.michiganradio.org/post/number-nassar-accusers-approaches-500.
v
Based on privacy considerations, we have not referenced individual survivors by name and have instead cited to
statements from survivors collectively.

20

to put the athletes first, working around their schedules. He offered appointments after-hours at
his MSU clinic; weekends at his home in Holt, Michigan; and for national team members
exhausted by a day of training, he came to their cabins or hotel rooms for treatments.8 Many
athletes were grateful that a[t]his amazing doctor was willing to take time out of his busy schedule
to help me.a9 Nassar often performed legitimate Osteopathic Manipulative Treatments a a set of
hands-on techniques employed by doctors of osteopathy10 a and did not engage in sexual abuse
during every treatment session. But with hundreds of athletes, on thousands of other occasions
over a period of almost three decades, Nassar committed criminal sexual abuse.
According to survivor statements, Nassaras pattern of sexual abuse began no later than the
early 1990s, as he was finishing his medical degree at the MSU College of Osteopathic Medicine.11
Claiming that he was conducting a study on behalf of his medical school, Nassar invited girls that
he had groomed at a local gym to his apartment, one at a time. When each girl showed up at his
apartment, he asked her to take a bath. He then directed her to lie on his treatment table in his
living room while he performed a full-body massage.

The full-body massages included

penetrating each of these girls with his fingers.12 vi
Nassar eventually developed a series of methods to normalize the abuse during seemingly
routine medical appointments. As described in greater detail in Part II.B, Nassar varied how much
information he shared with the athlete to justify the nature of the abusive procedure, ranging from
clinical explanations to providing no warning at all.13 One athlete recalled that athe first time it
happened, you were massaging my back as normal, and then without warning, or explanation, you

vi

On September 11, 2018, a woman filed a civil lawsuit stating that in the early 1990s, Nassar had drugged and raped
her during a treatment and that Nassar had videotaped the rape. The lawsuit states that local police and MSUas athletic
director became aware of Nassaras conduct, but did not take any action against Nassar. Civil Complaint, Court Filings
on file with the Independent Investigators.

21

stuck your ungloved fingers into my vagina.a14 The survivors universally reported that Nassar
never wore gloves during his abuse.15
Many survivors described the assaults as painful. One gymnast testified to asearing paina
that lasted for 30 minutes as Nassar inserted his fingers into her and grunted while she lay there
terrified.16 Another testified that she went into asuch shock that I flinched and I grabbed the exam
table with both hands as hard as I could . . . just waiting for you to be done, for it to all be over.a17
A third survivor testified that in a[t]reatment after treatment[,] I closed my eyes tight, I held my
breath, and I wanted to puke. My stomach pierced me with pain.a18 Other survivors, however,
recounted that their main emotion during the abuse was confusion. As Nassar abused them,
questions, paired with justifications, came rushing through their minds: a[I]snat it weird that heas
not wearing gloves[,] I wonder if he does this to other girls[,] [w]hy is he closing his eyes? Heas
a doctor though, Iam sure itas fine. Plus, heas Larry. Heas been so nice to me and someone with
his name I can obviously trust, right?a19 As a result, many athletes explained that they adid not at
the time think he was molesting me, just that this procedure was awful.a20
In the immediate aftermath of the assaults, many athletes felt relieved that the procedure
was complete and did not consciously recognize the actions as abusive and criminal. But others
described an intense period of embarrassment and humiliation as they attempted to reconcile the
abuse they had just suffered with Nassaras reputation.21 One survivor recalled how she sat in agreat
disbelief, complete shock, and total humiliation.a22 Another testified to the aintense sense of terror,
anxiety, and disbelief that came washing over me. I lay there in pain unable to speak, staring
blankly at the wall, desperately searching for a way to escape.a23
Beyond the immediate pain of the assaults and the awful and embarrassing aftermath, the
survivors and their families have poignantly described the long-term consequences of the abuse.

22

Survivors described grappling with self-doubt and self-blame as they tried ato figure out how I
became so brainwashed not to realize that it was abuse at the time.a24 Many spoke of lifelong
troubles with trust and intimacy,25 and athe pain of never trusting someone physically again.a26
Others described periods of anxiety, bouts of panic attacks,27 and aparalyzing flashbacks.a28 The
survivors explained how unwelcome memories ainvade at the most inopportune times,a29 and how
they live with a pain that creates aa seemingly immovable obstacle that stands waiting for me as I
attempt to approach each new day.a30 Many detailed how their lives spiraled out of control; they
suffered from eating disorders31 and from ahorrible anxiety attacks . . . that make me want to rip
out of my own skin.a 32 They endured aincredibly long sleepless nights,a 33 punctuated with
nightmares that caused them to vomit34 and included images of being atrapped in his examination
room . . . yelling but my voice doesnat work.a35 Survivors described self-harm, such as cutting,36
and thoughts of suicide,37 aso that I can turn off the thoughts of him, get rid of the nightmares.a38
One mother recounted how her daughter took her own life abecause she couldnat deal with the
pain anymore. It just became worse as the years went by until she couldnat deal with it anymore.a39
Finally, in addition to the children and women he directly abused, Nassar downloaded
thousands of images of child pornography over a period of decades. Starting no later than 2004,
Nassar downloaded at least 37,000 separate images and videos.40 The material depicted achildren
as young as infants,a and included aimages and videos of prepubescent children being vaginally
and anally raped by adult males, children being digitally penetrated, prepubescent children
performing oral sex, and prepubescent children engaged in other sex acts.a41 At least one gymnast
has stated in a civil complaint that Nassar took photographs of her during the abuse and shared
these photographs with other pedophiles.42

23

B.

Efforts to Bring Nassar to Justice

As discussed in greater detail in Part III.A, over more than two decades, a number of
survivors of Nassaras abuse have stated that they reported his conduct to adults, but none of these
reports led to adult intervention to stop Nassar from continuing to assault athletes. In the late
summer and early fall of 2016, however, an overwhelming series of complaints finally resulted in
criminal charges, civil lawsuits and public exposure of Nassaras crimes.
On August 4, 2016, the Indianapolis Star published an article titled aA blind eye to sex
abuse: How USA Gymnastics failed to report cases,a which detailed how USAG had failed to alert
authorities to allegations of sexual abuse by coaches.43 On the morning the article was published,
a gymnast who had been abused in 2000, and who had wrestled with whether to file a police report
ever since, contacted the Indianapolis Star to report that Nassar had abused her under the guise of
medical treatment.44 Within the month, the Indianapolis Star received two additional complaints
from two former Olympians with similar allegations of abuse.45 On August 29, 2016, the gymnast
who first contacted the Indianapolis Star, and who had since independently consulted with medical
and legal professionals about Nassaras conduct and the possibility that police would bring
charges,46 filed a criminal complaint against Nassar with the MSU police, alleging that she was
sexually assaulted in 2000 when she was 15 years old.47 The next day, MSU suspended Nassar
from clinical and patient duties pending its investigation.48
At first, Nassar reacted swiftly and affirmatively to the reports of misconduct. He sat down
with the MSU police on the day after the August 29, 2016 police report.49 In that interview, Nassar
explained that he had been performing apelvic floora techniques since the early 1990s and had
lectured extensively on the treatment.50 He explained that he constantly talked with his patients
during the procedure to ask whether the treatment was making the patient feel better, and that he
relied on the patient to provide feedback.51 He explained that he rarely performed procedures
24

involving penetration, and that he would do so only to treat a broken coccyx.52 Nassar expressed
shock that anyone could be hurt by his treatments, given that he constantly was receiving feedback
from the patient.53
Nassar also reached out to the Dean of the MSU College of Osteopathic Medicine, William
Strampel, immediately after learning of the allegations. The two spoke on August 31, 2016 and
exchanged emails over the following week. 54 At first, Nassar offered to no longer perform
Osteopathic Manipulative Treatments and to focus instead on teaching and administrative
matters.55 Nassar repeated his position that a[w]hen I perform these treatments, I always am asking
the patient if they are comfortable with my hand placement and if they feel relief of their pain. If
they respond that it is not relieving their pain or they are not comfortable, I readjust and change
treatment. If they tell me yes, they are comfortable and yes it does help then I trust that they are
telling me the truth.a56 Nassar also notified Dr. Strampel that a reporter from the Indianapolis Star
had contacted him about the allegations, and Nassar sought to discuss with Dr. Strampel his
approach to answering the reporteras questions.57 Shortly before Nassaras interview, Dr. Strampel
wrote to Nassar: aGood luck. Keep me informed as much as you want. I am on your side.a58
Nassar also reached out to one of his colleagues to inform him of the allegations and to ask this
colleague to garner support in his defense.59
Nassar continued to reiterate his defenses during two interviews, one with the MSU Office
of Institutional Equity (aOIEa) on September 8, 2016, and one with a reporter from the
Indianapolis Star on September 12, 2016. In the interview with the MSU OIE, Nassar explained
the ostensible medical purpose for his treatments; emphasized that he had been performing his
treatments for a long time, including with Olympic athletes; discussed how he lectured on pelvic
floor treatments; and stated that he talked to the patient throughout the procedure.60 Likewise, in

25

the interview with the Indianapolis Star, Nassar showed the reporter a video of the treatments in
an effort to explain that the allegations against him were the result of a patient misunderstanding
his work.61 Nassaras attorney also told the reporter that Nassar never used any procedure involving
vaginal penetration.62 The interview was cut short after the reporter and Nassar learned that a
former gymnast had filed a lawsuit against Nassar alleging that Nassar had abused her between
the years 1994 and 2000.63
On September 12, 2016, the Indianapolis Star published the first article publicly naming
Nassar. 64 Following the Indianapolis Star article, the complaints started flooding in.

By

September 25, 2016, at least 16 women had filed criminal complaints against Nassar with the MSU
police.65 It would grow to 81 by February 2017,66 and the publicly known count is now well over
400.67 Women of many different ages from all across the country were making police reports.
Some stated that they had previously made reports to adults with no result and were now
redoubling their efforts.68 Some women explained that the Indianapolis Star article helped them
put a label on the abuse they had suffered.69 Others explained that they had always trusted that
Nassar was performing legitimate medical treatments, but the Indianapolis Star article caused
them to realize that they had experienced sexual abuse.70 These survivors described how they
could feel their hearts sink the moment they heard the news and realized that they had been
abused.71 As one survivor recounted, aWhen I saw Nassaras face on the news I immediately
knew.a72 Other survivors, however, still wanted to give Nassar the benefit of the doubt, with one
explaining that at first she acould not believe it. I would not believe it. I laughed it off,a73 and
another explaining, aI didnat want to let myself believe it actually happened to me.a74
Even with the reports of abuse mounting, Nassar continued to receive support from people
in positions of authority. In particular, Nassaras longtime friends John Geddert and Kathie Klages,

26

both gymnastics coaches, came to his defense. Mr. Geddert,A then-owner of Twistars, told the
Indianapolis Star in September that Nassar is aprobably one of the most respected gymnastics
professionals Iave ever had to deal with,a75 and Ms. Klages, then-womenas gymnastics coach at
MSU, told her gymnasts in an emergency team meeting on September 12, 2016 that ashe did not
believe that any of the allegations against [Nassar] had any truth,a and that ashe would feel
comfortable right then sending her own daughter or granddaughter to Dr. Nassar for treatment.a76
A former member of the MSU gymnastics team reported to the media that later in September 2016,
Ms. Klages circulated a greeting card during a team meeting and asked the gymnasts to sign it in
a show of support for Nassar.77 Around that same time, according to testimony, a gymnast spoke
to Mr. Geddert to report that she had been abused,78 and Mr. Geddert responded that awhat Larry
did was a medical treatment and [you] need to do [your] research.a79
Nassar also received support from other friends in the medical and gymnastics worlds. The
day after the initial Indianapolis Star article, a medical professional reached out to let Nassar know
that she was thinking of him and asending vibes for strength.a80 And certain members of the
community not only defended Nassar, but also attacked the survivors for coming forward, accusing
them of amaking up these lies just for the attention.a81 One of the first public survivors testified
that even individuals she considered her friends did not believe her and called her aa liar, a
whore.a82
Armed with this support, Nassar continued to strike a defiant tone; in his response to the
Indianapolis Star article, his attorney stated that Nassaras decision to retire from USAG awas not
influenced by the current allegations because he was unaware of those allegations until yesterday.
Instead, he retired because it was a voluntary position and he wished to pursue other interests
outside of USA Gymnastics.

During his retirement, Dr. Nassar continues to support USA

27

Gymnastics and has been called on by coaches and staff many times since his retirement to assist
the athletes with various health issues.a83 Nassar actively cultivated assistance, remarking in a
September 15, 2016 email to Dr. Strampel that he was trying to round up support abefore the aMe
Toosa come out in the media and the second media blitz occurs.a84
The next day, however, Dr. Strampel wrote to Nassar that athere seems to be more people
who have come forward,a and that athere is a report of an investigation back in 2004, that I did not
hear about.a 85 He closed the email chain by stating that a[t]hings are moving outside of my
control.a86 Later that day, MSU sent Nassar a letter stating that the University had received reports
that Nassar was in violation of the protocols that had been put in place following the 2014 Title IX
investigation (detailed in Part III.A.4) and that the University had also learned that Nassar had not
been forthcoming about prior patient complaints. 87 In response, Nassar wrote: aMy heart is
breaking but I will stay strong in my Faith and with the support of my family and my friends I will
overcome this.a88 On September 20, MSU terminated Nassaras fixed-term appointment.89
The day before he received his notice of termination, Nassar took his work laptop to a
computer service store and paid to wipe all of its content. By the next day, Nassar had placed a
number of hard drives containing thousands of images of child pornography in his trash for
roadside collection in an attempt to destroy them. Instead, the garbage truck was late and the
police were able to seize the hard drives. 90 Around this same time period, Nassar asked his
colleague, Dr. Brooke Lemmen, to box up and remove files from his office. Dr. Lemmen removed
the files from Nassaras office but, after taking the files home, decided to turn them over to MSU.91
After Nassar was terminated from his position at MSU on September 20, 2016, he
continued to receive support from former colleagues, members of the gymnastics and medical
communities and supporters in his hometown of Holt, Michigan. In early November 2016, Nassar

28

received more than 2,700 votes for a school board position, over 20 percent of the total, even after
having withdrawn his name from contention.92 And in a November 17, 2016 email, he wrote to a
former colleague, aI also gain strength from the continued support I receive from the community.
I have 27 physicians, 21 physical therapists and 122 patients/parents/coaches all willing to testify
to support me and the list continues to grow each week.a93
But four days later, on November 21, 2016, the Michigan Attorney Generalas office
charged Nassar with three counts of criminal sexual conduct against a minor under the age of 13,
resulting in his arrest and arraignment in Ingham County Court.94 The charges stemmed from
Nassaras abuse of the daughter of his family friends and were unrelated to his medical work.95 The
Attorney Generalas office also revealed that it was investigating complaints filed by dozens of
former patients.96 Support for Nassar started to fall apart following the news that he was accused
of abusing a girl who was never his patient and that dozens of former patients had filed
complaints.97 Nevertheless, Nassar continued to reach out for support, and one survivor testified
that Nassar sent her a message on the day after he was first arrested asking her to pray for him and
expressing thankfulness that he was able to spend the holiday with his family.98 Further evidence
against Nassar emerged on December 14, 2016, when a federal grand jury indicted Nassar on
charges of child pornography.99 After the FBI arrested Nassar on these charges on December 16,
2016, 100 support for Nassar almost completely evaporated, with some of Nassaras former
supporters describing it as a amoment of clarity.a 101 As one survivor noted, even with the
avalanche of young women making reports about his abuse, aIt took 37,000 pornographic images
for people to believe.a102 After his arrest, Nassar was held in the Newaygo County Jail in White
Cloud, Michigan for the duration of the criminal proceedings.103

29

C.

Legal Proceedings
1.

Criminal Proceedings

Nassar faced charges in three separate courts. He faced federal charges in the Southern
Division of the Western District of Michigan, and he faced state charges in two Michigan state
courts located in Ingham County and Eaton County.104
In the federal case, prosecutors indicted Nassar on three charges, and in July 2017, Nassar
entered into a plea agreement, pursuant to which he pleaded guilty to charges of child pornography
and destruction of evidence.105 On December 7, 2017,106 he received a sentence of 720 months
(60 years).107
In Ingham County Circuit Court, Nassar faced 26 counts of criminal sexual conduct, which
represented only a fraction of the 81 complaints the MSU police department had received as of
February 21, 2017, the date of the criminal complaint.108 Nassar pleaded guilty to seven counts of
criminal sexual conduct in the first degree; as part of the plea deal, Nassar agreed that the Court
could take into consideration testimony from any complainant during the sentencing phase.109 In
Eaton County Circuit Court, Nassar faced 13 charges of criminal sexual conduct. Nassar pleaded
guilty to three counts of criminal sexual conduct in the first degree in that court on November 29,
2017, 110 again agreeing that the Court could take into consideration testimony from any
complainant during the sentencing phase. 111 Although not all of the 265 survivors who were
identified at the time of the sentencing phase testified, 112 156 survivors spoke or contributed
statements during the Ingham County sentencing hearings, 113 and 65 spoke or contributed
statements during the Eaton County sentencing hearings.114 Both courts permitted live streaming,
and news media televised the survivorsa statements on national broadcasts. Following the
survivorsa statements, a judge of the Ingham County Court sentenced Nassar to between 480 and

30

2,100 months (40 to 175 years).115 A judge of the Eaton County Court sentenced Nassar to 40 to
125 years.116
Nassar is currently prisoner number 21504-040, serving his sentence in United States
Penitentiary Coleman II,117 a high-security federal prison in central Florida.118
2.

Other Proceedings

Nassar has also faced over 50 civil lawsuits.119 The many civil suits have named numerous
other defendants, including the USOC, USAG, MSU, former USAG CEO Mr. Penny, Mr. and
Ms. Karolyi, Twistars and Mr. Geddert, among others.120 On May 16, 2018, MSU announced that
it had settled the cases against it for $500 million, $75 million of which is to be set aside to pay
future claimants.121
In addition to the criminal proceedings against Nassar and the civil lawsuits, many federal
and state bodies are conducting investigations. On January 25, 2018, the Senate Committee on
Commerce Science and Transportation opened an investigation into the USOC, USAG and
MSU;122 that same day, 27 Members of the House of Representatives sent a discovery request
letter to the USOC and USAG; 123 also on January 25, 2018, the Michigan House of
Representatives started its investigation into MSU;124 on January 27, 2018, the Michigan Attorney
General announced the existence of an ongoing investigation led by a special prosecutor into
MSUas conduct;125 on February 8, the House Committee on Oversight and Government Reform
began its investigation into the USOC, USAG, MSU, the Karolyi Ranch and Twistars; 126 on
February 26, 2018, the Department of Education announced a new investigation into MSUas
compliance with Title IX;127 and on March 7, 2018, the House Energy and Commerce Committee
launched its investigation into the USOC, USAG, MSU, USA Judo, USA Swimming and USA
Taekwondo.128 The Indiana Attorney Generalas Office is also conducting an investigation into
USAG.129
31

At the end of March 2018, Dr. Strampel was charged with two misdemeanor counts of
willful neglect of duty related to his alleged actions during and after Nassaras 2014 Title IX
investigation. 130 Dr. Strampel also faces one felony count of misconduct in office and a
misdemeanor count of fourth-degree criminal sexual conduct.131 At the end of June 2018, a Texas
grand jury indicted Nassar on six counts of sexual assault and indicted longtime USAG athletic
trainer Ms. Van Horn on one count of sexual assault in connection with the abuse of six gymnasts
at the Karolyi Ranch in Huntsville, Texas.132 The Texas prosecutors elected not to file any charges
against Mr. and Ms. Karolyi.133 On August 23, 2018, the Michigan Attorney Generalas special
prosecutor announced that Ms. Klages had been charged with lying to a peace officer in connection
with her statements denying that she had received reports of Nassaras misconduct prior to 2016.134
On September 28, 2018, a Texas grand jury indicted Mr. Penny on charges of tampering with
evidence in connection with the removal of documents from the Karolyi Ranch; Mr. Penny was
arrested on these charges on October 17, 2018, and taken into custody until being released on bail
following his arraignment.135 In mid-November 2018, the Michigan Attorney General charged
former MSU President Lou Anna Simon with two felony counts and two misdemeanor counts
alleging that Ms. Simon made false or misleading statements to the Michigan State police.136

32

II.

NASSARaS SYSTEM OF ABUSE

A
A

A

A

A

A

SELECTEDA FINDINGSA
iSS

InA theA lateA 1980sA andA earlyA 1990s,A NassarA carefullyA cultivatedA aA reputationA asA aA
hardworking,A dedicatedA volunteer,A andA inA 1996,A heA wasA namedA toA theA positionA ofA
NationalA MedicalA CoordinatorA forA USAG,A aA positionA heA wouldA holdA forA almostA 20A
years.A

iSS

NassarA usedA hisA positionA asA NationalA MedicalA CoordinatorA forA USAG,A andA asA theA
doctorA toA Olympians,A toA projectA anA imageA asA anA exceptionalA doctor.A

iSS

NassarA groomedA hisA patientsA byA actingA asA aA caringA afriendaA inA theA oftenA harshA
environmentA ofA competitiveA gymnastics.A A NassarA regularlyA gaveA hisA patientsA gifts;A
providedA careerA advice;A offeredA toA performA treatmentsA onA eveningsA andA
weekends,A manyA timesA forA free;A andA ostensiblyA actedA asA theA aathleteasA advocate.aA

iSS

NassarA alsoA appliedA aA varietyA ofA techniquesA toA normalizeA theA abuse,A includingA
maskingA hisA abuseA asA aA medicalA treatment,A talkingA toA hisA patientsA throughoutA theA
abuse,A andA abusingA patientsA whileA theirA parentsA wereA inA theA room.A

iSS

NassarasA medicalA cover,A reputation,A positionA asA aA doctor,A roleA asA aA confidantA andA
theA perceivedA unlikelihoodA thatA aA successfulA physicianA wouldA commitA sexualA abuseA
silencedA survivors,A causedA numerousA adultsA toA disregardA reportsA fromA survivors,A
andA contributedA toA multipleA failedA investigations.A

33

A
A

A

A

A

A

One significant contributing factor to Nassaras ability to assault athletes for close to three
decades without facing consequences was his carefully constructed system of abuse. Nassar
cultivated a reputation and image as a highly skilled, well-meaning, and deeply caring doctor;
established relationships of trust with his colleagues; groomed his patients and their parents; and
used specific methods and means to normalize and disguise his abuse. Survivors raised complaints
infrequently, and when they did, as discussed in Part III.A, adults in a position to intervene failed
to act.
A.

Nassaras Career: Building a Facade and Grooming Athletes

Nassar began working with gymnasts when he was in high school, where he served as a
trainer for his schoolas gymnastics team. 137 Following his graduation from the University of
Michigan in 1985 with a degree in kinesiology, he worked as a graduate assistant trainer at Wayne
State University.138 While serving in this position, he reached out to USAG to serve as a volunteer
on the medical staff and was soon appointed to work at the 1987 Pan Am Games.139 In 1988, he
volunteered at additional USAG events, including the pre-Olympics trials and the post-Olympics
tour.140 That same year, he began working with gymnastics coach Mr. Geddert at the Great Lakes
Gymnastics Club, and he began medical school at the MSU College of Osteopathic Medicine.141
Nassar continued to work at local gymnastics clubs and at USAG events throughout the
late 1980s and early 1990s as he attended medical school.142 One witness observed, he apractically
lived in the gym.a143 He was athere almost every single day for hours,a arriving early to tape
ankles and staying late to tend to pulled muscles.144 From 1991 to 1993, he received the Region 5
Contributor of the Year award; in 1993, 1994 and 1996, he received the Michigan Contributor of
the Year award; and in each year from 1993 to 1997, he received a similar award from the United
States Womenas Gymnastics Elite Coaches Association. 145 By the mid-1990s, following his
graduation from medical school, Nassar had established himself as an expert on gymnastics
34

injuries, and in 1996, he served as the Womenas National Team physician at the Olympic
Games.146 In that role, Nassar attended his first Olympic Games,147 where he was well-positioned
to capitalize on the success of the Womenas Team that earned the first-ever team gymnastics gold
medal for the United States.148 Indeed, one of the enduring images from the Games depicted
Nassar reaching out to help a limping Kerri Strug following her vault.149 Coming out of these
successful Games, Nassar was named to the position of National Medical Coordinator, a position
he would occupy for close to 20 years. In that same period, Nassar was also named an assistant
professor at MSU and began working as a team doctor at Holt High School in Holt, Michigan.150
Over the ensuing decades, Nassar established himself as aa miracle worker,a who acan fix
anyone or anything.a151 Nassar volunteered at the National Team training camps, held at the
Karolyi Ranch;152 at the Womenas Artistic Gymnastics World Championships in 1991, 1995, 1999,
2003, 2007, 2010 and 2011; and at the 1996, 2000, 2008 and 2012 Olympic Games, among other
events.153 Nassar also drafted medical guidelines for USAG,154 reviewed the performance of other
medical professionals,155 helped decide which medical personnel would work at which events,156
and lectured at USAG Congresses and other conferences, including on the importance of the pelvic
floor to core strength.157 Indeed, Nassar was open about his focus on the pelvic area and recorded
instructional videos, composed PowerPoints and exchanged emails discussing the importance of
the ligaments in the pelvic area.158
As detailed in Part V.B.1, Nassaras colleagues at USAG held him in high regard. The Vice
President of Member Services told him that a[t]here could be NO one better to represent the USA
than you.a159 The former director of the Womenas Program and of the National Team Training
Center, Gary Warren, remarked that aI have always admired your dedication to the athletes and
coaches. Your energy level, your compassion and your commitment is unsurpassed by anyone I

35

know.a160 And Nassar described his relationship with Ms. Karolyi as incredibly close, noting that
awe have a working relationship of trust.a 161 Nassar used similar language to describe his
relationship with key colleagues, writing that Ms. Karolyi, together with Assistant U.S. Womanas
Olympic Team Coach Steve Rybacki and athletic trainer Ms. Van Horn, comprised his ainner
circle of confidence,a with whom he shared confidential injury information.162 In 2006, a high
ranking member of USAG wrote to the USOC regarding credentialing Nassar and Ms. Van Horn
for the 2008 Olympics: aWe cannot begin to tell you the importance these two individuals have on
the womenas gymnastics National Team,a 163 a sentiment again shared six years later: aThe
womenas team has determined that it will be essential that Dr. Larry Nassar is a member of the
delegation.a164
Not only did the cumulative experience and close relationships at USAG continue to
cement Nassaras role at that organization, but Nassar also leveraged his Olympic reputation for his
work outside of USAG. Nassar adorned his MSU office with pictures of Olympians, which as one
survivor noted, was a asmall yet significant detail that strengthened my trust in Mr. Nassaras
intentions.a165 Survivors remarked that they afelt so incredibly lucky to be there,a166 and were ain
awe,a 167 a feeling Nassar cultivated by regularly referencing the Olympic pictures. 168 Upon
passing the famous photograph of Kerri Strug, he noted, aThatas me[.] I taped her up so she could
do that.a169
Nassar enjoyed a celebrity status within the gymnastics community, and he was able to
cultivate the belief that his help was essential to success at the highest levels. Gymnasts sought
out his treatments not only because he was the rare doctor who aunderstood gymnastics,a but also
because they believed treatments from Nassar were critical to their success.170 As one survivor

36

noted, Nassar was asomeone that I counted on . . . so that I could reach my highest potential,a171
or as another simply stated, Nassar was ahope in the face of tragedy.a172
Alongside this reputation as an exceptional doctor to Olympians, Nassar developed a
reputation as a physician who cared deeply about treating patients in a holistic manner and as a
caring friend in the harsh environment of competitive gymnastics. One survivor commented that
for aa young girl away from her home being worked into exhaustion by screaming coaches, a
kindly doctor offering relief from pain and a little sympathy was easy to like.a173 In the words of
another survivor, Nassar was athe good cop,a who defended gymnasts against overbearing coaches
and aliterally and metaphorically put us back together.a174 aHe was the good guy in a sport of
cruel people.a175 Nassar was often willing to take the time to listen to his patients,176 and a survivor
recounted that he was amy close friend who always had my best interests in mind, whether it is
about my injuries, my eating habits, my gymnastics practices, school choices, college decisions,
career path, and all the way up to my family plans.a177 Nassar reinforced this impression by giving
his patients gifts a Olympic pins to the young gymnasts he treated at MSU178 and pieces of bread
and forbidden candy to the Olympic athletes during training camps.179
In his public statements and actions, Nassar was careful to cultivate his reputation as an
ally of the athlete. For example, in a 2004 gymnastics listserv conversation, Nassar responded to
a parentas assessment that she needed a second opinion because her daughteras orthopedist is avery
conservative and I think he hates gymnastics,a by writing: aPlease, be very cautious[.] Let her
heal properly and then continue with her training. Please, keep things in perspective.a180 Nassar
struck a similar tone during an interview on a popular gymnastics podcast, stating: aNot just
physically, but mentally you have to protect your athletes, you have to let them know that we care,
you have to not just let them know but let them feel it, let them understand it, let them breathe

37

it.a181 Writing in the USAG National Team Medical Staff Guidelines, he stated that the afirst
pronga of treatment is to asee and treat the whole person,a because a[o]ne of the most important
factors in providing effective medical care to our athletes is trust.a182 Reflecting on his career in
a 2014 Facebook post, he continued with this theme: aMy continued advice is to always be the
athleteas advocate, always.a 183 Even outside of competitive gymnastics, Nassar consistently
exuded an image of a do-gooder, someone who embodied wholesome values, whether by plowing
his neighboras driveway after a snowstorm or volunteering to teach Sunday School.184 Nassar even
updated his email signature line to include a reference to his charity, Gymnastics Doctor Autism
Foundation, following his establishment of the foundation in 2011.185
Toward the end of his career, Nassar continued to build on his reputation, and in 2012, he
was elected to the Region 5 Hall of Fame.186 In a letter congratulating Nassar on his induction
into the Hall of Fame, Mr. Penny and Peter Vidmar, then-Chair of the Board of USAG,
summarized Nassaras dual reputation as a world-class doctor and a caring friend: a[E]veryone at
USA Gymnastics recognizes the incredible commitment you have made to the welfare of athletes.
Not only have you provided outstanding medical support, but you have been a friend and
confidante.a187 While at the time of this letter USAG was already turning to a different leader for
its medical program, Nassar continued to serve as the head medical professional for the Womenas
Team.188 In 2014, Nassar announced that he planned to serve as the doctor for the Womenas Team
through the 2016 Olympics,189 and USAG began planning for Nassar to attend those Games.190
When Nassar announced his retirement from USAG a year in advance, in September 2015,191 he
suffered no immediate harm to his reputation and continued to see patients, who believed they
were lucky to see such a talented and seemingly well-meaning doctor.

38

The combination of a well-respected doctor and a caring adult who appeared to be
completely devoted to the welfare of athletes was a powerful trust-building tool. As the mother of
a survivor testified, Nassar awas someone we completely trusted. He was our friend, our
neighbor.a192 Survivors were atold to trust [him] by everyone. My parents, my coaches, and even
by my teammates.a193 But as another survivor summarized, aLarryas the most dangerous type of
abuser, one who is capable of manipulating his victim through coldly-calculated grooming
methodologies, presenting the most wholesome and caring external persona as a deliberate means
to ensure a steady stream of young children to assault.a194
B.

Nassaras Methods for Normalizing the Abuse

On thousands of occasions across almost three decades, Nassar criminally sexually abused
hundreds of children and young women. Nassar adopted various methods of abuse, but the
unifying theme is that he effectively normalized his criminal acts, convincing his patients that the
awful, uncomfortable and confusing procedure was medically necessary a or at least sowing
enough doubt in their minds. And Nassar only needed to create sufficient confusion so that the
cumulative effect of his reputation and grooming could weigh on the scales and convince survivors
to not identify the criminal acts as abusive, or at least lack confidence in any such determination.
Nassar used various justifications for performing treatments in the pelvic region. If the
athlete presented with hip problems, Nassar might explain that he needed to perform an
aintravaginal adjustmenta to adjust the bones in the athleteas hips.195 If the athlete presented with
back pain, Nassar might explain that there was a pressure point in the pelvic floor that would lessen
the pain,196 or that he needed to arealigna the patientas back.197 If the athlete presented with a
hamstring issue, Nassar might explain that you have to get up in there to massage.198 And Nassar
often told athletes that they had a adumb butta that restricted their flexibility, and he had to treat
this condition by manipulating the pelvic floor.199
39

Nassar varied how much information he shared with the athlete concerning the ostensible
justifications for the abusive procedure. Occasionally, Nassar explained the invasive nature of the
procedure by using a model or pointing to a page in a textbook.200 He also told some athletes that
an intravaginal manipulation was athe easiest way to stretch [the hamstring] without pain,a201 or
that he ahad to relieve the pressure in those muscles down there.a 202 With other athletes, he
explained only that the next procedure was aa little invasivea203 and amight be uncomfortable.a204
With still other athletes, Nassar provided no warning that he intended to massage areas around the
pelvic floor,205 or mentioned only that he was going to perform an aadjustment.a206 For these
athletes, Nassar often started slowly massaging closer to the pelvic region before escalating his
criminal acts.207 Nassar also regularly touched the athletesa breasts under the guise of fixing an
issue with the ribs, shoulder or other upper body area.208
As a doctor of osteopathy, Nassar regularly performed hands-on treatments known as
Osteopathic Manipulative Treatments. A fundamental principle of these treatments is amyofascial
continuitya a that tightness in one muscle group can lead to a corresponding looseness in a separate
muscle group a and therefore Nassar had an asserted medical basis for performing treatments in
areas removed from the location of injury.209 Although Nassar had no medical support for any of
his abusive, criminal acts, by simply referencing the ostensible medical basis of the procedure,
even with a cursory explanation of needing to aget up in therea or to arealign,a Nassar coated his
abuse in a patina of medical justification. Conversely, on the other end of the spectrum, when
Nassar started his abuse with little to no warning, the implicit message was that this procedure is
so normal, so standard, that it required no additional explanation.
During the procedure, Nassar also varied his strategies for normalizing the abuse.
Survivors recalled how Nassar committed the assaults aall the while talking to me as if what [he

40

was] doing was perfectly normal,a210 with one survivor remarking that it was alike when you go
to the dentist and they talk about random stuff to try to make you feel at ease.a211 At other times,
Nassar asked if everything was OK, or if anything hurt.212 On some occasions, Nassaras questions
seemed to serve the dual purpose of putting his patients at ease while also satisfying his sexual
desires, such as when he asked the athletes ahow it felt,a213 or telling athletes that he hoped he was
making them feel better.214 Nassaras comments sometimes crossed over into explicitly sexual
topics, although he usually kept the comments seemingly lighthearted. He told some athletes that
he was aplayinga with them,215 made comments to other athletes along the lines of showing their
boyfriends the technique 216 and asked some athletes about their sexual experiences with their
boyfriends.217
However, Nassar was not entirely in control of himself during his abuse. Nassar acted
aroused during some of his assaults, and many survivors have recounted that he had an erection.218
Others observed that he panted and breathed heavily during the assaults and would sweat profusely
from his forehead.219 Some gymnasts noted a acreepya look on his face.220 And as one survivor
detailed in an interview with a reporter, in one especially egregious episode, Nassar drugged a
gymnast and, dropping any pretext of a medical procedure, climbed on top of the gymnast and
abused her.221
Both during and after the procedures, Nassar was prepared to manage questions and
concerns. If an athlete questioned Nassar during an exam, he assured her that the treatment would
alleviate the pain.222 If an athlete told him to stop, Nassar would merely reposition his hand.223
On at least one occasion, when an athlete stated, astop, youare hurting me,a Nassar continued the
abuse a implicitly refusing to acknowledge that he was engaging in any improper acts.224 He also
assured athletes that he performed the procedure on many girls.225

41

One particular way that Nassar normalized his assaults was by abusing athletes while the
athleteas parent was in the room.226 To do so, he turned the athlete away from the parent and
positioned himself between the parent and the athlete.227 Sometimes Nassar even engaged in
conversation with the parent during his assault.228 The ability to abuse survivors in the presence
of their parents was a powerful cover. One survivor testified to a adisoriented sense of safety since
my mom was there.a229 Another testified that she aassumed it was necessary since he did it with
my mother in the room, and I just never fully understood.a230 And a third remarked, aI also told
myself that if my mom thought it was weird she would have said something about it, but what I
didnat realize was you had always positioned yourself and me in a way so that she couldnat see
what was happening.a231
Nassaras mere title of adoctora was a powerful cover and silencing mechanism, and many
survivors testified that they simply adidnat know how to act,a during and after the abuse. 232
Gymnasts were awilling to trust and allowed the doctor to do anything to help [them] feel
better,a233 with one survivor explaining that aI was supposed to never question anything you did
because you were a doctor.a 234

Survivors expected that a medical procedure might be

uncomfortable and therefore, even though Nassaras abuse afelt wrong,a235 they did not recognize
his actions as abusive, reasoning that aweare taught from an early age that doctors are there to help
you,a236 and a[j]ust because I did not like the treatment, it did not mean that it shouldnat have been
done.a237
Moreover, Nassar was more than an ordinary doctor; gymnasts had been told ahe was the
best and he would be my best shot of not being in pain anymore.a238 Athletes, therefore, aassumed
from there that anything that happened was medically necessary.a239 Again, even when survivors
recognized something was amiss, they could not believe that they were experiencing abuse. As

42

one survivor stated, aI kept repeating in my head, this is a mistake, this isnat real. I thought, heas
a famous doctor, thereas no way he would do something inappropriate.a240 As a different survivor
remarked, she aknew it felt strange, but he was the national team doctor,a 241 with another
commenting that she reasoned ahe was a famous sports medicine doctor, and I assumed the gross
thing he did would help me get better.a242
Nassaras carefully cultivated reputation as a trusted friend further helped ensure the
survivorsa silence, with survivors recounting that even though ait hurt and it was uncomfortable,a
they trusted Nassar243 and atruly believed he had my best interest at heart.a244 Another survivor
summarized her thoughts with, awhy get rid of a perfectly nice, kind and caring doctor because I
felt a little uncomfortable?a245
The sheer unlikelihood that someone as well-respected as Nassar would be committing
sexual assault also drove the athletes to stay silent, with one survivor explaining, aI remember
thinking it was a mistake, why would he ever need to do that?a246 Another commented that aI
couldnat possibly believe that someone in such a powerful position would do that to anyone so I
started to make myself believe that it didnat happen.a247 And a third emphatically stated, aI refused
to believe there were people as evil as [Nassar] in the world.a248
The cumulative effect of Nassaras reputation, grooming and methodical means of abuse
created a class of survivors who shared a similar, strange experience that many of them could not
yet label as criminally abusive. As a result, when survivors spoke to each other and learned that
Nassar had conducted the same procedure on other athletes, they reaffirmed each otheras belief
that the procedure must be fine and quieted the suspicion that something was wrong.249

43

III.

WHO KNEW WHAT WHEN AND WHAT WAS AND WAS NOT DONE IN
RESPONSE

A
A

A

A

A

A

A

SELECTEDA FINDINGSA

A

iSS

OverA aA periodA ofA decades,A numerousA adultsA ignoredA credibleA reportsA ofA NassarasA
criminalA abuse.A

iSS

InA 2004A andA 2014,A theA MeridianA TownshipA PoliceA andA MSU,A respectively,A failedA toA
effectivelyA investigateA allegationsA againstA Nassar,A resultingA inA noA chargesA beingA
filedA inA responseA toA credible,A firstahandA accountsA ofA abuse.A

A

iSS

OnA JuneA 17,A 2015,A USAGA wasA informedA thatA multipleA athletesA wereA uncomfortableA
withA treatmentA methodsA thatA NassarA hadA performedA onA them.A A OverA theA courseA ofA
theA nextA fiveA weeks,A USAGA conductedA anA internalA investigationA withA theA assistanceA
ofA aA privateA investigatorA beforeA reportingA theA matterA toA lawA enforcement.A A USAGA
didA notA makeA anyA reportA toA civilA childA protectionA authorities.A

A

iSS

USAGasA legalA counselA notifiedA NassarA ofA theA internalA investigationA whileA itA wasA stillA
ongoingA andA beforeA USAGA hadA reportedA NassarA toA theA FBI.A A USAGA didA notA informA
membersA ofA theA gymnasticsA communityA ofA theA athletesaA concernsA orA ofA theA
investigation;A instead,A USAGA developed,A inA consultationA withA Nassar,A falseA excusesA
forA NassarasA nonaappearanceA atA USAGA events.A A

A

iSS

Mr.A PennyA informedA Mr.A BlackmunA andA Mr.A AshleyA atA theA USOCA inA JulyA 2015A ofA
allegationsA ofA sexualA misconduct,A tellingA Mr.A BlackmunA thatA NationalA TeamA
membersA hadA allegedA misconductA byA theA NationalA TeamA doctor.A A Mr.A PennyA
notifiedA themA bothA ofA theA planA toA reportA theA conductA toA lawA enforcement.A A AfterA
receivingA thisA information,A Mr.A BlackmunA andA Mr.A AshleyA didA notA alertA anyA otherA
USOCA employeeA orA boardA member,A independentlyA confirmA thatA USAGA hadA
reportedA theA conductA toA lawA enforcementA andA appropriateA stateA authorities,A orA
takeA anyA otherA action.A

iSS

InA lateA SeptemberA 2015,A whenA LarryA Buendorf,A thenaChiefA SecurityA OfficerA atA theA
USOC,A approachedA Mr.A BlackmunA followingA Mr.A PennyasA independentA reportA toA
Mr.A Buendorf,A Mr.A BlackmunA toldA Mr.A BuendorfA thatA heA wasA awareA ofA theA situationA
andA didA notA furtherA engageA theA USOCasA thenaChiefA ofA SecurityA onA theA matterA orA
appropriateA childaprotectiveA measures.A

44

A

A

A

A

A

A

A

A

A

iSS

USAGA reportedA NassarasA conductA toA FBIA agents,A includingA JayA Abbott,A SpecialA
AgentA inA ChargeA ofA theA IndianapolisA office,A onA JulyA 28,A 2015.A A ApproximatelyA oneA
monthA later,A theA IndianapolisA officeA concludedA itsA initialA investigationA andA
transferredA theA matterA toA theA FBIA officeA inA Detroit.A A

iSS

TheA dayA afterA makingA theA FBIA report,A USAGA relievedA NassarA ofA anyA furtherA
assignmentsA andA requestedA thatA NassarA notA communicateA withA USAGA athletesA orA
personnel.A A NassarA almostA immediatelyA violatedA thisA requestA byA textingA aA gymnast,A
andA laterA informedA USAG,A inA SeptemberA 2015,A thatA heA wouldA noA longerA honorA thisA
request.A A USAGA tookA noA effectiveA stepsA toA enforceA itsA noacontactA directive.A

iSS

InA earlyA SeptemberA 2015,A NassarA communicatedA hisA decisionA toA aretireaA toA USAG.A A
OnA SeptemberA 8,A 2015,A Mr.A PennyA informedA Mr.A BlackmunA andA Mr.A AshleyA byA
emailA ofA thisA developmentA and,A twoA daysA later,A informedA theA FBI.A A NeitherA USAGA
norA theA USOCA informedA anyoneA outsideA ofA theseA threeA organizationsA ofA NassarasA
pretenseA thatA heA hadA retiredA voluntarilyA followingA aA longA andA successfulA career.A A
TheA SeptemberA 8,A 2015A emailA referencingA NassarA byA nameA wasA deletedA fromA Mr.A
BlackmunasA andA Mr.A AshleyasA respectiveA emailA accounts.A

iSS

InA theA fallA ofA 2015,A afterA theA fileA hadA beenA transferredA toA theA DetroitA office,A
Mr.A PennyA andA AgentA AbbottA metA informallyA forA aA abeerA andA conversation,aA whereA
Mr.A PennyA offeredA toA provideA assistanceA toA AgentA AbbottA inA securingA aA highalevelA
positionA asA ChiefA SecurityA OfficerA forA theA USOCA uponA Mr.A BuendorfasA anticipatedA
retirement.A A A

A

iSS

InA lateA AprilA 2016,A followingA nearlyA eightA monthsA withA noA evidentA actionA byA theA
DetroitA officeA ofA theA FBI,A Mr.A ParillaA contactedA theA LosA AngelesA FBIA officeA toA
arrangeA aA meetingA forA USAGA toA reareportA theA NassarA allegations.A A TwoA weeksA later,A
Mr.A PennyA andA Mr.A ParillaA metA withA FBIA agentsA fromA theA LosA AngelesA office.A A TheA
FBIasA LosA AngelesA officeA thereafterA beganA toA interviewA witnesses,A butA didA notA
completeA itsA investigationA orA arrestA NassarA priorA toA theA IndianapolisA StarasA publicA
exposureA ofA NassarA inA SeptemberA 2016.A

A

iSS

AsA theA IndianapolisA StarA beganA investigatingA USAGasA failureA toA reportA allegationsA ofA
sexualA misconductA involvingA USAGA coaches,A Mr.A PennyA reachedA outA toA aA detectiveA
atA theA IndianapolisA MetropolitanA PoliceA DepartmentA forA assistanceA toA akillA theA
story.aA A TheA detectiveA lobbiedA reportersA andA tookA otherA actionsA inA consultationA
withA Mr.A PennyA forA theA purposeA ofA minimizingA negativeA mediaA coverageA ofA USAG.A A
AA fewA weeksA later,A afterA theA IndianapolisA StarA publishedA itsA articleA concerningA
Nassar,A Mr.A PennyA reachedA outA toA AgentA AbbottA andA soughtA hisA inputA andA
assistanceA inA connectionA withA theA mediaA coverageA ofA NassarasA abuseA andA theA
mannerA inA whichA USAGA wasA beingA portrayed.A A A

A

45

A

A

A

A

iSS

OnA orA aboutA NovemberA 11,A 2016,A afterA learningA thatA TexasA RangersA hadA arrivedA
unannouncedA atA theA KarolyiA RanchA andA statedA thatA theyA wouldA beA returningA withA aA
searchA warrant,A Mr.A PennyA instructedA aA USAGA employeeA toA retrieveA anyA andA allA
documentsA atA theA RanchA relatedA toA NassarA orA medicalA care.A A TheA employee,A asA
directed,A broughtA theA documents,A inA aA largeA suitcaseA andA multipleA boxes,A toA
USAGasA IndianapolisA offices.A A ItA isA notA clearA whatA happenedA toA someA ofA theseA
documents.A A

46

A

A.

Early Reporting of Nassaras Abuse and Notice of Other Conductvii

Among the reasons that many survivors did not report Nassaras conduct to people in
positions of authority was a fear that no one would believe them.250 That fear proved to be wellfounded.251 Over more than two decades, a number of survivors of Nassaras abuse reported his
conduct to coaches, trainers and other adults in positions of authority, but none of these reports led
to adult intervention to stop Nassar from continuing his abuse of athletes. Based on our review of
available materials, Nassaras close friends Mr. Geddert and Ms. Klages ignored the reports they
received, and other adults not only declined to take action to halt Nassaras abuse, but also
discouraged athletes from voicing their concerns. Even when law enforcement received a direct
report of sexual abuse, and MSU conducted a full Title IX investigation in response to allegations
of sexual assault, nothing happened. Nassaras reputation and ostensible medical justifications were
credited over the direct accounts of survivors, allowing Nassar to continue his abuse. And while
USAG and the USOC, in the summer of 2015, were put directly on notice of the credible
allegations by National Team members that Nassar had sexually abused athletes under his care,
USAG and the USOC did not take effective action to halt Nassaras abuse. Only the September
2016 reporting by the Indianapolis Star, an ensuing avalanche of complaints and the discovery of
child pornography on Nassaras computer hard drives, including images of child sexual abuse
involving infants as young as eighteen months, finally broke the pattern of disbelief and inaction.
These events in turn led to criminal charges and a public accounting of Nassaras crimes, almost 30
years after his serial sexual abuse had begun, and more than 400 survivors later.252

vii

Our Independent Investigation focused on awho knew what whena and what was and was not done in response at
the USOC and USAG. A recitation of the early reports to adults is necessary to understand in full the environment
that enabled Nassaras abuse and to provide context for the institutional and individual failures to intervene and halt
Nassaras abuse. Part III.A relies largely on publicly-available information to tell the story of almost 20 years of
inaction by adults who were in a position to stop Nassar.

47

1.

Reports to Geddert and Klages

According to publicly available sources, Mr. Geddert and Ms. Klages received among the
earliest reports of Nassaras abuse; they were also longtime friends of Nassar. The three began their
gymnastics careers working together at a Michigan club in the late 1980s.253 Each then went on
to successful and decorated careers a Mr. Geddert as the owner and coach at Twistars, a club with
a record of producing top-level gymnasts, and Ms. Klages as the head coach of the Michigan State
womenas gymnastics team.254
Mr. Geddert is reported to have engaged in abusive methods of coaching.255 Gymnasts
explained in their testimony at Nassaras sentencing hearings that Mr. Geddert verbally abused the
gymnasts who trained with him, applying a fear-based coaching technique, and forced gymnasts
to train on injuries. According to one gymnast, while Mr. Geddert abroke [gymnasts] mentally
and physically, depriving us of water on a hot summeras day in the un-air conditioned gym or
pushing us to practice on broken bones,a Nassar was athe one who stepped in. You defended us.
You stood up to him on our beha[lf]. You protected our bodies from further pain.a256 Gymnasts
afelt like Larry was my hero. He was going to yell at John for mishandling me,a257 and, therefore,
they sought shelter with Nassar, whose kind words and comforting presence masked his abuse.
Nassar protected Mr. Geddert. When Mr. Geddert was facing possible criminal liability
stemming from his physical abuse of a young gymnast, Nassar personally texted the gymnastas
grandmother to vouch for Mr. Geddert.258 And according to testimony and other public statements
from the survivors, Mr. Geddert repeatedly failed to act on notice of Nassaras abuse. A gymnast
who trained with Mr. Geddert testified that, in 1998, her mother reported an inappropriate
treatment by Nassar to Mr. Geddert, who arranged for the gymnast not to see Nassar again for oneon-one treatments, but took no further action.259 Likewise, a different gymnast, who trained with
Mr. Geddert in the 2000s, testified that her mother reported Nassaras conduct to the tight-knit
48

Twistars community, but that no action was taken.260 A third gymnast stated in an interview with
a reporter that, after Nassar abused her during the 2011 World Championships in Tokyo, Japan,261
she was traveling in a car with Mr. Geddert and three other gymnasts and stated that, aLast night,
it was like Larry was fingering me.a262 The other gymnasts were shocked, one of them arebukeda
her, but Mr. Geddert did not react.263 And as noted above in Part I.B, after Nassar was first publicly
accused, Mr. Geddert defended him as aone of the most respected gymnastics professionals Iave
ever had to deal with.a264
Ms. Klages had less day-to-day interaction with Nassar, but remained his loyal friend
throughout their careers. A former gymnast testified during the sentencing hearings that when she
was 16 years old and while participating in a youth gymnastics program at MSU during the 1997a
98 time period, she was abused by Nassar and reported concerns about his atreatmenta to
Ms. Klages.265 According to a recently filed civil complaint, Ms. Klages responded by informing
the gymnast that she must be amisunderstandinga or areading intoa Nassaras conduct and that any
report would have serious consequences.266 The gymnast testified that Ms. Klages then asked
other participants of the youth program whether they had felt uncomfortable with a procedure
performed by Nassar, but even after another gymnast answered in the affirmative, Ms. Klages
never reported these concerns.267 The gymnast testified that Ms. Klages instead informed Nassar
of her report.268 At the gymnastas next appointment with Nassar, he explained why she had been
mistaken and proceeded to abuse her again.269
Ms. Klages steadfastly continued to stand by Nassar, including during the fall and winter
of 2016. Ms. Klages asked MSU gymnasts to sign a card of support for Nassar in September 2016.
Following Nassaras arrest, Ms. Klages told investigators for the Michigan Attorney Generalas
office that she could not recall receiving any reports of Nassaras abuse prior to 2016.270 And she

49

was one of the very few people to continue to support Nassar following the revelation that he had
collected thousands of images of child pornography, reportedly remarking to the mother of a
survivor that the pornography could have been planted.271 On August 23, 2018, Ms. Klages was
indicted on two counts, one felony and one misdemeanor, of lying to a peace officer in connection
with her statements asserting a lack of prior knowledge of reports of Nassaras abuse.272
2.

Reports to Coaches, Trainers and Other Adults over a Span of Decades

Based on testimony from the sentencing hearings, around the same time that Mr. Geddert
and Ms. Klages received reports of abuse, the mother of a survivor spoke to her daughteras coach
and reported to him that Nassar had penetrated her daughter with his ungloved fingers.273 The
mother testified that the coach responded by saying that he had known Nassar for years and that
her account of the treatment could not have happened.274 And according to a recently filed civil
complaint, a gymnast informed an assistant coach at Twistars in 1998 that Nassar had touched her
inappropriately. 275 The coach responded by stating that Nassar awouldnat do that,a and the
gymnast never made another report.276
In the 1999a2001 time period, three different MSU athletes reported Nassaras conduct to
adults without any apparent responsive action being taken against Nassar, according to testimony,
recently filed civil complaints and media reports. First, an MSU softball player reported to a trainer
on the softball team that Nassar had inserted his fingers into her during a treatment; the trainer
responded that Nassar was a world-renowned doctor performing legitimate medical treatment.277
After Nassar continued his abuse, the athlete spoke to supervising trainers in the MSU athletic
department, who provided the athlete with a similar response.278 Second, an MSU track and cross
country athlete reported to her coach that Nassar had penetrated her during a treatment. The coach
responded that Nassar was aan Olympic doctor and he should know what he is doing.a279 And
third, a former MSU volleyball player went to see Nassar, who she recalled was ajokingly referred
50

to as the crotch doc for his unconventional methods of treating back and hip pain.a280 After Nassar
abused her, she spoke to a trainer at MSU a one of the trainers who had reportedly been contacted
by the softball player a and stated that she wanted to make a report about discomfort with Nassaras
treatment.281 The trainer discussed the process of filing an official complaint, and the athlete
understood from the discussion that she could not just file a complaint saying that she was
auncomfortable,a but instead would have to accuse Nassar of criminal wrongdoing.282 Following
her conversation with the trainer, the athlete decided against making a report.283
In 2004, according to her own statements in media interviews and testimony, a 12-year-old
daughter of Nassaras family friends reported to her parents that Nassar had been sexually abusing
her for years.284 Her parents discussed the allegations with Nassar and a child psychiatrist, and
Nassar was able to convince both the parents and the psychiatrist that he had not acted
inappropriately. 285 Nassar then met with the survivor, and in a feint designed to reassert his
dominance, told her that if anything like that ever should happen to her, she would need to atell
someone.a286
As reflected in media reports, in 2004, a gymnast who had been abused in 2000 warned the
head coach of a Michigan gym against sending athletes to Nassar for treatment.287 The gymnast
explained that Nassar had sexually assaulted her under the guise of medical treatment and that the
coach should not send athletes to Nassar.288 The coach responded by expressing her concern to
the gymnast that there would be negative fallout if people heard what she was saying about
Nassar.289 And despite the gymnastas warning, the coach continued to send gymnasts to Nassar.290
Finally, according to media reports, in January 2016, two gymnastics coaches learned from
a former gymnast that Nassar had penetrated her during a medical appointment five years earlier.291
One of the coaches spoke with a doctor who practiced in sports medicine about the treatment, and

51

both the doctor and the coach concluded that the conduct constituted sexual assault.292 The two
coaches then discussed the situation with each other and expressed concern about the consequences
of making an accusation against such a high-profile person within USAG.293 The coaches decided
against making a report.294
3.

Meridian Township Police Investigation

In 2004, Nassar abused a 17 year old who sought treatment for back pain.295 She was
hesitant to report Nassar due to a fear athat no one would believe me.a296 Despite these hesitations,
she told her mother and they filed a police report with the Meridian Township, Michigan Police
Department.297 The daughter detailed how Nassar had attempted to penetrate her, had rubbed her
breasts and had neither explained the invasive procedure nor worn gloves.298 The police took her
statement and sent her to a hospital for a sexual assault kit.299
The police then interviewed Nassar about the medical basis for the procedure and reviewed
a PowerPoint presentation he provided to explain the procedure.300 Failing to interview any other
practitioner about the medical basis of the procedure or to conduct any additional investigation,
the police credited Nassaras account.301 The police concluded the investigation without a referral
to a prosecutor adue to the facts presented to [the police] by Dr. Nassar.a302 The police did set up
a meeting between the girlas parents and Nassar, where Nassar told the parents that it was a
misunderstanding and that because their daughter was not a gymnast, she was not as comfortable
with her body.303
4.

MSU Title IX and Police Investigation

In 2014, a recent MSU graduate made a Title IX report concerning Nassaras abuse, where
she detailed Nassaras inappropriate conduct in an interview with an employee from MSUas Office
of Inclusion and Intercultural Initiatives and an MSU police detective.304 Specifically, she related
that Nassar had made inappropriate comments about her boyfriend, molested her breasts and
52

massaged her vaginal area in a sexual manner.305 The student reported to MSU that she tried to
stop the assault by telling Nassar that he was hurting her, but Nassar responded that he was aalmost
donea and continued to assault her.306 MSU investigators interviewed other witnesses, including
friends of the reporting student.307
The MSU Title IX investigators and police confronted Nassar with these allegations in
separate interviews. Nassar explained in both interviews that his massaging of the chest and pelvic
regions had a medical purpose, that he had been performing these treatments for a long time and
that he teaches and lectures on pelvic floor treatments. 308 In the Title IX interview, Nassar
addressed the studentas allegation that the treatment did not stop after her complaint by explaining
that he would have understood the studentas statement to indicate that his specific hand placement
was causing pain rather than an issue with the procedure in general.309 Nassar explained that his
standard operating procedure is to aexplain as he goes,a and that he talks throughout his
appointments about where he is about to place his hands.310 Nassar added that he was avery hurt
to think that he violated a patientas trust,a that ahe was so sorry, that he never had any inappropriate
intent and that it especially hurts because helping people is what he does.a311
The Title IX report also notes that Nassar discussed a slide from a afrequently used power
point that contains Star Trek images and is entitled aPelvic Floor: Where no man has gone
before.aa 312

The report does not state whether Nassar provided MSU with PowerPoint

presentations in 2014; Nassar shared his PowerPoint presentations with USAG in 2015 and MSU
in 2016 following allegations of abuse, and he aused them to lecture frequently.a313 Nassaras
PowerPoint presentations have bizarre language and images. As Nassar stated to the Title IX
investigators, one of his slides is based on a Star Trek theme. The Star Trek slide in his PowerPoint
presentation contains a video with scrolling text: aThese are the voyages of the aSports Pelvic

53

Floora specialist/Whose life time mission . . . to boldly go where no man has gone before (in most
of our young gymnasts a hopefully).a314 In a different slide, Nassar quotes an 11-year-old gymnast
as saying aLarry, I think I hurt my WhoHaaa; in another, Nassar uses the title: aDo your athletes
have a PP Problem.a315
The investigators evaluated the complaint by consulting with other physicians who
practiced in the field of Osteopathic Manipulative Therapy, but the physicians they consulted were
Nassaras own colleagues.316 Many of these colleagues had known Nassar for decades, and they
vouched for him, stating that he was a well-respected doctor who conducted appropriate and
professional procedures. 317 Although one colleague, an athletic trainer, is reported to have
received a complaint concerning Nassar in the early 2000s, 318 this trainer told the MSU
investigators that she ahas never had a complaint about Dr. Nassar . . . and has no concern about
him crossing a line between medically appropriate and inappropriate.a 319 Ultimately, each
colleague told the Title IX investigators that she considered Nassaras conduct to be medically
appropriate.320
The Title IX report concluded, based on the statements from these medical practitioners,
that they acannot find that the conduct was medically inappropriate and thus, cannot find it was
sexual in nature.a 321 The report criticized Nassar for his failure to explain the nature of the
procedure, failure to communicate to the patient how to stop the procedure, failure to provide the
patient with the option of having another person in the room, and for his inappropriate comments
about the patientas boyfriend.322 The investigators drafted two conclusions to the report. In the
report provided to the student, the MSU investigators stated that they found athe claim helpful in
that it allows us to examine certain practices at the MSU Sports Medicine Clinic.a323 In the internal
report, the investigators discussed the many ways in which Nassaras conduct had exposed the

54

Sports Medicine Clinic to legal liability, including Nassaras failure to adequately explain his
invasive, sensitive procedures; his failure to obtain consent; his failure to provide patients with the
option to have the procedure performed over clothing; and the effects of his conduct in exposing
patients to unnecessary trauma based on aperceived inappropriate sexual misconduct.a324
Following the investigation, MSU imposed certain requirements on Nassar, including that
(i) there would always be a second person in the room during procedures involving a sensitive area;
(ii) Nassar would modify his procedure to minimize skin-to-skin contact; and (iii) if skin-to-skin
contact was necessary, Nassar would explain the procedure in detail.325 In communicating these
requirements to Nassar in July 2014, the former dean of MSUas College of Osteopathic Medicine,
Dr. Strampel, explained that he was ahappy this has resolved . . . and I am happy to have you back
in full practice.a326 MSU never ensured that Nassar implemented these requirements, and when
Nassar was permitted to return to practice following the investigation, he immediately returned to
serially sexually abusing athletes.327 viii
Almost a year after the Title IX report, the MSU police department forwarded the case to
the Ingham Countyas prosecutoras office with a recommendation to charge Nassar with fourthdegree criminal sexual conduct, a misdemeanor,328 but in December 2015, the prosecutoras office
declined to pursue charges against Nassar, reasoning that Nassaras procedure appeared to be aa
very innovative and helpful manipulation.a329
5.

Nassaras Longtime Colleagues

Nassar worked closely with numerous medical professionals over the course of his career.
Although there is no evidence available to the Independent Investigators that these professionals

viii

Dr. Strampel faces two counts of willful neglect of duty related to his alleged actions during and after Nassaras
2014 Title IX investigation. Complaint, People v. Strampel, No. 18-0472FY (Ingham Cty., Mich. Mar. 27, 2018).
Dr. Strampel is also facing two additional criminal charges, a felony misconduct in office charge and a fourth-degree
criminal sexual assault charge. Complaint, People v. Strampel, No. 18-0472FY (Ingham Cty., Mich. Mar. 27, 2018).

55

had knowledge of Nassaras abuse, their very presence a working next to a serial abuser a was an
important feature of his facade.
At USAG, Nassar developed a strong relationship with his co-worker, athletic trainer
Ms. Van Horn. Since the two first met at the 1988 Olympic Trials,330 they traveled together,
collaborated on presentations and shared confidential injury information.331 In June 2015, Nassar
referred to Ms. Van Horn as the anecka to his ahead.a332 In all of the years they worked side-byside, Ms. Van Horn never raised any concerns about Nassaras medical practices. Interviewees
describe Ms. Van Horn as good at her job, but apainfully shya and someone who never
contradicted Nassar, and instead did awhatever [Nassar] told her to do.a 333 Ms. Van Horn is
currently facing criminal charges in Texas stemming from Nassaras abuse of gymnasts,334 and she
declined to participate in the Independent Investigation.
At MSU, Dr. Lemmen worked closely with Nassar. Dr. Lemmen was aware that Nassar
had resigned from his position at USAG following a review of his treatment methods that had
made athletes feel aunfomfortable.a 335 Instead of reporting this news to her supervisors,
Dr. Lemmen provided advice to Nassar and recommended that he speak with lawyers.336 And
when Nassar faced his first civil lawsuit in August 2016, he asked Dr. Lemmen to remove medical
files from the MSU Sports Medicine department so that he could identify the anonymous
plaintiff.337 Dr. Lemmen removed the files, but ultimately decided against turning them over to
Nassar, and she returned the files to MSU on the following day.338
6.

Notice of Other Conduct by Nassar

In addition to the direct reports of abuse that went unaddressed and the failures by Nassaras
co-workers to report any concerns about his conduct, employees of both USAG and the USOC
learned of actions that a while seemingly innocent at the time a in retrospect are examples of
missed warning signs. Employees and athletes at USAG were aware that Nassar had a practice of
56

taking extensive photographs of gymnasts during events. Nassar would then send gymnasts and
their coaches DVDs of these photographs.339 In around 2010, Mr. Penny told Kathy Kelly, the
former-Vice President of the Womenas Program, that Nassaras practice of taking photographs at
competitions abothereda him, as Nassar was attending in his capacity as a physician and USAG
had retained professional photographers to cover the events. 340

Mr. Penny stated to the

Independent Investigators that he did not suspect that Nassar had any nefarious intentions in taking
these photographs, but he asked Ms. Kelly to tell Nassar to stop.341 ix Ms. Kelly thereafter spoke
with Nassar, who agreed to end his practice of taking photographs at meets and other competitive
events.342
At the Olympic Games, the Womenas Artistic Gymnastics team had a practice of separating
themselves from the rest of Team USA, including by staying in different accommodations and, in
particular, not receiving medical care at the central USOC medical clinic.343 Shortly prior to the
2012 Games, the USOC appointed Dr. Bill Moreau as the new Managing Director of Sports
Medicine. Dr. Moreau spoke with Nassar at the Games about the practice of treating gymnasts
outside of the central USOC medical area, telling Nassar that it would be asafer for youa to treat
the gymnasts next to other athletes and that Nassar ashouldnat take care of athletes alone,a given
the absence of any witnesses who could defend Nassar in the event of a dispute with an athlete.344
Dr. Moreau explained that he would never treat patients without a chaperone, suggesting that
Nassar should not either.345 Nassar responded to Dr. Moreau that Ms. Karolyi awonat let mea treat
the gymnasts next to the other athletes because she does not want athe gymnasts to be with the
boxers.a346 Following this conversation, Dr. Moreau visited the area where Nassar was treating
gymnasts. Upon arriving, he observed Nassar performing treatments in an open setting, next to

ix

Mr. Penny's interview with the Independent Investigators spanned two days in August 2018.

57

Ms. Van Horn and with multiple athletes present.347 Dr. Moreau concluded that there was no
reason to believe the treatment setting was unsafe or inappropriate.x
At the end of the Games, a USOC medical staff member filled out an evaluation of Nassar.
The evaluation gave Nassar high scores on aclinical acumena and arespects athletes and involves
them in clinical decision-making,a and also noted as a strength that Nassar was avery dedicated to
his female athletes.a Nassar received an aunsatisfactory scorea on afunctions as a team player,a
however, and the evaluation noted that he adoes not appear to trust other medical providers to work
with his athletes.a Nassar received an overall score of 41 out of 70, and the evaluation concluded
that the USOC should not consider Nassar for another Games appointment.348 xi
B.

Reporting to USA Gymnastics

On June 17, 2015, Sarah Jantzi, a gymnastics coach with Twin City Twisters, notified
USAGas then-Senior Vice-President Rhonda Faehn by phone that Nassar had made one of her
gymnasts (aAthlete 1a) feel uncomfortable.349 Athlete 1, who was a minor at the time, had gone
to see Nassar for an injury. After Ms. Jantzi overheard Athlete 1 explaining her discomfort with
Nassar to another gymnast and inquired about her concerns, Athlete 1 told Ms. Jantzi that she had
gone to see Nassar for a knee injury.350 She explained that he had massaged her groin area atoo
closea to her vagina and had sent her a private Facebook message telling her that she looked
beautiful in her prom dress.351 Ms. Jantzi also provided Ms. Faehn with the names of two other
gymnasts (aAthlete 2a and aAthlete 3a) who may have experienced athe uncomfortable factora
with Nassar. 352 Ms. Faehn immediately relayed this information to Mr. Penny, then-CEO of

x
Every member of the USAG Womenas National Team at the Olympic Games in London has since identified as a
survivor.
xi
The USOC also prepared a review of Nassaras treatment of athletes at the Colorado Springs Olympic Training Center
in 2005. The review stated in part: aRelates well with young athletes. . . . Always willing to take time to work with
athletesa personalities. . . . Strengths: Osteopathic/manual medicine hands-on skill sets.a USOC-R&G-00071500.

58

USAG, who stated that he would handle the matter and notify the proper authorities.353 xii By
aproper authorities,a Ms. Faehn understood Mr. Penny to be referring to law enforcement. 354
Mr. Penny subsequently spoke directly with Ms. Jantzi to confirm the report. Ms. Jantzi, after
conveying the allegations to Mr. Penny, asked him if she needed to report the matter to aany other
authorities.a355 Mr. Penny responded that ahe would handle it.a356 Neither Mr. Penny nor anyone
else acting on behalf of USAG notified law enforcement or child protective authorities of the
athlete concerns at that time.357
Mr. Penny then contacted USAGas legal counsel, Scott Himsel of Faegre Baker Daniels
LLP (aFaegrea).358 xiii While USAG has asserted a claim of attorney-client privilege with regard
to the substance of Mr. Pennyas conversations with counsel,359 the outcome of their conversations
in June 2015 is evident: the decision was made to hire a private investigator to interview the
athletes who had expressed concerns about Nassaras conduct and to assess whether a report should

xii

While Mr. Penny acknowledged receiving a call from Ms. Faehn regarding the concerns of one or more athletes, he
recalled that the conversation awas very general.a Penny Interview. Mr. Penny recalled that Ms. Faehn relayed that
Athlete 1 felt uncomfortable after receiving a private social media message from Nassar. He also recalled learning
from Ms. Faehn that Athlete 1 had concerns regarding Nassaras medical treatments; he did not recall Ms. Faehn
providing him with any detail about the nature of the medical treatments or identifying any other athletes who felt
uncomfortable. Penny Interview. Nor did he recall telling Ms. Faehn he was going to make a report to the proper
authorities: aThat never came up because no one was describing [what happened] as molestation or abuse.a Penny
Interview. Ms. Faehnas recollection is corroborated by the contemporaneous notes she took during her call with Ms.
Jantzi. Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety,
Insurance and Data Security (June 5, 2018), Ex. A. The statement she submitted to Congress on June 5, 2018 is in
accord. Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety,
Insurance and Data Security (June 5, 2018).
xiii
The Independent Investigators requested interviews with Mr. Himsel and his colleague, Daniel Connolly, through
their counsel. Counsel declined on behalf of their clients, citing, among other reasons, a concern that Faegreas
arepresentation of USAG cannot be fairly assessed or describeda absent a waiver of attorney-client privilege by USAG
that would allow Messrs. Himsel and Connolly to discuss awhat advice [the firm] may have given USAG, what
information was available (or not available) to the firm at the time it gave that advice, or the extent to which USAG
may have heeded the firmas advice (or not).a Letter from Margaret Keeley to the Independent Investigators (Nov. 26,
2018). Although USAG, through counsel, agreed to make certain accomodations in response to other concerns raised
by Messrs. Himsel and Connolly, it did not agree to a waiver of the attorney-client privilege, and Messrs. Himsel and
Connolly, through counsel, declined to answer any questions on any topic, including on the subject of non-privileged
communications with Nassar and his counsel, or otherwise to participate in the Independent Investigation. Letter
from the Independent Investigators to Margaret Keeley (Nov. 20, 2018); Letter from Margaret Keeley to the
Independent Investigators (Nov. 26, 2018).

59

be made to law enforcement. The next day, Mr. Penny contacted Athlete 1as mother and informed
her that he was aware of the concerns that Athlete 1 had raised about Nassar and that the matter
would be handled by USAG.360 Mr. Penny emphasized the need for privacy.361 On July 3, 2015,
USAG retained Fran Sepler, a workplace investigator with experience interviewing survivors of
sexual abuse. She had no prior relationship with USAG.362
Although Mr. Penny participated in a previously scheduled USAG Board meeting on June
28, 2015 in Greensboro, North Carolina, he did not report either the athlete concerns or the
retention of Ms. Sepler to the full board. 363 Instead, following the board meeting, Mr. Penny
privately confided in a small group of board members: Board Chair Peter Vidmar, Vice-Chair Paul
Parilla and Director Dr. Jay Binder.364 xiv He informed them that a minor female athlete had raised
concerns about Nassaras conduct during medical treatments and that USAG, on advice of counsel,
had hired a female investigator to speak with the athlete and her parents to better understand the
nature of her discomfort. 365 Although Mr. Parilla and Mr. Vidmar had differing recollections
regarding the level of detail that Mr. Penny provided about the athleteas concerns, Mr. Vidmar
recalls being advised by Mr. Penny that a gymnast on the womenas team had expressed concern
about Nassaras conduct. 366

Mr. Vidmar understood from Mr. Pennyas description of the

allegations that Nassaras treatments had made the gymnast afeel funny.a Specifically, the athlete
had sought treatment from Nassar for a knee injury, but Nassar had manipulated her close to her
groin area and made her feel uncomfortable. 367 Mr. Vidmar also recalled that the allegations
amade [his] blood curl,a and that he told the assembled group, in words or substance, that Nassar
awill never touch one of our athletes ever again.a368

xiv

Although Dr. Binder initially expressed a willingness to participate in the Independent Investigation, he thereafter
failed to respond to repeated requests to schedule an interview.

60

Following discussion, the group decided there was insufficient information to determine
whether the reports concerned sexual abuse or an uncomfortable medical procedure, and concluded
that further investigation was needed.369 Mr. Penny, Mr. Vidmar, Mr. Parilla and Dr. Binder also
addressed in that initial meeting the need to protect athletes in the interim and agreed that Nassar
should not be allowed to have any involvement with USAG events or athletes during the pendency
of the investigation.370 However, as discussed in Part III.G.2, no action was taken to effect this
decision until several weeks later, and then without benefit of measures to ensure effective
implementation.
On June 30, 2015, 13 days after the initial report of athlete concerns, USAG received an
additional report regarding potential misconduct by Nassar.371 Specifically, Ms. Jantzi informed
Ms. Faehn that she had learned from Athlete 1 that another elite gymnast (aAthlete 4a) had stated
that Nassar had amassaged her oddly as well.a372 Athlete 4 was a minor at the time. According to
Ms. Faehn, she promptly relayed this information on July 1 to Mr. Penny, who stated that he would
contact Athlete 4as parents and areport this as well.a373 There is no independent corroboration that
Mr. Penny provided Athlete 4as name to the FBI; and the FBI declined to provide any information
to the Independent Investigators concerning this or any other matter.374
In late June or early July 2015, Mr. Penny and Ms. Faehn went to see Kathy Kelly, the
former Vice-President of the Womenas Program, regarding Nassar. 375 Mr. Penny informed
Ms. Kelly that a gymnast had expressed discomfort with Nassaras treatments and inquired whether
Ms. Kelly had ever heard similar complaints about Nassar. When Ms. Kelly replied that she had
not, Mr. Penny asked her whether she thought Nassar was capable of sexual abuse.376 Ms. Kelly
answered that she did not, although she cautioned that her personal opinion was irrelevant.377

61

1.

Fran Sepleras Investigation

Ms. Sepleras investigation took place over the course of several weeks, commencing in
early July, and included interviews with three athletes: Athlete 1, Athlete 3 and Athlete 5. USAG
facilitated the scheduling of each interview, and at least some of the athletes were informed in
advance that Ms. Sepler was a private investigator acting on behalf of USAG.378 At the conclusion
of each interview, Ms. Sepler provided a report to USAG.379 Although there is no evidence that
Ms. Sepler provided written reports or memoranda of the interviews to USAG, the substance of
the interviews and Ms. Sepleras conclusions are separately memorialized in contemporaneous
internal USAG memoranda and communications.380 xv
On July 3, 2015, the same day USAG formally retained Ms. Sepler, Mr. Penny put
Athlete 1as mother in touch with Ms. Sepler via email to arrange a meeting among Ms. Sepler,
Athlete 1 and Athlete 1as mother.381 On July 11, 2015, Ms. Sepler interviewed Athlete 1, who was
then a member of the National Team and a minor.382 According to an internal memorandum
prepared by USAG, Athlete 1as interview was consistent with the information that previously had
been relayed to USA Gymnastics.383 Specifically, Athlete 1 reported her discomfort with Nassaras
treatments and identified other athletes who had experienced similar discomfort with Nassaras
procedures.384
On the same day that Athlete 1 was interviewed by Ms. Sepler a July 11, 2015 a Mr. Penny
sent himself what he later described as a astream of consciousnessa email to memorialize athings
that were on [his] mind.a385 Although Mr. Penny wrote aContact the FBIa in his email-to-self,386
USAG did not contact the FBI until the close of Ms. Sepleras investigation two weeks later.387 xvi

xv

Mr. Penny stated to the Independent Investigators that USAG did not receive written reports of the interviews,
Penny Interview, and no such records were produced by USAG to the Independent Investigation.
xvi
Mr. Penny has since stated that he does not recall the context for this email or what he was thinking when he wrote
aContact the FBI.a Penny Interview.

62

Mr. Penny also stated in his same email-to-self on July 11, 2015, that a[w]e have been advised by
our attorneys that it is in everyoneas best interest for Larry Nasser [sic] to not be given any
assignment with USA Gymnastics.a388 An additional ten days elapsed before USAG directed
Nassar not to contact any gymnasts and not to participate in any USAG events.389 xvii
Even after being given a no-contact directive by USAG, Nassar continued to contact
gymnasts by text message. Upon learning on August 20, 2015, that Nassar had almost immediately
ignored the directive by sending a text message to Athlete 3,390 USAG did not confront Nassar or
his counsel with the violation of the no-contact directive. Instead, five days later, without any
specific reference to the text message to Athlete 3, Mr. Himsel generally reminded counsel to
Nassar of the instruction.391 Specifically, Mr. Himsel stated: aAs I mentioned in response to your
question when we spoke, Dr. Nassar can best help expedite the review by refraining from being in
contact with USAG personnel and athletes while it is on-going. And we continue to ask that he
refrain from any such contacts.a392
Nor did USAG inform employees that Nassar had been told not to contact gymnasts,
thereby disabling USAG as an organization from monitoring Nassaras compliance with the nocontact directive. Mr. Penny instead expressly limited the number of individuals who were
informed of the allegations regarding Nassar and shared with them only certain details, as he
deemed necessary. These individuals included Renee Jamison, then-Executive Office Manager
and Mr. Pennyas personal assistant; Ron Galimore, then-Chief Operating Officer; and
Ms. Faehn.393 Ms. Faehn was necessarily in the circle of knowledge by virtue of being the first

xvii
Ms. Sepler has stated that she insisted, as a condition of her acceptance of the investigator role, that Nassar be
directed to have no contact with athletes during the pendency of her review. Letter from Fran Sepler to the Independent
Investigators (Sept. 5, 2018), on file with the Independent Investigators. We were not able to identify any
corroboration for this account. USAG did not issue such a directive to Nassar until two days prior to the close of Ms.
Sepleras investigation.

63

point of contact within USAG for the athlete concerns.394 xviii Mr. Penny instructed each of these
individuals, as well as Mr. Parilla, Mr. Vidmar and Dr. Binder, anot to have any conversations
with anyone concerning this issue.a395 Mr. Pennyas insistence on maintaining the confidentiality
of the Nassar matter extended beyond USAG employees and directors. He also instructed
Ms. Jantzi, as well as the athletes being interviewed and their parents, to refrain from speaking
with anyone else about the complaints regarding Nassaras conduct.396 Ms. Faehn recalled that, in
the course of reporting Athlete 4as concerns, Ms. Jantzi told her that ashe knew she wasnat
supposed to talk about Larry.a397
Following Ms. Sepleras interview of Athlete 1, she concluded that the information
provided awas inconclusive as to whether abuse or misconduct had occurred,a and that an
interview with at least one additional athlete was warranted.398 After evaluating Ms. Sepleras
report of her interview with Athlete 1, and her recommendation to interview at least one additional
athlete, USAG determined that Ms. Sepler should continue with her investigation and interview
Athletes 2 and 3, whom Ms. Jantzi had described during her initial call with Ms. Faehn as
potentially sharing a feeling of discomfort with respect to Nassaras conduct.399 Both of these
athletes were adults at the time, and Mr. Penny requested that Ms. Faehn reach out to them directly
to arrange the interviews without adisclosing the nature of the conversation, other than that it is
private or confidential.a400 Mr. Penny stated: aOur preference is for them to meet privately with

xviii

On December 7, 2018, Leslie King, Vice President of Communications for USAG, reported to the Independent
Investigation through counsel for USAG that a after reflecting on her October 18, 2018 interview with the Independent
Investigators, during which she reported no recollection of being aware of the Nassar allegations in 2015 a she now
recalls that she was advised by Ms. Jamison in alate Fall 2015 that Nassar had been reported to the FBI.a Email from
Christopher Schneider, counsel to USAG, to the Independent Investigators (Dec. 7, 2018), on file with the Independent
Investigators. Consistent with her present recollection, on September 28, 2015, upon Nassaras retirement from USAG,
Ms. King sent an email to Mr. Penny, Ms. Jamison and Mr. Galimore in which she commented, aTypically we would
post something when an individual retires after years of service, which I am guessing we do not want to do.a
USAG_HR_O00006085. Ms. King further stated through counsel that she did not learn the identity of the athletes
who made the allegations against Nassar until 2017. Email from Christopher Schneider, counsel to USAG, to the
Independent Investigators (December 7, 2018), on file with the Independent Investigators.

64

the interviewer and not involve their coach or their parents. If they had to involve someone, the
preference would be their parents.a401 Ms. Faehn objected to Mr. Pennyas request, stating that
parents or coaches should be involved given the seriousness of the matter, and declined to facilitate
the interviews.402 While expressing his irritation with Ms. Faehn for her refusal to facilitate the
interviews as requested, Mr. Penny agreed that Ms. Faehn would not have to arrange the interviews
herself and agreed that the athletesa parents could be involved.403
Notwithstanding a contemporaneous statement by Mr. Penny that a[t]he reason we are
doing this is entirely to determine if this has occurred with multiple athletes,a so that USAG can
atake action with a higher degree of resolve and evidence,a404 there is no available evidence that
Athlete 2 a who has since publicly identified as a survivor of Nassaras abuse a was ever contacted
by Ms. Sepler for an interview. Nor does there appear to have been any effort to schedule an
interview for Ms. Sepler with Athlete 4, whose concerns Ms. Jantzi had separately relayed to
USAG almost two weeks earlier.
Mr. Penny arranged for Ms. Sepler to conduct a second interview, with Athlete 3, on July
17, 2015.405 According to USAGas internal memorandum summarizing the interview, Athlete 3
reported that, while she had not experienced many treatments with Nassar, she was familiar with
the procedure.406 Athlete 3 identified another athlete whom she understood had experienced even
more unpleasant treatments with Nassar.407 Ms. Sepler reported to the Independent Investigation
in a written statement that Athlete 3 recommended to her that she contact this other athlete,
Athlete 5.408
The day after her interview, Athlete 3 contacted Ms. Faehn by phone to provide additional
details that she had not provided to Ms. Sepler. 409 Specifically, she informed Ms. Faehn that
Nassar had aactually penetrateda410 Athlete 5 with his fingers during a treatment at the World

65

Championships in Japan in 2011,411 and that the treatment took place in his hotel room with no
one else present.412 Ms. Faehn immediately reported this information to Mr. Penny and, at his
request, confirmed with Athlete 3 that Athlete 5 would be willing to speak about her experience
with Nassar.413 Mr. Penny then arranged an interview with Athlete 5 for Ms. Sepler the following
week.414 USAG did not commence any review at that time to understand how Nassar had been
able to treat athletes alone, in a hotel room, at a World Championship event.415 Nor did Mr. Penny
contact law enforcement or child protection authorities based upon the additional information
provided by Athlete 3.416
Shortly after her conversation with Ms. Faehn, Athlete 3 received a text message from
Ms. Sepler stating: aI appreciate your interest and concern in this matter a| but please remember
that there are risks in sharing information at this point. There is a process in place and staying
clear of the process will protect you and others.a417 Athlete 3 has stated publicly that she construed
the message from Ms. Sepler as an attempt to silence her.418 Ms. Sepler has denied that this was
her intent, stating that USAG had informed her that Athlete 3 wanted to initiate her own inquiry
with other athletes and that her text message was intended to athank[ ] [Athlete 3] for her interest,a
while explaining athat the investigative process was underway.a419 The Independent Investigation
has been unable to confirm from any source that Ms. Sepler was so advised by USAG, and
Ms. Sepler declined to be interviewed or otherwise to participate in the Independent Investigation
beyond submission of a written statement.420
Ms. Sepler interviewed Athlete 5 on July 23 or 24, 2015.421 As reflected in an internal
USAG memorandum summarizing the interview, Athlete 5 reported that she was aware of general
treatment techniques in the pelvic floor, but that the treatments she had received from Nassar were
different and more aggressive, and included digital penetration.422 In addition, Athlete 5 reported

66

no therapeutic effect, and instead reported that Nassar might be getting sexual gratification from
the procedure. Athlete 5 also stated to Ms. Sepler that Nassar had provided special attention and
gifts to her.423 Ms. Sepler concluded that Athlete 5 presented an unambiguous claim of sexual
abuse and recommended that USAG immediately notify law enforcement.424
USAG agreed to implement Ms. Sepleras recommendation and decided to notify law
enforcement on the next business day a Monday, July 27, 2015. Because Nassaras actions were
not confined to a single jurisdiction and USAG is affiliated with a federally chartered corporation
(the USOC), USAG determined that the report should be made to the FBI rather than to a local
law enforcement agency.425 USAG contacted the FBI on July 27, 2015; a meeting was convened
at the FBIas offices in Indianapolis on the following day, Tuesday, July 28, 2015.426 There is no
available evidence of any report to child protection authorities.
C.

Reporting to the United States Olympic Committee

On July 25, 2015, after USAG had already decided to report the matter to the FBI,
Mr. Penny notified the USOC about the allegations against Nassar. According to a
contemporaneous email from Mr. Ashley to Mr. Blackmun, Mr. Penny spoke with Mr. Ashley
early in the morning on Saturday, July 25, 2015, to inform him of certain information concerning
sexual misconduct and to request that he arrange a conference call with Mr. Blackmun for later
that day so the three of them could discuss the matter.427 Mr. Ashley then sent Mr. Blackmun an
email telling him that he had a along calla with Mr. Penny aregarding a safe sport issue he is
pursuing.a428 Mr. Ashley explained that Mr. Penny ais pretty distraught and is looking for some
helpa and would like to aget on the phone with the two of us to talk through his challenges and get

67

advice.a429 xix Due to scheduling issues, the conference call with Mr. Ashley did not take place;430
instead, Mr. Penny spoke directly with Mr. Blackmun later the same day.431
On their call, Mr. Penny informed Mr. Blackmun that national team athletes had expressed
discomfort with medical treatments they had received from USAGas national team doctor. 432
Mr. Blackmun did not inquire about the identity of the team doctor or the national team athletes,
and neither Mr. Penny nor Mr. Blackmun recalls either Nassar or the athletes being identified by
name during the call.433 xx According to Mr. Blackmun, Mr. Penny explained that USAG had
ahired someone on the outside to take a looka at the concerns and that the investigator had
conducted interviews with multiple athletes, at least one of whom described conduct that the
investigator considered to be sexual abuse.434 Mr. Penny further explained that the treatments
included vaginal penetration and that the doctor had provided videos and other materials to support
the notion that the treatments had a medical purpose, but that USAG could not conclude that the
treatments were legitimate and had made the decision to report the doctor to the FBI on the next
business day.435
Mr. Blackmun stated during his interview with the Independent Investigators that he told
Mr. Penny that he assumed USAG had taken steps to prevent Nassar from continuing to have
access to gymnasts, and that Mr. Penny had confirmed that Nassar would not treat anyone at USAG
going forward.436 However, Mr. Penny reported during his interview that the topic of whether
Nassar had continuing access to gymnasts was not a part of his conversation with Mr. Blackmun.437
Both agree that Mr. Blackmun concurred with USAGas decision to refer the matter to law

xix
During his interview with the Independent Investigators, Mr. Penny stated that he did not have a specific
recollection of the call with Mr. Ashley, although he acknowledged that such a call may have taken place.
xx
During his interview with the Independent Investigators, Mr. Blackmun stated that the name aNassara would not
have meant anything to him at the time of his conversation with Mr. Penny, and that his response would have remained
unchanged no matter who the athletes were. Blackmun Interview.

68

enforcement.438 Mr. Blackmun made clear during his interview that he immediately recognized
the seriousness of the matter because the concerns involved aa longstanding highly ranked USAG
official,a which, in Mr. Blackmunas mind, constituted a adifferent level of abuse.a

439

Mr. Blackmun went on to distinguish these allegations from other sexual abuse cases due to the
involvement of an ainsider,a as opposed to an individual aoutside of our control,a which amade
this one especially sensitive.a440
Mr. Penny asked Mr. Blackmun if Rick Adams, Chief of Sport Operations and Paralympics
for the USOC, could come to Indianapolis and assist USAG in its reporting of the matter given
Mr. Adamsa experience as a former detective and his role as the USOC liaison to NGBs. 441
Mr. Blackmun told Mr. Penny that he would get back to him,442 and later informed him that the
USOC did not feel it was appropriate for Rick Adams to participate or for the USOC otherwise to
get involved in USAGas report to law enforcement.xxi
While Mr. Ashley acknowledged knowing that USAG planned to refer the matter to law
enforcement and understood that the allegations related to a SafeSport issue involving a aminora
and an aadult,a 443 neither Mr. Blackmun nor Mr. Ashley disclosed either the sexual abuse
allegations or the USAG referral to law enforcement to any other person at the USOC. 444 xxii

xxi

Mr. Blackmun did not recall Mr. Pennyas request to involve Mr. Adams at this or any other juncture. Blackmun
Interview. However, Mr. Pennyas recollection is consistent with other evidence. First, in a contemporaneous email
following his own conversation with Mr. Penny, Mr. Ashley stated that Mr. Penny was alooking for some help.a
USOC-R&G-00022689. Second, and more directly, Mr. Adams recalled speaking with Mr. Blackmun about Mr.
Pennyas request that he assist USAG with a SafeSport issue sometime in the summer of 2015. Adams Interview. Mr.
Adams believed that Mr. Penny wanted him to go to Indianapolis and accompany him in discussions with law
enforcement or other parties in light of his law enforcement and legal background. Adams Interview. However, Mr.
Adams did not recall receiving any further detail about the matter, and did not know that it was related to athlete
concerns about medical treatments by the team doctor. Adams Interview. Mr. Adams stated that the decision
regarding whether or not he should go to Indianapolis would have been driven by factors such as whether law
enforcement had been notified, whether legal counsel was involved, and whether the NGB had followed its own stated
processes. Adams Interview. It was ultimately decided a either by Mr. Blackmun or by Mr. Blackmun in conjunction
with Mr. Adams a that Mr. Adams and the USOC would not participate. Penny Interview; Adams Interview.
xxii
In the email exchange between Mr. Ashley and Mr. Blackmun on July 25, 2015 setting up the phone call with Mr.
Penny, Mr. Ashley wrote: aLet me know how I can help keep this moving.a USOC-RG-00022689. Both Mr.
Blackmun and Mr. Ashley recall having a conversation with each other concerning the matter. Mr. Blackmun stated

69

Mr. Blackmun stated to the Independent Investigators, without having any direct recollection, that
he believed he would have shared the athlete allegations and the referral to law enforcement with
Larry Probst, Chair of the USOC Board of Directors, on one of their regularly-scheduled weekly
calls. 445 However, there is no evidence of such a communication and Mr. Probst has no
recollection of being apprised of the allegations or the referral in the summer of 2015.446 He
instead recalls first learning of the matter when the Indianapolis Star broke the story over a year
later, in September 2016.447
On September 8, 2015, Mr. Penny sent an email to Mr. Blackmun and Mr. Ashley, with
the subject aFYI a Larry Nassar,a which identified Larry Nassar by name in writing to the USOC
for the first time. Specifically, Mr. Penny said aJust a quick follow-up notea that aLarry Nassar
announced his retirement from USA Gymnastics this past weekend.a448 Although Mr. Penny,
through counsel, had by then advised Nassar of the athlete complaints, he went on to say that he
was anot too sure what prompted this, however, it could have been a number of thingsa and
promised to keep Mr. Blackmun and Mr. Ashley aposted as [he] learn[ed] more.a 449 Neither
Mr. Blackmun nor Mr. Ashley responded directly by email to Mr. Penny or forwarded the email
to any other individual at the USOC, including any board members.450 xxiii
Mr. Blackmun did not have a clear recollection of this email, but acknowledged that he
was asurea he would have understood the Larry Nassar referenced in Mr. Pennyas follow-up email

during his interview that he understood that Mr. Ashley had heard the facts directly from Mr. Penny. Mr. Blackmun
recalled that he and Mr. Ashley had the same reaction a this case was especially tragic because athis guy was a trusted
advisor, someone whom USAG had empowered to be a leader of the organization.a Blackmun Interview.
Mr. Blackmun observed that he knew Mr. Ashley well enough to know how sick the story made Mr. Ashley feel.
Blackmun Interview. During Mr. Ashleyas interview, he reported having only a ageneral recollectiona that he may
have talked with Mr. Blackmun in the week after the call with Mr. Penny and stated that he believed the conversation
with Mr. Blackmun was agenerala in nature. Ashley Interview.
xxiii
Two days later, on September 10, 2015, Mr. Penny notified FBI Agents Abbott and Langeman that aearlier this
week we received a notice from Dr. Nassar that he was aretiringa from his involvement with USA Gymnastics.a
USAG_00036569.

70

to be the National Team doctor alleged to have engaged in sexual misconduct.451 Mr. Ashley, by
contrast, stated to the Independent Investigators that he had no recollection of the email and that
he would not have concluded that the follow-up note to him and Mr. Blackmun related back to the
conversations that took place with Mr. Penny on July 25, 2015. xxiv Mr. Blackmun explained
during his interview, which spanned two days in July and August 2018, that, likely prompted by
the email about Nassaras retirement, he convened a meeting with a small group of individuals at
the USOC in or about September 2015 ato talk about making sure we do the right follow-up on
our side.a452 Although he subsequently acknowledged through counsel that he was mistaken in
his recollection that he had initiated such an internal review,453 Mr. Blackmun explained in detail
during his interview with the Independent Investigators that he had called the meeting because he
awanted to make sure that we were doing everything that we should be doing in response and that
our response was appropriate.a454 Mr. Blackmun was certain that the meeting included Mr. Adams
and in-house counsel, either Gary Johansen or Chris McCleary, and likely Mr. McCleary. 455
Mr. Blackmun mentioned that it was possible that Malia Arrington, then-Director of Ethics and
SafeSport, attended the meeting as well.456 Mr. Blackmun further reported that Mr. Adams was
going to take charge following the meeting to amake sure [the USOC] was doing everything that
[it] should be doing.a457 Mr. Blackmun reiterated that the purpose of the meeting was to make
sure they were adoing the right thing,a458 and that his point of view going into the meeting was
that the USOC needed to make sure the Nassar concerns did in fact get reported to law enforcement
and that the USOC was doing everything it was asupposed to be doing.a459 He stated specifically:

xxiv

During his interview with the Independent Investigators, Mr. Ashley stated that he did not recall the content of his
along calla with Mr. Penny on July 25, 2015, apart from the call relating to sexual abuse allegations involving an
aadulta and a aminor.a Ashley Interview. When he reviewed the September 8, 2015 email from Mr. Penny, Mr.
Ashley observed that Mr. Penny did not usually raise matters of personnel retiring from USAG with him, but that Mr.
Penny may have sent this email because Nassar was such an important figure at USAG. Ashley Interview.

71

aThat was my point of view: what else should we be doing, if anything, and have we been able to
confirm that USAG did in fact report this? That was it.a460 Regarding confirmation of what
exactly USAG was doing to ensure that no athletes would be treated by Nassar going forward,
Mr. Blackmun stated, aI donat remember myself thinking through that, but I would have expected
our SafeSport team to do that.a461
Notwithstanding Mr. Blackmunas detailed recounting of the effort he put in motion at the
USOC to follow up and take appropriate steps in response to the allegations of child sexual abuse,
there is no evidence that either Mr. Blackmun or Mr. Ashley initiated any USOC internal review
of the Nassar matter in the summer or fall of 2015, or at any time prior to the public exposure of
Nassaras crimes in September 2016. After the Independent Investigators notified Mr. Blackmun,
through counsel, of the lack of corroborating evidence for the internal review and asked for an
explanation, Mr. Blackmun informed the Independent Investigators, through counsel, that he was
mistaken in his recollection about having undertaken such an effort. The USOC did not, in fact,
take any steps after receiving notice of the allegations from Mr. Penny to assess whether Nassar
had treated athletes at USOC facilities or while on the medical staff at the Olympic Games or other
USOC events.462 Nor did the USOC undertake any follow up to ensure the safety of athletes, such
as confirming that USAG had in fact referred the allegations of abuse to law enforcement or that
USAG had implemented effective measures to prevent Nassar from having any further contact
with athletes. Similarly, the organization did not take any steps to ensure that Nassar would be
denied access to athletes at USOC training facilities or at USOC-sponsored events.463 Nor did it
make any independent report to any child protection authority.464 At no point did Mr. Blackmun
or Mr. Ashley provide USOC personnel, including those with relevant expertise in SafeSport
matters, with any of the information from Mr. Penny regarding the alleged sexual misconduct or

72

the referral to law enforcement. By way of example, Malia Arrington, then USOCas Director of
Ethics and SafeSport, did not learn of the sexual misconduct allegations, or more specifically that
a USAG team doctor was alleged to have sexually abused one or more athletes, until the allegations
were made public in the Indianapolis Star approximately one year later.465 Nor did Mr. Blackmun
notify the USOCas Board of Directors, notwithstanding that SafeSport issues were a continuing
subject of discussion at board meetings during this time.466 According to witness interviews,
USOC board members remained unaware of the allegations and the potential ongoing threat to
athletes until the Indianapolis Star published its account of Nassaras abuse in September 2016.467
Although neither Mr. Blackmun nor Mr. Ashley initiated a conversation with anyone else
at the USOC about the allegations, Mr. Penny separately, and without consultation with either
Mr. Blackmun or Mr. Ashley, reached out in September 2015 to another senior officer of the
USOC. Specifically, on September 24, 2015, several weeks after USAG had reported Nassar to
the FBI, Mr. Penny contacted Larry Buendorf, then the Chief Security Officer at the USOC, and
arranged to meet with him while they both were attending the U.S. Olympic and Paralympic
Assembly in Colorado Springs.468 The email correspondence between the two reflects that the
meeting being scheduled pertained to athe FBI issue.a469 When they met, Mr. Penny informed
Mr. Buendorf that USAG had a situation with a doctor who was using a questionable medical
technique and that the FBI was investigating him. 470 Mr. Buendorf did not have any prior
knowledge of the matter or the fact that it had previously been reported to Mr. Blackmun and
Mr. Ashley.471 Mr. Penny requested that Mr. Buendorf a who had worked for the Secret Service
for close to 23 years before joining the USOC a use his law enforcement connections to find out
the status of the investigation.472 Mr. Buendorf agreed.473 Over the next two days, Mr. Penny
forwarded Mr. Buendorf several documents with additional information about USAGas

73

investigation and the report to law enforcement.474 These documents identified Nassar and the
athletes who had spoken with the investigator by name, and they included a link to Nassaras
Dropbox account. 475 Mr. Buendorf did not send a reply email to any of these emails from
Mr. Penny.
As memorialized in Mr. Buendorfas contemporaneous notes, he promptly went to see
Mr. Blackmun about the matter that Mr. Penny had brought to his attention. Specifically, in a
personal appointment book that he maintained, Mr. Buendorf included the following entry in
handwritten notes for September 28, 2015: ameet with Scott re: Steve Penny & Doctor
technique.a476 On that day, Mr. Buendorf went to Mr. Blackmunas office, informed him of his
conversation with Mr. Penny, and explained that the FBI was conducting an investigation
regarding a doctoras technique.477 Mr. Buendorf did not identify Nassar or any of the athletes by
name during his brief conversation with Mr. Blackmun, and he did not refer to the emails he had
received from Mr. Penny.478 Mr. Blackmun did not ask for the identity of the doctor or pose any
other questions and responded that he was already aware of the situation.479 The conversation
ended there. xxv Mr. Buendorf did not have any further discussions about the matter with
Mr. Blackmun or anyone else at the USOC.480 xxvi
In short, as of September 8, 2015, Mr. Blackmun and Mr. Ashley had been informed by
Mr. Penny of the sexual abuse allegations and the referral to law enforcement, and both had
received the September 8, 2015 email regarding Nassaras retirement, which Mr. Blackmun
acknowledged he would have connected at the time to the July 25, 2015 report of sexual
xxv

Mr. Blackmun reported no recollection of this meeting with Mr. Buendorf. Blackmun Interview.
On October 2, 2015, Mr. Buendorf informed Mr. Penny that he had connected with the FBI in Colorado Springs
and that agents there had arecommended you remain in contact with your bureau contact,a referring to agents in the
Indianapolis office. USAG_01207301. No information with regard to the status or substance of the investigation was
provided to Mr. Buendorf by the Colorado Springs agents. Buendorf Interview. Mr. Buendorf apologized to Mr.
Penny for not being able to be more helpful, and they did not speak of the matter again. Buendorf Interview;
USAG_01207301.

xxvi

74

misconduct. During the roughly year-long period thereafter, from September 2015 to September
2016, neither Mr. Blackmun nor Mr. Ashley engaged with USAG on the reported concerns, shared
the information with others at the USOC, or took any other action in response to the information
from Mr. Penny to ensure that responsible steps were being taken by USAG and the USOC to
protect athletes:
First, as noted above, there is no evidence that Mr. Blackmun or Mr. Ashley ever told
anyone at the USOC about the information they had learned from Mr. Penny.
Second, after consideration of Mr. Pennyas request for the USOC to get involved and help
with the reporting to law enforcement of Nassaras alleged abuse of national team members,
Mr. Blackmun declined on behalf of the organization.
Third, while Mr. Pennyas September 8, 2015 email to Mr. Blackmun and Mr. Ashley
identifying Nassar by name was recovered from Mr. Pennyas email account at USAG, it was no
longer present, in either Mr. Blackmunas or Mr. Ashleyas email account, at the time searches were
run by counsel to the USOC in the spring of 2018 for production to the Independent
Investigation.xxvii Surrounding emails from the same 2015 time period remain intact in both email
accounts.481 While Mr. Ashley stated in his interview that he had no recollection of ever receiving
or deleting the September 8, 2015 email, Mr. Blackmun acknowledged receiving the email;482 he
also acknowledged deleting it.483 Specifically, having registered its significance, Mr. Blackmun
stated in his interview that he may have purposely deleted the September 8, 2015 email, noting its
sensitivity and explaining that he was concerned about the potential for his email account to be
xxvii

The September 8, 2015 email was produced to the Independent Investigators by USAG on May 10, 2018. After
determining that the email had not been produced by the USOC, the Independent Investigators shared the email with
the USOCas outside counsel and requested confirmation that the email was not in the USOCas possession. Thereafter,
upon receiving confirmation that the email was not in the USOCas possession, the USOCas outside counsel engaged
a third-party computer forensics firm to conduct a review of when and how the email had been deleted from Mr.
Blackmunas and Mr. Ashleyas respective email accounts. A copy of the forensics report, together with the September
8, 2015 email, is appended as Exhibit B.

75

hacked.484 In this regard, he stated that he had been apprised by an IOC official that a Russian
hacking group, Fancy Bear, had infiltrated the IOCas email system.485 According to Mr. Blackmun,
the IOC official cautioned him that the USOCas email system could similarly be vulnerable.486
Mr. Blackmun did not recall when this conversation with the IOC official took place in relation to
his receipt or deletion of the September 8, 2015 email.487 He stated, however, that he was asuper
sensitivea about the potential for hacking and observed that, abecause there was an active
investigation, if the Russians wanted to use [the September 8 email about Larry Nassar,] they
probably could.a 488 Despite extensive forensic recovery efforts led by Stroz Friedberg, an
independent firm with digital forensics expertise, there is no recoverable data to establish the dates
of deletion of the September 8, 2015 email from Mr. Blackmunas and Mr. Ashleyas respective
email accounts. Nor is there any available evidence to establish any temporal relationship or lack
thereof between the deletions and the asserted concern about Russian hacking. Mr. Blackmun has
since stated through counsel that, while he believes he did delete the email ashortly after receiving
it,a he no longer arecall[s] what he was thinking as to a reason for deleting the email.a489
Fourth, while Mr. Blackmun emphasized in his interview that, within weeks of learning of
the athlete concerns, and likely prompted by receipt of the September 8 email, he had initiated an
internal effort at the USOC to alert his SafeSport team to the allegations and to confirm that the
USOC was taking all appropriate steps to respond to the allegations and ensure athlete safety,490
no such conversations were had and no such steps were taken. Counsel to the USOC has confirmed,
following a thorough search at the request of the Independent Investigation, that they found no
documentary support in the form of an email, calendar entry or other record at the USOC that
reflects any internal project or working group or other effort to address the Nassar allegations until
after the Indianapolis Star broke the story about Nassaras abuse in September 2016. Nor do any

76

of the individuals at the USOC with whom Mr. Blackmun recalled conferring, or with whom he
believed he may have conferred, have any recollection of any meeting or discussion about either
the athlete concerns or the need for a thoughtful internal review and response by the USOC.
Mr. Adams, Ms. Arrington and counsel were unequivocal in their recollections that they did not
learn of the allegations against Nassar until they were reported in the media in September 2016.
Fifth, when Mr. Buendorf went to Mr. Blackmunas office to meet with him about the
athlete allegations regarding Nassar that Mr. Penny had recently brought to his attention,
Mr. Blackmun did not engage Mr. Buendorf in discussion or seek his advice on appropriate childprotective measures.491
Sixth, when Susanne Lyons sent an email to Mr. Blackmun in February 2018 expressing
dismay over recent media coverage based on her understanding that Mr. Blackmun had not been
aware that Nassar was the alleged perpetrator until the public disclosures in the Indianapolis Star,
Mr. Blackmun remained silent and left uncorrected her clear misunderstanding.492
D.

Referral to the Federal Bureau of Investigation

USAG contacted the Indianapolis office of the FBI on July 27, 2015 and set up a meeting
for the following day to report the allegations against Nassar. 493 Mr. Penny, Mr. Parilla and
Mr. Himsel, legal counsel to USAG, participated in the meeting.494 Three FBI agents were in
attendance: Jay Abbott, then Special Agent in Charge; Gregory Massa, Assistant Special Agent in
Charge; and Michael Langeman, Supervisory Special Agent.495 The agents were briefed on the
athlete concerns regarding Nassaras treatment techniques and Ms. Sepleras investigation,
particularly with respect to her interview of Athlete 5.496 Mr. Penny provided the FBI with links
to the PowerPoints and videos that Nassar had shared with USAG, a memorandum that USAG had
prepared summarizing the timeline of events, and contact information for Athletes 1, 3 and 5.497

77

Following the meeting, the agents confirmed that the FBI would consult with the United States
Attorneyas Office (aUSAOa) for the Northern District of Indiana on next steps, but would at least
interview Athlete 5.498
On July 29, 2015, after conferring with the U.S. Attorneyas Office, Agent Abbott contacted
Mr. Penny to arrange an interview with Athlete 5.499 Agent Abbott explained, aAt the conclusion
of that interview, the FBI will determine next steps with referral to the Western District of
Michigan and the FBI Detroit Division, if necessary, as per counsel from the USAO here in the
Northern District of Indianaa and awill also provide an update to [USAG] at that time.a 500
Mr. Penny responded later that evening to confirm that he had aspoken with the mother of
Athlete [5] in Southern California and explained the steps we have takena and that a[s]he is going
to speak with her daughter and hopefully get back to me as soon as possible.a501
Mr. Penny notified the FBI once he heard back from Athlete 5as mother, and the agents
reached out to Athlete 5 directly to set up an interview, considering both Indianapolis and
California, where Athlete 5 lived, as potential venues.502 In the interim, Mr. Penny remained in
regular communication with the FBI regarding the scheduling of Athlete 5as interview. For
example, on August 12, 2015, Mr. Penny contacted Agents Abbott, Langeman and Massa to ask
about the FBIas timing with respect to Athlete 5as interview.503 Agent Massa assured Mr. Penny
that the FBI has amade it a priority and will ensure the interview gets scheduled and conducted.a504
On August 27, 2015, Agent Massa emailed Mr. Penny to afollow[ ] up on the interview of
[Athlete 5] in LA.a505 He noted that Agent Langeman ahas attempted on three occasions to set up
the interview,a but Athlete 5 ahas not returned any of his phone calls.a 506 Mr. Penny sought
clarification on whether Agent Langeman had contacted Athlete 5 directly, or had tried to contact
her mother, explaining that he had learned from Athlete 5 that her mother had aeither lost the phone

78

or it was stolen.a507 Mr. Penny then independently contacted Athlete 5as mother by email and
asked Agent Langeman for the opportunity to atake one more shot at trying to get them to Indya
for an interview.508
Thereafter, USAG arranged to fly Athlete 5 and her mother to Indianapolis for an interview
with the FBI. On August 31, 2015, Mr. Penny emailed Agent Langeman, copying Agent Massa,
to inform them that a[w]e are looking at getting [Athlete 5 and her mother] here Thursday night
and flying home Friday evening.a509 However, the following day, September 1, 2015, Agent
Langeman informed Mr. Penny that the FBI would be conducting a phone interview, rather than
an in-person interview, with Athlete 5 based on a discussion with Athlete 5as mother. 510
Specifically, Agent Langeman stated that he had informed Athlete 5as mother that the purpose of
the initial interview was just to aestablish the violation and initiate the investigationa and that
Athlete 5 may need to participate in a amore in depth, perhaps forensic interviewa in the future;
he also explained that the case would be transferred to the Detroit Office of the FBI after the initial
interview because that office had aprosecutorial venuea and would therefore have ainvestigative
purview.a511 Agent Langeman relayed that a[a]fter considering these facts, the inconvenience of
the travel involved, the potential for a more in depth intetview [sic] in the near future and the
comfort level of [Athlete 5], the decision was made to conduct the initial interview
telephonically.a 512

He stated that the interview was atentatively scheduled for tomorrow

afternoon/eveninga and that a[o]nce the interview is conducted and memorialized, the case will be
packaged and sent to the Detroit office who will take full ownership of the case and proceed where
the evidence leads.a513
Concurrently with his efforts to facilitate the FBIas interview of Athlete 5, Mr. Penny sent
the agents numerous emails to set up an interview with Athlete 3. For example, on August 6, 2015,

79

Mr. Penny informed the FBI that Athlete 3 would be available for an interview on August 16,
2015. 514 Several days later, Mr. Penny notified the FBI that Athlete 3 had requested that the
interview be postponed while she prepared for an upcoming competition.515 On August 27, 2015,
Athlete 3as mother emailed Mr. Penny and Ms. Faehn ato touch base . . . about the investigation
and find out what if anything [they] are able to share at this point.a516 She reiterated that Athlete 3
awants to cooperate fullya and requested that the FBI contact Athlete 3 and her family directly if
they need to speak with Athlete 3. 517 Mr. Penny then updated the FBI that Athlete 3 ahas
reconnected and wonders if the FBI would like to speak with her.a518
On September 4, 2015, Mr. Penny sent Agent Abbott an email, in follow up to an earlier
call, to summarize his understanding of the status with regard to setting up an interview with
Athlete 3:
Athlete [3] is located in Boston. We had hoped she would stay
following the Championships for an interview on that Sunday. That
became a distraction to her so we cancelled the Sunday interview so
that she could still focus on the competition. I did not know whether
or not the agents would follow up with her by phone or otherwise,
but she is the athlete that first made us aware of the abuse issue. Her
mother has contacted me several times for updates and I just tell her
I donat have much information. She has informed me that her
daughter has not been contacted by the FBI.519
Mr. Pennyas email also reflected his understanding that the FBI had completed a phone
interview with Athlete 5 earlier that week.

520

Mr. Penny identified another individual

(aAthlete 6a), with whom he thought the FBI might wish to speak.521 Mr. Penny recalled that
Athlete 6 had trained at Twistars since she was young and, according to her mother, had received
medical treatments from Nassar for a long time. 522 Because of these experiences, Mr. Penny
believed that she would be especially familiar with Nassar and that the FBI might want to interview
her.523 In his email to the FBI, Mr. Penny stated:

80

[Athlete 6] is an athlete that has not been involved but was a member
of the team in 2011 in Japan. Athlete [5] reported that when she
went into the hotel room in Tokyo, [Athlete 6] was receiving
treatment and left the room when [Athlete 5] arrived. I do not know
if this was mentioned during the interview conducted by the FBI but
wanted to share it in case it is helpful.524
In response to Mr. Pennyas email, Agent Abbott confirmed that apertinent interviews have
been completed and the results have been provided to the FBI and the USAO in Michigan (Detroit)
for appropriate action if any.a525 Mr. Penny was not directly apprised by the FBI as to which
athlete or athletes the FBI had interviewed in connection with its inquiry, although he believes
there were ano communication[s] with the first athlete whatsoever.a526 According to public reports
by Athlete 3, she was not contacted by either the Indianapolis office of the FBI or the USAO for
the Northern District of Indiana.527
Thereafter, on September 10, 2015, Mr. Penny notified Agents Abbott and Langeman that
aearlier this week we received a notice from Dr. Nassar that he was aretiringa from his involvement
with USA Gymnastics.a528 From all available evidence, there was no discussion at this or any
other time between USAG and the FBI regarding steps to ensure the safety of athletes during the
pendency of the investigation. Specifically, no issues or concerns were addressed by USAG and
the FBI regarding Nassaras retirement or the false representations he made regarding the reasons
for his separation from USAG a all couched in terms of a long and illustrious career and the selfless
desire as aa good mentora to make room for other colleagues.529 As a result, and notwithstanding
that he was under active FBI investigation for multiple credible allegations of sexual abuse of
minor athletes, Nassar was allowed, not merely to control the public narrative of his departure, but
thereby to continue to have access to girls and young women, including at MSU, Twistars and
Holt High School. It was not until the Indianapolis Star publicly reported the allegations against
Nassar, some 14 months later, that the public was made aware of Nassaras abuse.

81

E.

Communications with Nassar

On July 22, 2015, USAG apprised Nassar of the allegations against him in a call from
USAGas outside counsel, Mr. Himsel, and his colleague, Mr. Connolly.530 In advance of that call,
on July 20, 2015, USAG counsel met with several USAG employees a namely, Mr. Penny,
Ms. Jamison, Ms. Faehn and Mr. Galimore.531 xxviii The day after that meeting, Mr. Penny sent
himself what he would later describe as a astream of consciousnessa email setting forth his
thoughts on the contemplated conversation with Nassar.532 His email-to-self included his thoughts
in the form of a list:
Larry
Contact by attorneys
Concerns brought forward about techniques
Massage under their garments
No draping
Groin area
No gloves
Lotion
Concern about this technique with young female athletes
No formal complaint
No formal investigation
Have not contacted law enforcement
Need to sort through this in a respectful and private manner
Distance from USA Gymnastics and the athletes
Not involved in camps or competitions
Set up a meeting to discuss with Larry that involves legal counsel if
desired as soon as possible
Resolve the issue to everyoneas satisfaction so long as nothing
aggregious [sic] has taken place.
Everyoneas interest to cooperate.533
At the time he sent this email to himself a apparently proposing to advise Nassar that there was
ano formal complainta against him and ano formal investigation,a and that the goal was to asort

xxviii

Mr. Galimore reported to the Independent Investigators that he did not recall attending the meeting. He stated
that he was likely at the Pan American Games, which concluded on July 20, 2015, although he acknowledged that he
may have come back to the United States a day or two early. Galimore Interview. At least one other participant
recalled Mr. Galimoreas participation in the meeting. Faehn Interview.

82

through this in a respectful and private mannera and aresolve the issue to everyoneas satisfaction
so long as nothing [egregious] has taken place,a with everyone having an ainterest to cooperatea534
a USAG had engaged Ms. Sepler, who was then actively investigating athlete complaints,535 and
Mr. Penny had been apprised of allegations that Nassar had digitally penetrated at least one athlete
on three separate occasions.536 In considering this approach, Mr. Penny appears to have been
balancing USAGas need to direct Nassar to keep his adistance from USA Gymnastics and the
athletes,a and in particular not to attend the upcoming Secret U.S. Classic competition, with a goal
of keeping Nassar in the fold and maintaining his acooperat[ion].a537
Later that same day, Mr. Penny emailed all of the participants at the July 20, 2015, meeting,
together with Dr. Binder, Mr. Parilla and Mr. Vidmar, to provide a asummary of the points that
will be made tomorrow morning in a phone conversation between USA Gymnastics legal counsel
and the interested party,a referring to Nassar:
i*

aAttorneys are contacting on behalf of my client USA Gymnastics and with the approval
of the Chairman and Vice Chair of USA Gymnasticsa board of directorsA*

i*

USA Gymnastics has been made aware of concerns regarding therapy techniques, and that
athletes are uncomfortable.

i*

These concerns are being reviewed and USA Gymnastics has decided that it is in
everyoneas best interests to not attend the Classic.

i*

At the earliest appropriate point, we wish to contact this medical professional for his
perspective, and during this period we request he not communicate with USA Gymnastics
personnel or athletes.a538
Later that day in the evening, Mr. Penny and Ms. Faehn called Ms. Karolyi to inform her

that Nassar would not be attending the upcoming Secret US Classic competition.539 Mr. Penny
explained that athletes had raised concerns about Nassaras treatment techniques, although he did
not describe the concerns as being of a sexual nature. 540 Ms. Karolyi responded with what
Mr. Penny and Ms. Faehn perceived as surprise, and then sought assurance that a doctor would be

83

on site for the competition.541 xxix When Ms. Karolyi continued to inquire about Nassar at the
competition, Ms. Faehn informed her that Nassar was being investigated.542
On July 22, 2015, Mr. Himsel and his partner Mr. Connolly called Nassar as planned to
inform him that concerns had been raised regarding some of his medical techniques and to request
that he not attend the Secret US Classic.543 Nassar agreed not to attend the competition and stated
that he would send counsel information regarding his medical techniques to help answer any
questions.544 Mr. Himsel then sent Nassar an email summarizing their call, using much of the
language from the email Mr. Penny had sent to selected USAG personnel, board members and
counsel the day before:
As we explained on the call, USA Gymnastics has been made aware
of concerns regarding some of your therapy techniques, and that
athletes are uncomfortable with certain areas of their bodies that are
being treated. These concerns are being reviewed, and USA
Gymnastics has decided that it is in everyoneas best interest that you
not attend the Secret US Classic in Illinois this weekend. As we
mentioned on the phone, I am sure you can appreciate as a medical
professional that in todayas atmosphere, we need to address these
concerns thoroughly and discreetly. We understand from our call
that you will not attend the Secret US Classic this weekend. USAG
will make alternative arrangements.
At the earliest appropriate point, we will contact you with additional
information and to get your perspective.
Let me reiterate that during this period, we respectfully requested
that you not communicate with USA Gymnasticsa personnel or
athletes. We understood that you agreed to this request. We
suggested during the call that Ron Galimore advise the medical team
that you are not attending the Classic for personal reasons. Ron will
now proceed to do so.
You mentioned that you could send me some links regarding your
medical techniques in response to this email. Please feel free to do
so.a545

xxix

Mr. and Ms. Karolyi declined through counsel repeated requests for interviews with the Independent Investigation.
Email from Gary Jewell to the Independent Investigators (Mar. 8, 2018), on file with the Independent Investigators.

84

Nassar responded to Mr. Himselas July 22 email stating that he felt ahorriblea that anyone
felt uncomfortable with his medical treatments and that in his view he acommunicate[s] wella with
athletes to amake sure they are comfortable with [his] treatments since [he is] touching them in
sensitive areas.a546 Nassar also stated that he had anot had any complaints in the past.a547 He
sought to explain that the apelvic floor is an issue with gymnasts since they have stress urinary
incontinencea and that his pelvic floor treatments are a legitimate medical procedure ato enhance
core stability.a548 He also shared with counsel the link to a dropbox containing amany of [his]
videos and power points of these techniques.a549 Mr. Himsel shared the links to Nassaras Dropbox
with Mr. Penny, who then forwarded them to Ms. Faehn.550
Many false statements are embedded in this exchange between counsel to USAG and
Nassar. First, as noted above and reflected in counselas email to Nassar, false explanations were
proposed by USAG a thereafter agreed to by Nassar a for the express purpose of masking the true
reason for Nassaras failure to attend the USAG Classic competition. 551 Second, Nassaras
representation that he always made sure athletes were comfortable with his treatments is belied by
the accounts of numerous survivors that he never explained what he was doing or obtained their
consent.552 Third, Nassaras statement to USAG counsel that there had been no prior complaints
against him was demonstrably false. As of July 2015, Nassar was aware of several separate and
independent complaints against him, including complaints in 2004 and 2014 that led to
investigations involving Nassar. 553 Finally, all of Nassaras representations about the medical
legitimacy of his treatments and how ahorriblea he felt about having unwittingly made athletes
feel uncomfortable were pure lies.
After establishing that Nassar had agreed not to attend the competition, Mr. Himsel
explained to Nassar the details for how Nassaras absence would be presented to the medical

85

team.554 Mr. Himsel informed Nassar that athis evening or tomorrow Ron Galimore will let the
medical team know that you have advised USAG that you will be unable to attend the Classic this
weekend.a555 In response, Nassar inquired, aCan we just say that i am sick? That would make
more sense to everyone. Would that be ok?a556 Mr. Himsel agreed to use the cover story Nassar
suggested, stating, aWeall let Ron know to advise people that you werenat feeling well and decided
to stay home.a557 Nassar thanked him and noted, aThat just makes more sense and honestly since
your phone call i have been feeling sick. This hurts beyond hurt.a558
Shortly thereafter, on July 23, 2015, Nassar emailed Mr. Himsel and Mr. Connolly and
informed them that athe story worksa a he explained that he told Dr. Brooke Lemmen, one of his
colleagues at MSU and a fellow USAG volunteer, that he could not attend the Secret US Classic
because he was anauseated, not feeling well and staying homea and that she believed him.559 xxx
He also apromise[d] to stay with the story and not discuss [it] with anyone as we stated earlier,a
with the exception of his wife.560
Nassaras communications with USAG reflect that Nassar, growing anxious, continued to
rely on defenses that had worked for him in the past. In a long email to USAGas counsel, dated
July 23, 2015, Nassar observed that ait is important to have this completed before P&G
Championships,a and detailed the ways in which the current situation was aextremely difficulta
for him:
i am very disappointed in myself for not being better at explaining
my treatments but I always talk to the athlete and get feedback while
doing these treatments since they are in a sensitive area. I know I
am slowing down, I just want to get through 2016 and be done. I
am tired. 30 years is a long time working at this intensity and in
such a personal sensitive nature with tens of thousands of encounters
with adolescent females. It is one thing to see them in the asterile,
professionala doctoras office with their parent present. It is another
xxx

Whether in response to Nassaras email confirmation or for other reasons, it does not appear that Mr. Galimore ever
sent the contemplated email to the medical team regarding Nassaras non-attendance at the Classic competition.

86

to do the same treatments with no parent present, in a common
lounge room or training room. There are always other people
present and all is done out in the open. Actually, when you think
about it, it is an amazing accomplishment to have gone 29 years on
the national team without a single complaint about my treatments. I
wanted to stop after 2012 but Martha Karolyi decided to go another
4 years. These past few years have been a huge struggle for me and
I wish I had stopped in 2012. I have been training 2 female doctors
to take my place, Dr. Green and Dr. Lemmen. I do not want to place
another male in the same situation I have had to deal with for so long.
I am an osteopathic physician and touching/manipulating people is
my profession. I do not want to become that aold doca that lost his
touch. This has been a wake up call for me to get back on my game
better and to be even more careful and more detailed to my
explanations for all my treatments. It is hard enough explaining
things to adults, let alone children who are miles away from
home/parents.561
This further email from Nassar to USAG counsel elaborated on his earlier false
representations about the legitimacy of his medical treatments and the steps he took to ensure the
comfort of athletes under his care, while also repeating his lie about the absence of any prior
complaints against him. In this email, Nassar also sought overtly to draw upon one of the more
brazen elements of the cover he had built to anormalizea his conduct and hide his crimes:
performing his abusive acts with parents in the room under the guise of legitimate medical
treatment.
Several days later, on July 27, 2015, Nassar followed up with USAG counsel to request a
meeting aas soon as possiblea and to obtain amore specifics of the treatment in questiona so he
could aretrieve any documentation of this encounter with the gymnast.a562 Nassar sent another
email two days later to Mr. Himsel, copying Mr. Connolly, and suggested that they meet the next
morning to awork together to bring a light to the issue at hand.a563 He reiterated that he awould
like to move forward with this since I will need to be at USA P&G Championships in
Indianapolis.a564 In response, Mr. Himsel declined Nassaras request for a meeting, explaining that

87

USAGas review would not be completed before the USA P&G Championships and proposing
another cover story to explain Nassaras non-attendance:
Thanks for the invitation to meet, however we have not yet reached
that point in our review. Previously you had expressed your wish
that this review be concluded before Championships in Indianapolis
(beginning August 13). Unfortunately, the review will not be
concluded by that time. Because the review is on going, USA
Gymnastics has determined that it is in everyoneas best interest that
you not attend USA Gymnastics events or communicate with USA
Gymnastics athletes and personnel until further notice. In addition,
we suggest that prior to Championships that Ron Galimore will once
again advise the medical staff (the Athlete Care Coordinator) that
you cannot attend for personal reasons, unless you prefer a different
approach that we are prepared to discuss.
Please advise whether Ron may do so. Thanks again for the
information you have already provided. We appreciate your
patience and cooperation.565
Before Mr. Himsel sent this response to Nassar, Mr. Penny shared a draft of the email with
Agent Abbott for approval.566 Agent Abbott responded that, agiven the assessment stage of the
FBIas involvement, I do not see any issues with your proposed communication to Dr. Nassar,a but
he copied the FBIas Chief Division Counsel ain case he determines something to the contrary.a567
Agent Abbott also copied Agents Langeman and Massa afor their information and input if
desired.a568 Later that day, Mr. Penny informed Agent Abbott that USAG had received another
email from Nassar and determined that it was important to respond to him ato keep things calm.a569
He further asked whether USAG could proceed with sending Nassar the proposed response if they
had not received any comments from the Chief Division Counsel by 10:00 a.m. the following
morning.570 Agent Abbott responded promptly: aCertainly respond as you deem appropriate,a
noting that he did not know if the Chief Division Counsel would have time to review by then.571
While Mr. Penny was corresponding with the FBI, Nassar wrote back to Mr. Himsel
requesting amore details of what is happening, who has made the complaint, and what the

88

complaint is.a572 On July 30, 2015, Mr. Himsel forwarded this email from Nassar, together with
his embedded email to Nassar proposing an innocuous reason for Nassaras nonattendance at the
P&G Championships, to Mr. Penny, Mr. Parilla and Ms. Jamison. 573 Mr. Penny then, in turn,
forwarded the email string in full to Agent Abbott, copying Mr. Himsel, with a note that read in
part:
As you can see below, we have a very squirmy Dr Nassar. Our
biggest concern is how we contain him from sending shockwaves
through the community. In conversations with Scott [Himsel], we
are trying to make sure that any correspondence with him is
consistent with FBI protocol. Right now we are looking for a
graceful way to end his service in such a manner that he does not
achase the story.a
Without disclosing to him that we have reported our concerns, I am
inclined to want Scott [Himsel] to give him some explanation as to
why we need some distance. We just know we are dealing with a
unique character here.574
Agent Abbott responded the same day and informed Mr. Penny that a[y]ou certainly are able to
advise Dr. Nasser [sic] as you deem appropriate and we in no way want to hinder that or lead you
to believe you must follow an aFBI protocola though the FBI will not confirm or deny any ongoing
investigation OR assessment.a575
Also on July 30, 2015, Nassar sent an email to Mr. Himsel, copying Mr. Connolly,
instructing USAG that a[i]f I am not going to be at Championships, then it is due to financial
reasons with my clinical practice, which is an accurate statement.a576 Mr. Himsel responded that
he understood, and that Mr. Galimore would aproceed accordingly.a 577 Consistent with this
agreement, in an email approved by Mr. Penny,578 Mr. Galimore that day notified Dr. David Kruse,
USAGas Athlete Care Coordinator, that aI was just informed that Larry Nassar is unable to come
to Indianapolis for the P&G Championships. He has to focus on his clinic during this time.a579

89

Over a month later, on September 2, 2015, Nassaras legal counsel, Matthew Borgula of
Springstead Bartish & Borgula Law P.L.L.C., informed Mr. Himsel that Nassar would ano longer
honor [USAGas] request to provide false excuses to his colleagues, the USAG staff and/or the
athletes about his absencesa from USAG events, and intended to acommunicate with members of
the USAG staff and athletes that wish to speak with him.a580 Mr. Borgula noted that he had not
heard from USAG in several weeks despite USAGas prior assurances that athe investigation into
Dr. Nassaras medical techniques would be resolved without unnecessary delaya and requested that
USAG aconclude its investigation.a581 Shortly after Mr. Borgulaas September 2 email, Nassar
announced his retirement, on September 6, 2015. 582 USAG formally acknowledged Nassaras
retirement through its counsel, in an email from Mr. Himsel to Mr. Borgula dated September 11,
2015. The email stated: aUSA Gymnastics acknowledges and accepts Dr. Nassaras statement of
retirement and duly notes that he will not be subject to further assignments.a 583 In response,
Mr. Borgula attributed Nassaras retirement to the astress caused by [ ]. . . USAG.a584
Mr. Himsel and Mr. Borgula continued to correspond about USAGas investigation after
Nassaras retirement. Although Mr. Himsel responded to Mr. Borgulaas arequest that the USAG
conclude its investigationa concerning Nassar, Mr. Himsel did not acknowledge or otherwise
address Mr. Borgulaas statement regarding Nassaras intent to resume contact with aUSAG staff
and athletes.a585 By this point, USAG a though not necessarily Mr. Himsel a was aware that
Nassar had already reached out to at least one athlete. Specifically, in an email dated August 20,
2015, Athlete 3as mother had informed Mr. Penny and Ms. Faehn that Nassar had sent Athlete 3
aa congratulatory text after the meet this past weekend.a Mr. Penny replied to Athlete 3as mother,
thanking her for aletting [him] know.a586 Notwithstanding Mr. Pennyas awareness of Nassaras
non-compliance with the one child safety measure USAG had imposed in response to the athlete

90

allegations, neither Mr. Penny nor anyone else at USAG confronted Nassar with his breach at the
time of its occurrence. Nor did USAG respond to Nassaras counselas written representation on
September 2, 2015 that Nassar henceforth planned to communicate with athletes and USAG staff
who wished to speak with him.587 These failures in tandem left unaddressed both Nassaras past
violation of the no-contact directive and his asserted present intention to continue to violate its
terms.
Nor is there any evidence that USAG addressed, either with the FBI or anyone else,
Nassaras failure to abide by the no-contact order, or otherwise took any steps to immediately
remedy the threat that Nassar, despite his separation from USAG, continued to pose to children
and young athletes in numerous venues and at other institutions, such as MSU, Twistars and Holt
High School. There is similarly no available evidence that the FBI independently acted to address
such concerns during the pendency of its investigation. As a result, athletes and their parents, as
well as other members of the gymnastics community, remained in the dark about the serious,
credible allegations of child sexual abuse leveled against Nassar. They were to remain in the dark
for another 14 months, with disclosure of the threat presented by Nassar finally arriving not from
USAG, the USOC or the FBI, but from the Indianapolis Star.
F.

Nassaras Quiet Retirement

USAGas decision not to disclose the allegations against Nassar or the referral to law
enforcement beyond a closely controlled inner circle enabled Nassar to retire quietly, on his own
terms and with his reputation intact. On September 6, 2015, Nassar sent an email to Dr. Kruse, an
individual with whom he had worked closely over the years and to whom he had reported since
2014, with the subject, aretirement from USAG.a Nassar stated:
I look back on 29 years of a wonderful adventure in my life as a
volunteer for USAG. As you know I was planning on retiring in

91

2016 but the time has come sooner rather than later. Please, accept
this as my official retirement from USAG. I wish you, the medical
team and the national team all the best.588
Dr. Kruse had no knowledge of the circumstances underlying Nassaras departure, and he
forwarded Nassaras email to Mr. Galimore and Ms. Jamison with a note stating, aI hope it becomes
appropriate, at some time in the near future, for USAG to handle Larryas retirement, after 29 years
of service, with the respect it deserves.a589
The next day, on September 7, 2015, Nassar emailed Dr. Moreau, the Managing Director
of the Sports Medicine Division at the USOC, notifying him that he had retired and requesting that
he be removed from the USOC Medical Advisory Committeexxxi now that he was ano longer
associated with an NGB.a590 Nassar commented that he had been atraining a staff for several years
in preparation for this day.a 591 Dr. Moreau stated during his interview with the Independent
Investigators that he had no indication at the time that Nassar was not, as Nassar had suggested in
his resignation email, generously astep[ping] backa to alet those that [he] mentored move ahead
and take [his place].a592 Nor did he know that the underlying circumstances of Nassaras departure
belied his description of himself in his resignation email as aupfront and honest to a fault at
times.a593
On September 27, 2015, Nassar publicly announced his retirement from USAG in a lengthy
Facebook post. In his post, he detailed his version of his biography and accomplishments over his
years of service to the gymnastics community. Nassar concluded his post with a photograph from
the 1996 U.S. Olympic Team Gymnasts Trials with a caption that read: a29 years with the
Womenas Artistic National Team and now it is time to step down and retire and let the next

xxxi

When the USOC was organizing a nationwide network of hospitals to provide care to elite athletes, the USOC
invited medical providers from various NGBs to provide their advice on potential partnerships. Nassar was invited to
join this advisory committee and attended two meetings. Moreau Interview. The committee was disbanded after the
USOCas National Medical Network was formed. Moreau Interview.

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generation move forward.a 594 Mr. Penny was alerted to the Facebook post by Leslie King,
USAGas Vice President of Communications, the next day, September 28, 2015. 595 Also on
September 28, 2015, Mr. Penny asked Ms. Faehn to monitor Nassaras Facebook page. Ms. Faehn
looked at Nassaras Facebook page that day, but she did not continue to monitor the page. 596
Ms. Faehn informed Mr. Penny, via email, that Nassaras Facebook page was amild with his posting
his retirement and everyone thanking him and wishing him well.a597
Notwithstanding knowledge of Nassaras Facebook post, USAG did not make any
statements, either to the public or to USAG personnel, to correct Nassaras representations that his
decision to retire was wholly voluntary. Mr. Penny informed the USOC and the FBI in September
2015 that Nassar had announced his retirement from USAG,598 but these communications appear
to be the only disclosures that Mr. Penny made regarding Nassaras quiet retirement. The failure
to correct Nassaras false narrative of a routine retirement at the end of a long and illustrious career
kept his cover intact and allowed him to maintain his status and role in the sports community a all
while under investigation for child sexual abuse of athletes under his care.
USAGas decision not to inform the medical team and other personnel that Nassar was under
investigation for sexually abusing athletes a and to actively conceal the reason for Nassaras
absences from USAG events and the true circumstances of his retirement from USAG a had
consequences. Nassar continued to be invited to calls and was consulted on issues affecting the
medical team.599 Athletes, coaches and trainers all continued to seek out his opinion on medical
issues, sometimes with the knowledge of USAG officials. For example, on August 8, 2015, a
coach emailed Ms. Karolyi, copying Ms. Faehn and Nassar, and explained that he had sent Nassar
an MRI of an athleteas foot for a second opinion.600 After noting Nassaras recommended course
of treatment, the coach stated that he atrust[ed] Dr Larrya and agreed with his advice. 601

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Employees at USAG also continued to view Nassar as an authority in his field and to seek him out
for his expertise. For example, on February 24, 2016, Lynn Moskovitz-Thompson, the Managing
Director of Club and Educational Services at USAG, invited Nassar to be a presenter at an
upcoming USAG educational event regarding Sports Injury and Concussion.602 Nassar accepted
the invitation and contacted Ms. Karolyi to inform her that he would be speaking at the event.603
Ms. Karolyi relayed this information to Ms. Faehn; Ms. Faehn then contacted the Vice-President
of Member Services at USAG, Cheryl Jarrett, who confirmed that Nassar had been invited to
participate and noted that a[w]e have never been communicated to about not asking him.a 604
Ms. Faehn then relayed to Ms. Jarrett that Nassar ahad been dismissed from USA Gymnasticsa
and instructed her to speak to Mr. Penny,605 who responded to her question of whether Nassar
could lecture at the upcoming event with a terse aNo.a606 On March 11, 2016, 16 days after she
had issued the invitation, Ms. Moskovitz-Thompson emailed Nassar to retract the invitation and
explain that she awas not aware that you are no longer a part of National Medical Staff therefore
we must go a different direction.a607 Further, trainers, including USAG medical staff, continued
to consult Nassar on issues related to medical treatment and staffing. For example, on August 6,
2015, Nassar provided input on a resident who was being considered for inclusion on the medical
team.608 Dr. Kruse stated that he had aconfidence in [the resident] since Larrya endorsed her skills
and agreed to Nassaras proposed plan for utilizing the resident for manual procedures.609
There is also evidence to suggest that individuals employed by USAG, without being privy
to the true circumstances of Nassaras departure, may have continued affirmatively to recommend
him to the public following his aretirement.a Rachel Brazo, Director of Program Administration
at USAG, reflected on this scenario in an email to Mr. Galimore and Mark McCreary, Chief

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Administrative Officer at USAG, after USAG personnel were informed of the allegations on
September 12, 2016610 a the same day that the Indianapolis Star broke the story about Nassar:
I feel like I have indirectly been put in a position where I may have
recommended that a parent put their child in harmas way because
staff werenat made aware of allegations[.]
I am not sure the timing of when we first heard about these
allegations against N[assar] but I am sure it wasnat yesterday. I have
been managing the USA Gymnastics National Health Care and
Sports Referral Network for many years. This morning I removed
N[assar] from this referral list on our website, not because anyone
told me to but because itas my job and my responsibility. I have also
removed him from the list of the Referral Network review board, the
list of selected doctors that review other doctors in their field for
inclusion in the network. For yearsa [sic] when members call and
ask for referrals for medical services with doctors who have
experience with gymnastics I direct them to this referral list on our
website. Not only was N[assar] on it up until this morning but he
has approved some of the other doctors on it. These doctors are not
asked to take background checks and apparently can remain on the
list even after we receive allegations, as happened with this case. It
is my hope and my assumption that this was simply an oversite [sic]
and that it honestly didnat occur to anyone on Senior Staff that
N[assar] was on the Healthcare Referral Network which is a public
document on our website[.] At some point you have to trust us, the
staff, to do our jobs. This includes giving us needed information to
help us protect not only children, but ourselves and this organization.
We canat do that without all the facts. It sounds like there was
direction from law enforcement to not make the allegations public
or to not take any action but at some level staff is not the public and
a minimum level of caution is warranted. Do we not sign
confidentiality statements each year for these types of situations?611
Ms. Brazoas ahopea and aassumptiona at the time that it was simply an oversight that had
led USAG not to take appropriate protective steps to remove Nassar from the organizationas
network of trusted medical providers is not borne out by the facts. Not only had Mr. Penny kept
the vast majority of USAG personnel in the dark about Nassaras alleged misconduct, but the
organization also failed to implement any systematic child-protective measures to ensure that
Nassar would be stopped from further abusing athletes while under investigation for serial sexual

95

abuse. As a result, Nassar not only remained on USAGas list of recommended physicians on the
organizationas public website, 612 but he also continued to see patients and pursue other
opportunities following his departure from USAG. 613 Specifically, with no disclosure of the
athlete complaints or the pending investigation, Nassar ran for a position on the Holt High School
Board of Directors in 2016614 and continued to have uninterrupted access to patients at Holt High
School, Twistars and MSU for a full year following his departure from USAG.615 During this
period of silence, dozens of girls and young women have publicly reported that they were sexually
abused by Nassar.616
G.

Period of Inaction Following Reporting to USAG, the USOC and the FBI

During the period from Nassaras announced retirement in September 2015 to the
Indianapolis Star article exposing Nassar a full year later in September 2016, no effective action
was taken by USAG or the USOC to protect vulnerable children and athletes from the ongoing
threat posed by Nassar. This period is also marked by unexplained delays on the part of the FBI.
1.

FBI Investigation

Following USAGas report to the FBI on July 28, 2015, the FBIas inquiry into Nassar
spanned many months and was still incomplete when the Indianapolis Star reported over a year
later that two gymnasts had accused Nassar of sexual abuse.617 The Bureauas investigation began
in the Indianapolis office following USAGas referral in late July 2015, continued in the Detroit
office following a transfer from the Indianapolis office in late September 2015, and was later
assumed by the Los Angeles office, following USAGas separate referral to that office in the spring
of 2016.
Early investigative steps in Indianapolis a On July 28, 2015, during USAGas initial
meeting with the FBI to report Nassaras alleged abuse of athletes, USAG provided the FBI with
contact information for the three athletes whom Ms. Sepler had interviewed as part of her
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investigation: Athlete 1, Athlete 3 and Athlete 5.618 During the pendency of the investigation out
of the Bureauas Indianapolis office, the FBI did not interview either Athlete 1 or Athlete 3.
Although Mr. Penny had arranged for Athlete 5 and her mother to fly to Indianapolis for an inperson interview with the Indianapolis agents,619 that meeting never took place. The FBI instead
decided to conduct the interview of Athlete 5 over the telephone.620 The telephonic interview took
place on September 2, 2015.621
While the investigation was still pending in the Indianapolis office, as noted in Part III.D,
Mr. Penny provided information to the Indianapolis agents about an additional athlete a Athlete 6
a who had potentially relevant information.622 Athlete 6 has since identified as a survivor of
Nassaras abuse.623
Transfer from Indianapolis to Detroit a After the matter was transferred from the
Indianapolis office to the Detroit office, the investigation appears to have stalled. There is no
available evidence that the Detroit office interviewed any witnesses or undertook any other
external investigative steps with regard to the Nassar allegations during the period from September
2015 through April 2016.
USAG attempted to monitor the progress of the FBIas investigation and, shortly after the
matter was transferred from Indianapolis to Detroit, sought guidance on how best to follow-up on
the status of the FBIas investigation. On September 24, 2015, three weeks after Agent Abbott
informed Mr. Penny that the matter had been transferred to the Detroit office,624 Mr. Penny asked
Mr. Buendorf to use his law enforcement contacts to obtain information about the status of the
investigation.625 As noted in Part III.C, Mr. Buendorf spoke with one of his contacts at the FBI
office in Colorado Springs, who suggested that Mr. Penny aremain in contact with [his] bureau
contacta in Indianapolis.626

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Mr. Penny separately sought guidance from USAGas outside legal counsel at Faegre.627
Although Mr. Penny did not contact the Detroit office of the FBI directly,628 on October 12, 2015,
he shared with Athlete 5as mother a message he had received from legal counsel in response to his
request for advice regarding how to proceed with the Detroit FBI office. The advice Mr. Penny
passed along to Athlete 5as mother was that the Detroit office would likely be most responsive to
a direct inquiry from Athlete 5 or her mother, accompanied by a reference to the prior telephonic
interview and a request for a further ain person interview in Michigan.a629 There is no available
evidence, however, that the contemplated further interview in Detroit ever took place.
The Nassar investigation appears to have languished in the Detroit office with no action
for over seven months.xxxii It is unclear whether the investigation ever would have left its dormant
status in the Detroit office if it were not for the intervening event of USAG making its second
referral to the FBIas Los Angeles office.
Second Referral by USAG to the Los Angeles Office a After months of not hearing any
update from law enforcement, USAG determined that it should make an additional report to a
different FBI office given the perceived lack of progress with the FBIas investigation. USAG then
contacted the FBI office in Los Angeles because Athlete 5 was from the area and it was among the
larger bureaus in the country. 630 On April 28, 2016, at Mr. Pennyas request, Mr. Parilla, a
California resident, contacted the FBI in Los Angeles to re-report athlete concerns about Nassar
and to set up a meeting.631 Mr. Parilla spoke with Agent Michael Hess and arranged a meeting for
May 10, 2016.632 Although Athlete 5 and her mother were originally scheduled to participate in
the May 10 meeting, the FBI requested a separate meeting with them. Mr. Penny put Athlete 5as
mother in touch with Agent Hess over email633 on May 8, 2016, so that Agent Hess and Athlete 5as

xxxii

The FBI declined to provide information regarding its handling of the Nassar matter, or any related
communications with USAG, in response to written requests.

98

mother could arrange a meeting for May 11, 2016, the day following USAGas scheduled
meeting.634
On May 10, Mr. Parilla and Mr. Penny met with Agent Hess and his colleague and relayed
to them essentially the same information they had provided to the Indianapolis office of the FBI
in July 2015. 635 Mr. Parilla brought a flash drive with relevant materials, including Nassaras
videos and PowerPoints, and he and Mr. Penny walked the agents through the allegations.636 The
following day, Mr. Penny sent Agent Hess an email with a arequest regarding any further steps
[the FBI] might take.a637 In keeping with his prior efforts to maintain a low profile within the
gymnastics community for the Nassar investigation, Mr. Penny underscored to Agent Hess that he
would greatly appreciate it a[i]f there is anyway [sic] you can not identify that USA Gymnastics
has filed the complaint against Dr. Nassar when you talk to people, but just generally suggest that
aa complaint has been filed.a It will keep things on a much more level playing field if no one can
point in any one direction.a638 The FBI did not respond by email to Mr. Pennyas request.xxxiii
After USAG, and thereafter Athlete 5 and her mother, met with agent Hess and his
colleagues, the FBIas investigation appeared to become more active, and the FBI reportedly opened
a aFull Investigationa for the first time in May 2016.639 xxxiv The FBI did not take any public action
against Nassar, however, until after Nassaras abuse of gymnasts had been exposed by the
Indianapolis Star, approximately four months after the FBIas May 11, 2016 interview of Athlete 5.
Review of the FBIas Handling of the Nassar Investigation a The factual record raises
concerns about the length of time it took and the manner in which the FBI conducted its

xxxiii

Mr. Penny stated during his interview with the Independent Investigators that he was concerned that asome people
may perceive [USAGas filing of a report against Nassar] as [Mr. Penny] going aftera Nassar because of a prevailing
view that Mr. Penny did not like Nassar. Penny Interview.
xxxiv
A aFull Investigation,a according to the FBI Domestic Investigations and Operations Guide, is distinct from an
aAssessmenta or a aPreliminary Investigation,a and may be opened where there is an aarticulable factual basisa of
apossible criminal . . . activity.a 2013 FBI Domestic Investigations and Operations Guide.

99

investigation into Nassaras abuse. The FBI is currently conducting an internal inquiry into its
handling of the allegations against Nassar. The FBIas actions in connection with the Nassar
investigation are also under review by the Office of the Inspector General for the Department of
Justice and by the Senate Judiciary Committee. No report or findings have been issued to date.
2.

Inaction by USAG

Apart from the repeated steps USAG took to follow up with the FBI on the status of its
investigation, USAG took no further affirmative steps to address the ongoing risk to children and
athletes posed by Nassaras quiet retirement.
USAG instead appears to have been preoccupied with confidentiality within the gymnastics
community. That preoccupation took many forms:
(i) narrowly confining the group of USAG personnel with knowledge of the Nassar
concerns to a small handful of employees,640 thereby compromising USAGas ability to monitor
Nassaras compliance with USAGas no-contact order;
(ii) limiting knowledge of the Nassar concerns to only a few board members, thereby
precluding oversight by the full board;641
(iii) affirmatively directing athletes, parents and coaches not to discuss the Nassar matter
with anyone other than Mr. Penny, thereby keeping the gymnastics community in the dark;642
(iv) directing Nassar not to speak with any USAG personnel, seemingly with an eye toward
keeping USAG personnel a other than the small group of employees in the circle of knowledge a
unaware of the athlete concerns;643
(v) through direction to Ms. Faehn, seeking to exclude parents and coaches from
participation in USAG-directed interviews of athletes who had expressed concerns about Nassaras
conduct;644

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(vi) failing to disclose the serious, credible allegations against Nassar to MSU, Twistars
and Holt High School a all youth-serving organizations with which Nassar was known to have
affiliations;645 and
(vii) following the referral to law enforcement in July 2015, continuing to insist on silence
and confidentiality, notwithstanding that Nassar had been apprised of the allegations against him
on July 22, 2015.646
In an email to Agent Abbott at the FBI dated July 30, 2015, Mr. Penny summed up in his
own words his mission on behalf of USAG: aOur biggest concerna is ahow we contain [Nassar]
from sending shockwaves through the community.a647
3.

Inaction by the USOC

As set forth in detail in Part III.C, above, the USOC took no action between the time it was
notified of the athlete concerns in July 2015 and the date the Indianapolis Star published its
account of Nassaras sexual abuse in September 2016. The USOC as an organization was
effectively disabled from considering and taking appropriate action in response to the athlete
complaints about Nassar due to the decision by two senior officers of the USOC to keep the matter
to themselves.
H.

Interactions Between USAG and the FBI

Our review identified a number of documents that reflect Mr. Pennyas efforts to cultivate
a personal relationship with Agent Abbott, then-Special Agent in Charge of the Indianapolis office
of the FBI and one of Mr. Pennyas key contacts with regard to the Nassar investigation. Emails
indicate that, in October 2015, two months after USAGas referral to the FBI and following the
early September transfer of the Nassar investigation from the FBIas Indianapolis office to the
Detroit office, Agent Abbott agreed to meet Mr. Penny for a beer.648 In an email from Agent
Abbott to Mr. Penny on October 20, 2015, Agent Abbott wrote: ajust another quick athank youa
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for the beer and conversation a few weeks ago.a649 The email also reflects that Mr. Penny had
offered to provide assistance to Agent Abbott as he considered his job prospects beyond the FBI,650
including in particular a potential opportunity for Agent Abbott to step into Mr. Buendorfas
position as the Chief Security Officer for the USOC upon Mr. Buendorfas anticipated near-term
retirement.651 As Agent Abbott stated after expressing his thanks to Mr. Penny for the beer and
the conversation: aI very much appreciate what you did. Though I realize there would be many
qualified applicants, the position with the USOC is truly a tantalizing and interesting possible
opportunity post-Bureau that I continue to think about.a652 He then signed off, aCheers and thanks
again, Jay Abbott, FBI SAC Indy.a653 Later that same day, Agent Abbott forwarded Mr. Penny a
link to a video of an interview he had done with a local news station about an FBI-State Police
initiative to combat violent crime.654 Mr. Penny responded, aThis is great. Thanks for sharing. I
am going to forward to Larry [Buendorf].a655 He also thanked Agent Abbott afor everything you
do.a656
There is no evidence that Mr. Penny followed through on his statement that he would
forward the video to Mr. Buendorf. Mr. Penny did follow through, however, on his offer to
provide assistance to Agent Abbott with regard to Agent Abbott potentially stepping into
Mr. Buendorfas role upon Mr. Buendorfas retirement from the USOC. In an email from Mr. Penny
to Mr. Buendorf in the summer of 2016, Mr. Penny wrote:
Hey Larry,
Looking forward to seeing you in Rio.
I wanted to let you know that I found a great guy who might be the
perfect fit for your role when you decide to leave. His name is Jay
Abbott and he is the senior agent in charge at the FBI office in
Indianapolis. Let me know if you would like to speak with him.
Regards,

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Steve657
Mr. Buendorf responded the same day with information on the timing of his anticipated
retirement and the aadvertisementa for the position that Agent Abbott could look out for the
following year. 658 He did not offer any substantive assistance. Mr. Penny responded with,
aThanks Bueny,a and nothing more.659
Shortly before the Nassar allegations broke, Mr. Penny again picked up his correspondence
with Agent Abbott, and Mr. Penny forwarded him the Indianapolis Star article on September 12,
2016.660 Thereafter, on September 21, 2016, Mr. Penny sent an email to Agent Abbott: aWill call
you shortly if that is okay. Am I in trouble?a661 Agent Abbott responded the same day, aNo. a|and
no worries. Hopefully you have chatted with LAas FBIas SAC by now re our conversation last
night. Catch up with you tomorrow during business hours if you desire.a662 On November 21,
2016, Mr. Penny wrote to Agent Abbott informing him that Nassar had been arrested,663 and then
sent a further email a few minutes later referencing aa press conference tomorrowa and inquiring
ahow it might portray us.a664 In response, Agent Abbott assured Mr. Penny that the aFBI will be
very professional.a665 On February 16, 2017, Mr. Penny sent another email to Agent Abbott about
USAGas atimeline of reporting.a666 The next day, February 17, 2017, Mr. Penny forwarded to
Agent Abbott a publicly available job posting for the USOC Chief of Security position.667 Agent
Abbott acknowledged the posting in response and wrote: aIam also aware of your timeline
reporting and will be happy to discuss further tomorrow morning.a 668 Later the same day,
Mr. Penny wrote again to Agent Abbott and reported: aThe us attorney is not helping. This is
getting much worse for me.a669 Agent Abbott responded: aSorry to hear that re the AUSA. He
must have his reasons.a670
These email exchanges do not afford a complete picture of the communications between
Mr. Penny and Agent Abbott, a number of which appear to have taken place in person or over the
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telephone.

They do, however, reflect an effort on Mr. Pennyas behalf, drawing upon his

relationship with and assistance to Agent Abbott, to encourage the FBI to support USAG and its
proffered atimeline of reportinga with regard to how USAG had responded to the Nassar
allegations. Similar to his successful effort in the summer of 2016 to enlist a detective in the
Indianapolis Metropolitan Police Department to defend USAG and its handling of the Marvin
Sharp allegations, as discussed in Part V.B.2.c, Mr. Penny appears here as well to have sought law
enforcement support for USAGas handling of the Nassar allegations. In this regard, the atimeline
of reportinga that Mr. Penny references in his email communications with Agent Abbott includes
an affirmative statement by USAG that athe FBI . . . assured USA Gymnastics that the FBI was
the appropriate agency to make the report and that USA Gymnastics had handled the matter
correctly.a671
I.

Further Actions by USAG

Even after the Indianapolis Staras public exposure of Nassar in September 2016, USAG
continued to take steps to control the flow of information regarding Nassaras alleged abuse of
athletes.
1.

Confidential Settlement Agreement with Survivor of Nassaras Abuse

In one notable example, in December 2016, almost three months after publication of the
Indianapolis Star article, USAG entered into a settlement agreement with a survivor of Nassaras
abuse, pursuant to which it agreed to resolve one of the athleteas claims against USAG for her
years-long abuse by Nassar on terms that included the athleteas agreement to sign a non-disclosure
agreement (aNDAa) prohibiting her from speaking publicly about Nassaras abuse, even though
many youth-oriented organizations have discontinued use of such NDAs.672 xxxv The existence of

xxxv

The agreement further sought to preclude the survivor from speaking to any individual not privy to the agreement,
with the exception of her parents, healthcare providers, accountants or attorneys.

104

the NDA was made public when the athlete filed a lawsuit in December 2017 challenging its
legality.673 On February 9, 2018, USAG represented in a letter to the Chairman and Ranking
Member of the Subcommittee on Consumer Protection Product Safety, Insurance and Data
Security that USAG had anot used NDAs in conjunction with any investigation.a674
2.

Removal of Documents from the Karolyi Ranch

On or about November 11, 2016, two months after the Indianapolis Star published its
article about Nassaras abuse, Texas Rangers showed up unannounced at the Karolyi Ranch in
Walker County, Texas.675 USAG a at Mr. Pennyas direction a immediately set in motion an urgent
effort to retrieve all medical forms and all records specifically pertaining to Nassar from the Ranch
before those documents could be seized by law enforcement.676 Mr. Penny ordered Amy White,
USAGas National Team Manager, and Gary Warren, then the National Team Training Center
Director, both of whom were at the Ranch that day, to immediately locate, pack up and remove
any and all documents at the Karolyi Ranch related to Nassar or medical care.677
At the time the Texas Rangers arrived at the Karolyi Ranch, Ms. White was leading an
acrobatics camp.678 The two Texas Rangers explained to Ms. White that they wanted to speak to
medical personnel, tour the Ranch and take photographs in connection with an ongoing
investigation.679 They did not have a warrant.680 While the Rangers were waiting, Ms. White
contacted Mr. Penny for guidance. 681 After consulting with counsel, Mr. Penny instructed
Ms. White to tell the Texas Rangers to leave and to offer that they could return at a mutually
agreeable time when there was no active camp in session.682
The Texas Rangers, visibly aggravated by the request that they leave the premises, stated
that they would be returning to the Ranch with a search warrant.683 Ms. White promptly relayed
to Mr. Penny that, while the Texas Rangers had left in response to his request, they had stated that
they would be returning with a search warrant.684 Upon hearing this report, Mr. Penny turned his
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attention immediately to retrieval of the records. He spoke by telephone with both Ms. White and
Mr. Warren.685 He first instructed Mr. Warren to atake all of the boxes out of the barna and give
them to Ms. White.686 Mr. Penny then directed Ms. White to review these materials and cull out
aanything that ha[d] Nassaras name on ita as well as aall of the participant welfare waiversa that
had been signed by gymnasts in connection with the provision of medical care at the Ranch.687 xxxvi
He directed Ms. White to return these records immediately to USAGas office in Indianapolis.
When Ms. White asked Mr. Penny how she was going to do that, he told her to go buy a big
suitcase. 688 When Ms. White proposed to send the documents back via Federal Express,
Mr. Penny insisted that she personally transport the documents to the airport and take them with
her on the plane.689 When Ms. White expressed concern about the high cost of transporting extra,
overweight baggage by plane, Mr. Penny became irritated and told her to follow his instructions
and not to question him.690
Ms. White thereafter went with a couple of colleagues from the Ranch to a local Target
store and bought a large suitcase.691 She went through the boxes that Mr. Warren had retrieved
and also took all of the files from the drawers in the office where she knew the medical waivers
for the womenas program to be maintained. 692 From this combined collection of materials,
Ms. White separated for return to Indianapolis anything that looked like it related to Nassar,
including printed emails, rooming lists, FIG documents,xxxvii directives from FIG, assignments and
participant welfare forms. 693

Ms. White specifically stated during her interview with the

Independent Investigation that aif [a document] had Nassar on it, . . . then she pulled it outa and

xxxvi

Ms. Brazo, the Director of Program Administration for USAG, was in Mr. Pennyas office at the time of this call
and heard Mr. Penny tell Ms. White to bring back to USAGas offices aanything to do with Larry,a including all medical
records, waivers and completed forms. Brazo Interview.
xxxvii
aFIGa refers to FA(c)dA(c)ration Internationale de Gymnastique, the international governing body of competitive
gymnastics.

106

included it in the materials for return to USAGas offices in Indianapolis, as directed by
Mr. Penny.694 She also collected a few ajump drives,a although she adid not know what was on
them.a695 She placed all of the materials she identified as responsive to Mr. Pennyas directive into
the suitcase she had purchased and a couple of additional boxes, and personally transported the
documents as checked baggage on her flight back to Indianapolis.696 Ms. White recalled that
Mr. Penny was anxious to receive the records immediately; although she had been planning to take
a day off upon her return from the Ranch, he told her to come to the office to drop off the
documents instead.697 The morning following Ms. Whiteas return to Indianapolis, she brought the
documents to USAGas offices, as directed.698
The documents inside the suitcase and boxes were not organized in any way.699 Nor did
USAG or anyone acting on USAGas behalf prepare a log of the documents that had been collected
and placed into the suitcase and boxes at the Karolyi Ranch.700 Ms. White delivered the suitcase
and one or two of the boxes to Ms. Brazo, who was tracking USAGas response to document
requests in connection with ongoing litigation.701 According to Ms. White, Mr. Penny intercepted
her in the hall and took the last box from her.702 It is unclear what, if anything, Mr. Penny did with
the contents of the box he retrieved from Ms. White.703
Ms. Brazo recalled during her interview with the Independent Investigation that, in or about
early November 2016, she had received from Ms. White aone box and one suitcase.a704 She did
not receive a second box and was unaware at the time that a second box of records had been
retrieved from the Karolyi Ranch.705 xxxviii Ms. Brazo sorted through the documents in the suitcase
and the one box.706 The contents included aforms that everyone who attended camp at the Karolyi

xxxviii

Ms. Brazo did not learn of the existence of a second box of documents until late 2017 or early 2018 when, in a
conversation with Ms. White, Ms. White informed her that she had brought documents from the Ranch in two boxes
and one suitcase. Brazo Interview.

107

Ranch completed, such as waivers, consent forms for treatment, pre-participation physicals and
agreements to follow camp rules.a 707 The box did not contain emails or other documents
pertaining to Nassar.708 Although Ms. Brazo never saw or reviewed the contents of the second
box that was intercepted by Mr. Penny, she reported during her interview that, upon learning of
the existence of a second box, she believed that the further box contained asomething differenta
from what was in the suitcase and the one box that she did review. Her belief stems from a
conversation she had with Ms. White in late 2017 or early 2018, during which Ms. White told her
that, when she had gathered the documents at the Ranch, aif it was an email with Nassaras name,
I did not even read it, I just put it in there.a709
Pursuant to requests from the Independent Investigation, USAG, through counsel,
represented that it had produced all documents in its possession that had been collected from the
Karolyi Ranch, and that these documents were contained in a specified range of documents within
the USAG production to the Independent Investigation.710 The documents within this specified
range include: (i) participant information and waiver forms, (ii) consent to treat forms, (iii)
insurance verification forms, (iv) medical authorization and disclosure forms, (v) pre-participation
physical evaluation forms, (vi) agreements to follow USAGas national team rules and (vii) athlete
lists for various competitions. 711 There are no emails or other documents that match the
description of aanything to do with Larrya or any documents that include Nassaras name or
otherwise reference Nassar.712
Citing attorney-client privilege, Mr. Penny declined to speak with the Independent
Investigators about anything pertaining to the removal of documents from the Karolyi Ranch.713
Ms. Whiteas recollection of events is corroborated by contemporaneous documents, including her
receipt for the purchase of the suitcase, 714 and the recollections of Ms. Brazo 715 and other

108

witnesses.716 Mr. Penny has since been indicted by a grand jury in Walker County, Texas, on one
count of tampering with evidence, a third-degree felony, in connection with his direction to USAG
personnel to remove medical forms and other Nassar-related materials from the Karolyi Ranch.717

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IV.

CONTRIBUTING CULTURAL CONDITIONS

A
A

A

A

SELECTEDA FINDINGSA
iSS

NumerousA featuresA embeddedA inA eliteA womenasA gymnasticsA renderA athletesA
particularlyA vulnerableA toA childA sexualA abuse.A A TheseA featuresA includeA theA
overwhelmingA presenceA ofA childrenA inA theA sport;A theA physicalityA ofA theA trainingA
environment;A strictA expectationsA ofA obedienceA andA deferenceA toA authority;A theA
normalizationA ofA intenseA physicalA discomfortA asA anA integralA partA ofA theA pathA toA
success;A theA exclusionA orA discouragementA ofA parentalA participation;A theA socialA
isolationA ofA manyA eliteA gymnasts;A andA theA presenceA ofA numerousA powerfulA
incentivesA forA gymnastsA toA toeA theA lineA andA avoidA arockingA theA boat.aA

iSS

TheA harshnessA ofA theA prevailingA trainingA methods,A asA exemplifiedA byA theA cultureA atA
theA KarolyiA Ranch,A furtherA amplifiedA theA pressuresA onA eliteA gymnastsA andA
intensifiedA theA expectationsA ofA perfection,A obedienceA andA deferenceA toA authority.A

iSS

TheA toneA atA theA topA fromA theA USOCA andA USAGA contributedA toA aA perceptionA amongA
athletesA thatA theA cultureA prioritizedA performanceA overA theirA welfare.A

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A
A

A

A

In developing and implementing his system of abuse, Nassar benefited from an embedded
culture in elite and Olympic gymnastics, certain features of which not only made the sport
inherently susceptible to child sexual abuse, but also operated to break down barriers to predatory
conduct. Even allowing for the benefit of 20/20 hindsight, the acute threat of child sexual abuse
in youth sport, and especially in elite womenas gymnastics, was present for those in leadership
positions to recognize and address throughout the lengthy span of Nassaras serial sexual abuse of
gymnasts.xxxix
A.

Embedded Features of the Sport

Numerous features embedded in elite womenas gymnastics render the sport conducive to
child sexual abuse, including: (i) the overwhelming presence of children in the sport; (ii) the
physicality of the training environment; (iii) strict expectations of obedience and deference to
authority; (iv) the normalization of intense physical discomfort as an integral part of the path to
success; (v) the exclusion or discouragement of parental participation; (vi) the social isolation of
many elite gymnasts; and (vii) the presence of numerous powerful incentives for elite gymnasts to
toe the line and avoid arocking the boat.a
Youth a Perhaps more than any other sport, gymnastics is a sport of youth. In 1976, 14year-old Nadia Comaneci astounded the world with routines that earned the sportas first perfect
10s at the Olympic Games, heralding a new degree of difficulty in the sport. Winning three gold
medals in the process,718 she served as athe most prominent aadvertisementa for a nascent trend
towards younger, pre-pubescent gymnasts which had begun in the late 1960s.a719 The previous
era of gymnastics had focused more on artistry and emotional expression than acrobatic feats,

xxxix

This Part draws from publicly available source material, as well as witness interviews and documents obtained
during the course of the Independent Investigation. The inclusion of a particular quote should not be construed to
infer the speakeras participation in the Independent Investigation.

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enabling athletes in their 20s and 30s to dominate the sport. For example, one of the most
decorated gymnasts of all time, Larisa Latynina, won her first World Championship all-around
title at age 23 a while four months pregnant a and her last European Championship all around-title
at age 30. 720 With Ms. Comanecias success, however, gymnastics began to prize technical
proficiency and skill: aWomenas gymnastics, which in the 1950s and 1960s was about grace, poses
and the ability to dance, was now about twists and turns in the air.a721 And in this regard, younger,
lighter gymnasts who had not yet undergone puberty had an advantage.
As the sport shifted towards youth, gyms began to be populated primarily by children. In
one representative account, a former gymnast noted: aI started gymnastics when I was 3. Most
good gymnasts do. Three or 4, maybe 5 if youare pushing it[.] By the time I was 7, I was training
16 hours a week. By the age of 9, it was 20.a722 Mr. Geddert, former owner of Twistars and
himself the subject of numerous abuse allegations, once observed: a[T]his is a little girlas sport[.]
With their body changes and the wear-and-tear everybody goes through, once they become women,
it just becomes very, very difficult.a723 Because the physical demands and rigors of the sport are
difficult to sustain over longer periods, it is generally believed that gymnasts apeak at an early agea
and that the period between ages 12 and 16 is particularly critical for their career development.724
Although the sport is again shifting in ways that provide more opportunities for older
athletes a including through rule changes that allow athletes to specialize in a specific event, as
opposed to competing in all events, and an increasing emphasis on power moves that rely on
muscle developed after puberty725 a the vast majority of elite gymnasts who represent the United
States in the World Championships and at the Olympic Games are still children.726 In the words
of one gymnast, aI think we have to remember, yes, these are world-class athletes, but theyare also

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little girls.a 727 And little girls have particular vulnerabilities, including a limited capacity to
recognize and protect themselves against inappropriate behavior by trusted authority figures.
Physicality of Gymnastics a Gymnastics is also unique in that it requires a measure of
physical contact between athletes and adults for instruction, safety and wellness. For example, a
coach may have to touch an athlete to stretch her, to assist her in completing a skill or to correct
her form. As one coach explained, aI call gymnastics a contact sport because we cannot teach our
athletes without touching them. We spot, poke, shape, and catch our athletes every day.a 728
Similarly, athletic trainers and doctors frequently touch athletes in the course of providing
preventative, emergency and rehabilitative treatments for injuries and other medical conditions.
In this way, coaches and medical personnel may have access to gymnastsa bodies in a manner and
to a degree that is not normal in other contexts.729 For example, one witness recalled that police
investigated his coach after a young female gymnast came home with a chalk handprint on her
chest area, but the contact was appropriate because the coach had acted to stop her from falling off
an apparatus.730 The witness stated that it awould have been natural for the coach to catch the girl
and push her up by her chest in that situation.a731
Strict Expectations of Obedience and Deference to Authority a By many accounts,
aGymnastics culture promotes obedience without question.a732 As one gymnast noted, she and
her teammates were aprogrammed to believe that any deviation from the prescribed methods
would enhance the probability of failure.a733 In their drive to succeed, many gymnasts ahand[ed]
[themselves] over completelya to coaches and medical staff,734 who were generally assumed to
have the specialized knowledge necessary to develop the athletesa skills and keep them safe in
what can be an aintensely scarya735 and aextreme[ly] danger[ous]a736 sport. In turn, these authority
figures often dictated every aspect of the gymnastsa training, from what leotards they wore, to

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when they worked out, to which skills they practiced, to what they ate and even to how they spent
their time outside of the gym.737 Another gymnast echoed more broadly that her coach adictat[ed]
[her] life,a notwithstanding that she was a self-described agooda but not aexcellenta gymnast who
atopped out on the provincial circuit.a738
By the time many gymnasts begin competing at the elite level, they have already lived aa
lifetime of obedience and engrained trust in coaches and staff.a739 As one witness explained, aI
was supposed to be quiet and do what I was told.a740 She noted that she and her teammates awere
raised not to question authority whatsoever[.] We were told to do something and we did it.a741 A
physical trainer who worked with many elite gymnasts observed that they were anever allowed to
make any decisions on their own; decisions were always made for them.a742 Consistent with this
observation, the witness recalled an incident involving an athlete who had injured her foot at a
championship event: multiple adults stood around her discussing what they should do and whether
she would compete, but at no point did anyone ask her how she felt or whether she thought she
would be able to compete.743
Many gymnasts recalled that they were aeager to pleasea authority figures, going to great
lengths to win their approval.744 Given the emphasis that coaches often placed on maintaining a
slim physique, many athletes recalled that these efforts often took the form of extreme measures
to keep their weight artificially low. One gymnast explained, aI took anywhere from five to 15
laxatives without missing a single day for those six years thinking that was the only way to stay
skinny enough and, therefore, be liked by my coaches and the national team staff.a745 Another
gymnast explained that she was often weighed twice a day and would thus forgo water and food
over the course of the training day so as not to risk the ire of her coaches.746 In the words of one
gymnast, even a[o]ur bodies did not belong to us.a747

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Several gymnasts have suggested that this sustained deference to authority and lack of
individual agency deprived them of the opportunity to learn to use their own voices or conditioned
them to refrain from doing so. One gymnast explained, aIn gymnastics, you got a pat on the back
if you were quiet and stayed in your lane a you never really felt comfortable using your voice.a748
Describing her own experience in the sport, another gymnast noted, aI was raised in the culture of
gymnastics where we were taught your voice doesnat matter. You follow instructions and never
complain, especially about treatment.a749 These sentiments were echoed by another gymnast, who
noted: aI have been told throughout my elite gymnastics career to not question authority as it was
disrespectful and I was told not to speak up. Therefore, I felt like I didnat have a voice.a750 A
survivor who was sexually abused by her coach at age 12 recalled that she knew he should not be
touching her the way he did, but she did not tell him to stop because aI was raised that you donat
really question authority.a751 One witness explained, a[I]f a guy who you are told to trust does
something that doesnat seem right, you donat trust your perception of the world enough to say
something or say no; you are told your perception and your voice [donat] matter.a752
A former USOC executive with experience in SafeSport issues observed that athletes in
sports that emphasize obedience and hierarchy, such as gymnastics, aare less likely to push back
on boundaries of what is or is not ok.a753 She noted that this feature of the sport makes it very
difficult for athletes to assert themselves even when they athink things are not ok.a754 The young
age of many gymnasts exacerbates this dynamic: as one witness observed, aThese girls are going
to do whatever they are told. They are not going to challenge it or talk about it. One can talk about
giving athletes a voice, but it is difficult to give an 8-year-old or a 10-year-old a voice.a755 xl

xl

The inherent intimacy of the coach-athlete relationship may also lead to abuse under the guise of adating.a The
existence of child-protective measures (or lack thereof) regarding appropriate boundaries between coaches and
athletes is discussed in Part V.A.5.

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Normalization of Intense Physical Discomfort as Integral to Success a The physical
demands of gymnastics often result in sustained physical discomfort, so much so that a in the
words of one gymnast a pain becomes a afact of life.a756 As one gymnast explained, aOne of the
most prevalent attitudes taught to young gymnasts . . . is silent suffering. From the beginning we
are taught to soldier on through intense training sessions, through the emotional roller coaster of
competition, through injury and fatigue, through pain.a 757 One witness, a former Olympian,
explained that many gymnasts have a mentality of a[w]hatever I need to do, I will do it. We know
gymnastics is difficult and we want it to be difficult. Whatever is put in our path, we accept it, and
do it. We donat ask questions.a758 Another recalled that she learned to look at injuries and pain as
a abadge of honor of how tough [she was].a759 Simply put, the culture awas to push the young
girls to be psychologically indestructible and stoic in the face of adversity, pain, or [any other
challenge].a760
Relatedly, many gymnasts expressed that they were reluctant to acknowledge their injuries
lest their pain be construed as weakness, which awas simply intolerable in the gym,a and could
lead to punishment or lost opportunities to compete.761 A female physical trainer recalled that an
athlete asked her to come into her room at the Karolyi Ranch to treat her privately so that she
would not be acaughta with an injury by her coach.762 On another occasion, an athlete told her
trainer that she wanted to be treated for an injury, but was atoo afraid of getting into trouble.a763
At the suggestion of her teammate, the athlete agreed to be treated in her teammateas hotel room
so she could pull a blanket over herself if the coach came in and make it appear as though she were
not the one receiving the treatment.764 As explained by a former national team member who broke
her back three times before the age of 14, aYouad rather hide the pain, even if you had a broken
bone, because you were so afraid of getting yelled at by your coach[.] You were so worried about

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looking weak in front of your coach or getting yelled at by your coach that youad just continue to
hurt yourself. It was ingrained in our heads.a765 Another former gymnast recalled that, as a 13old, she apushed through the excruciating paina of a severely pulled hamstring to complete a vault
to impress a top USAG coach, who aproceeded to yell at [her] and shamed [her] for not being
tough enough to fight through the paina more effectively.766 The coach then told her that she
awould never make the national team if [she] didnat toughen up.a767
A number of gymnasts have noted that, to the extent they did raise injuries with their
coaches or medical staff, they felt that their pain was ignored or dismissed, leading them to doubt
their own perceptions. For example, one former Olympian recalled in her memoir that a[i]f I had
ever started to talk about my pain or injury, [my coaches] would immediately cut me off,
dismissing it or making comments or gestures that I was becoming weak, faking, or exaggerating
injury out of laziness.a 768 She explained that a[t]hese negative mind games . . . confused my
psyche. I actually started to buy in to their psychology and believe that, perhaps, I didnat hurt that
much and that the sharp drilling pain in my leg was coming from my head. I remember thinking,
Is it my fault that I am in so much pain?a769 Another former Olympian publicly expressed similar
sentiments:
I was just told I was making it up. And I needed to lose weight. . . .
They always make excuses for pain. And itas just a joke. Because
you literally start thinking that your pain isnat real. I for so long
thought I was going insane. I thought I was making it up. Thatas
what everybody was telling me. Youare just making it up. You need
to work harder and eat less. And . . . then [itas] just a downward
spiral.770
One witness observed that gymnastics operated almost alike a culta in this sense, awhere what is
normal is reframed and you see everything through a funhouse mirror.a771
Exclusion of Parents/Discouragement of Parental Participation a In the interests of
avoiding unnecessary distractions, many gyms a especially those training high-level gymnasts a
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have employed policies or practices that restrict or sharply discourage parent access to their
children during training sessions or travel to competitions. For example, numerous former
gymnasts through the 2000s have reported that their parents were barred from their gyms or
restricted to specific areas in the gyms where they could not fully see or hear what was happening
on the training floor.772 Many gymnasts and staff members who trained or worked in gyms during
that time period have reported that, as a result of such policies, parents had little insight into what
actually took place during practice sessions or how their children were treated.773 As one former
gymnast said in describing her abusive coach, aHe could pretty much do whatever he wanted in
the gym because nobody was watching.a774
Although policies or practices that discourage or preclude parental involvement may be
falling out of favor, there are numerous recent examples of intentional exclusion of parents. For
example, parents were not permitted to attend training camps at the Karolyi Ranch, and this
remained the protocol through at least 2016.775 Moreover, although an unwritten rule, it was
widely understood that parents of National Team members were not permitted to travel with their
children or to stay at the same hotel based on Ms. Karolyias preferences.776 A USAG employee
explained that she often made travel arrangements for athletes and their parents, and that she
typically tried to separate them based on her understanding of the unofficial policy.777 Along the
same lines, an athletic trainer reported that parents were not allowed in treatment rooms at USAG
events except where an athlete appeared to have a serious injury.778
Social Isolation a In their pursuit of athletic achievement, many gymnasts find themselves
not only isolated from family and friends inside the gym and on the road, but also in their lives
outside the sport. The demands of elite gymnastics lead many gymnasts to asacrifice the kind of
lives other young people enjoy a school, social life, normal childhood recreation a in favor of

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home schooling, many hours of practice every day, and a limited circle of acquaintances based
around the gym.a779 This single-minded focus often means that athletes spend more time at the
gym than with their families. In one representative example, the mother of an elite gymnast
explained that she and her daughter anever really shared any teenage years together,a and that her
daughteras coach spent amore time raising [her] childa than she or her husband.780 A former
gymnast similarly recalled that once she aentered the world of competitions beyond the state line,
family vacations ended. And so did any memorable time spent with my brother.a781 The concept
of any regular social life is typically out of the question entirely. One elite coach noted that her
athlete asaw her friends that she grew up with going to prom and homecoming and all that stuff,
and she didnat get to participate in any of that, and I know that was a struggle.a782 As one former
elite team member succinctly put it, aThe only people you see are gymnasts[.] . . . The only people
you talk to are gymnasts and coaches. Socially, you have no idea what the hell is going on in the
real world. Youare so isolated.a783
Such social isolation may cultivate a certain innocence amongst elite gymnasts. As the
mother of one former elite gymnast observed, aAs a rule, gymnasts are very intelligent girls[.]
These kids can make international plane connections, make overseas phone calls, talk to the
press.a784 But, she explained, they are socially at a remove from normal life. aTheyare not thrown
in with the normal teen population.a785 Instead, as one gymnast explained, their perceptions of
anormala behavior are informed almost exclusively by the examples they see and the expectations
they feel within the four walls of the gym:
I had to accept that my coaches would yell and belittle me on a daily
basis. I wouldnat be allowed to have friends at school or go to school
dances because they were adistractions.a I would never go on
family vacations and rarely see my siblings perform in their sports.
I wouldnat be allowed to talk to my teammates at the gym because
that meant I wasnat focused. I couldnat feel like a person anymore

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if I wanted to reach my dream. I felt like a robot. This became my
anormal.a786
Given the years they spend in such isolated training environments, often from a young age, a
number of gymnasts have explained that they lacked any understanding that certain behavior was
not appropriate or constituted abuse until they were adults. For example, two sisters who were
abused by Nassar noted that they did not fully understand athe sweating and the pantinga that
Nassar exhibited during his medical treatments and did not come to recognize that they were
abused until after other gymnasts began to come forward with stories of similar encounters with
Nassar years later.787 Numerous other gymnasts noted that they believed the various forms of
abuse they endured from coaches and other authority figures in their gyms were normal, as they
lacked a broader reference point to inform their understanding. For example, in describing her
verbally and physically abusive coach, one former elite gymnast noted that he awould kind of
brainwash you into thinking all of his weird ways of disciplining you were normal, like when he
would stretch your shoulders past your breaking point until you screamed, but still wouldnat
stop.a788
Powerful Incentives for Gymnasts not to Rock the Boat a Elite gymnasts face powerful
incentives that serve to discourage them from taking any actions that could impede their singular
focus and dedicated pursuit of excellence in the sport. Perhaps chief among these is the narrow
window of opportunity in which they can achieve their goals. As one gymnast explained, aI had
a looming sense of the very narrow window of opportunity afforded me in gymnastics. Mortality
hovered persistently. Time was of the essence. Each passing year represented the narrowing of
the window, the tightening of the vise. Even the best gymnasts didnat usually compete beyond age
eighteen.a789 Another gymnast echoed these realities, remarking that a[i]n this country, gymnasts

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come built-in with an expiration date[.] Thereas this whole idea in the sport that if youare 16,
youare over the hill. So itas rush, rush, rush, push, push, push. Itas an obscene craziness.a790
In this context, some gymnasts have expressed fear that any distraction from their singleminded focus on their dreams may make it aimpossible to catch upa before the window of
achievement has closed.791 Because of these pressures, there is a sense that agymnasts are not
allowed to miss a season, rest and recover from injuries, or otherwise lose time.a792 Every training
day, every competition, is another building block for the foundation of an Olympic or college
career that must be developed in the span of a few short years. As one witness observed, aOne
thing that is clear about the USAG child population is how vulnerable they are. They are physically
very strong, but many of them live or die on whether they move on to the next competition, obtain
a college scholarship, etc. They have no power in that dynamic.a793
The incentives to carry on and prevail at all costs in order to maximize the potential for
success within a narrow window of achievement are amplified by a host of other pressures on elite
gymnasts, including not only their own personal level of investment and sacrifice, but also that of
their families and the intense pressure not to let their teammates down or disappoint the broader
community.
Personal Sacrifice. As described above, elite gymnasts make many sacrifices for their sport.
They endure physical pain and the constant risk of injury. They give up the typical diversions and
levity of childhood. In the words of one former gymnast, aPeople see the overall impression, the
tricks, the pretty music. They donat realize how hard we work, how much pressure weare under,
how much we give up of a normal life.a 794 Another witness observed that the lives of elite
gymnasts are often so exclusively devoted to gymnastics that it may be difficult for them even to
imagine any life outside of the sport.795 As an elite gymnast explained, aTo be able to excel, you

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have to live the sport youare doing. You have to eat it, sleep it. Itas a full-time job. It takes so
much of our time, thereas not much time to do otherwise. All I know now is gymnastics.a796 A
former Olympian captured the all-encompassing level of personal sacrifice when she observed that
a[t]he cult culture of Gymnastics convinces gymnasts that there is nothing more important than
their gymnastics. This thinking creates a mindset of knowing that they will sacrifice, they will
abide, they will do what they are told, they will always come second, and they will only be valuable
if they succeed.a797
Sacrifice by the Entire Family. An elite gymnastics career often involves immense
sacrifices by the athleteas family. For one, families of elite athletes must contend with the
substantial financial commitment required to fund the athleteas training, equipment, competition
fees, travel expenses and a whole host of other ancillary costs. That often means that parents,
brothers, sisters and other family members must ado without a lot of thingsa to enable the athlete
to pursue her Olympic dreams.798 As the mother of one Olympian recalled,
I didnat realize when I got into this sport how expensive it was. Just
the commitment over the years, sometimes it felt crushing. I didnat
think Iad be able to keep her in the sport. But then Iad think about it
and say: youave got to fight. If I had to sell, I sold almost all of my
jewelry, if I had to pick up extra shifts at work. Whatever it takes.799
Beyond the financial pressures, families of elite athletes often rearrange their whole lives to
accommodate the athleteas training and competition schedules, giving up the ordinary trappings of
family life and their own pursuits in the process.800 Sometimes, families must also make the
difficult decision to move or live apart in order to better support an athleteas career. As the mother
of an elite gymnast recalled:
We moved out of state, we lived with my father for a short time, we
lived with other team members that were near the gym as training
got more intense, we moved into a small apartment for [a year and
a half] in a dangerous area so we could be 3 [minutes] from the gym.

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Family vacations were . . . not even [to] be thought about. Life with
an Elite gymnast is just that, Gymnastics!801
A number of gymnasts have observed that such familial sacrifices increase the pressure
they feel to persevere at all costs in order to justify the investments that have been made on their
behalf. One elite gymnast noted that she trained with serious injuries because ayou donat want to
let your parents down. You think theyare spending all this money and time on you, and you donat
want them to think itas not worth it.a 802 Another recalled that, aMiserable as I was, I didnat
seriously entertain the idea of quitting gymnastics. After all my family had sacrificed and my
coaches had invested, it was out of bounds.a803 A long-time elite coach similarly stated that when
she asks athletes awhat they are stressed about, a lot of times they will say ait is so hard for my
parents to pay for this and [they] will be so devastated if I donat make the team.aa804
Notably, as Joan Ryan documents in her 1995 book, Little Girls in Pretty Boxes, families
may become so invested in an athleteas career by virtue of their own sacrifices that they have
difficulty stepping back enough to even recognize that the environment may be unhealthy, let alone
take the steps necessary to extricate and protect the child. In the book, a mother recalled that she
became obsessed with her daughteras elite gymnastics career and did not want her to quit even
when her daughter developed bulimia and depression in connection with the pressures of her
burgeoning career: aWe had come too far[.] It was to the point where if one girl quit the gym, you
wouldnat let your daughter spend time with her. You didnat want her to find out there was more
to life.a805 She went on to explain that when her daughter did quit the sport, she was overcome
with grief and anger: aI was grieving the loss of everything we put into this. I knew she could
have walked away with medals at the Olympics. Iall tell you what itas like. Itas like a death. All
the steps you go through when someone close to you dies. It was the same thing. Overnight a
door slammed shut.a806 When another elite gymnast told her mother she wanted to quit, her mother

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recalled to Ryan that she responded, aI put this much time and effort into this and, by God, if you
think Iam going to let you quit now, youare crazy. If I have to literally go out there and get up on
the beam with you, youare going to do it. If I have to beat you every day, youare going to do it.a807
Another mother dismissed her daughteras suggestion that she endured mental abuse during the
years she was coached by Mr. Karolyi, telling Ryan that if she had another daughter with talent,
she would send her to him because he was the best coach in the world.808
In addition, a witness noted that families may be reluctant to acknowledge an unhealthy or
abusive environment because doing so could hinder a childas achance to become the big championa
and upset everything that she and the family had worked so hard for.809 He explained, aI know
from experience that some of the parents knew that one gymnast was molested and even had sex
with a coach. They didnat take all the kids out of the gym and make a group protest . . . and write
to USAG or do something; they stayed with that coach. It happened in my gym.a810 A gymnastics
judge recalled a similar story: she explained that she filed a disciplinary complaint after witnessing
a coach hit his athlete, but the parents of the athlete refused to pursue the complaint even though
they were aware of the incident.811 To the contrary, they sided with the coach after he threatened
to bar their daughter from his gym, potentially upending her ability to secure a college
scholarship.812 As the father of the athlete said, the family afelt like we had no choice.a813
The Burden on Their Shoulders. Even beyond the pressures that arise for elite gymnasts
from their own intense dedication to the sport and that of their families, there is an enormous
weight of responsibility to deliver for the team a their teammates and coaches a as well as for the
broader community. As one coach described the pressures that rain down from all sides on these
young gymnasts:
The amount of pressure to succeed, to win, to have the best
execution, the most difficulty, the right look is mind boggling.

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There is so much judgment from everyone, spoken and unspoken.
The athletes want this so bad. They have worked their entire lives
for a coveted spot on the national team, worlds team, Olympic team.
Family and even friends want it for them. Their home clubs want to
see them succeed. Their state, their region, their school, and even
their town.814
In certain respects, this pressure is amplified as elite athletes advance in their careers and are within
striking distance of achieving the dreams they have chased and sacrificed for their entire lives. At
that critical juncture, they may be willing to do almost anything, to push through any challenge, to
pay any price. And they often do, with the full assent, whether implicit or explicit, of their
teammates, coaches, families and communities.
There is perhaps no more telling example than Kerri Strugas iconic vault on a badly
sprained ankle at the 1996 Olympic Games. At the time, the US team believed that the vault had
to be completed in order to secure the gold medal. 815 As millions of spectators watched on
televisions around the word, Ms. Strugas coach, Mr. Karolyi, screamed ayou can do ita816 from the
sidelines and sent her barreling down the mat without knowing the extent of her injuries or whether
she risked permanent harm.817 And when she stuck her landing before hopping on one foot and
collapsing in pain, the Olympic stadium and living rooms all over the world filled with cheers.
That moment has since become a source of national pride. And yet it also serves as a warning
about the casual disregard for athlete safety by those entrusted with their welfare and the
overwhelming pressure on athletes to persevere at any cost.
Ms. Strugas perseverance in the face of injury and pain is remarkable, but it is not unique
among elite gymnasts. As one former athlete commented,
[I]n the microcosmic world of hyper-competitive athletics, a highperformance culture where winning trumps all, obvious moral
choices become blurred. The sport, the team, a berth on the squad,
a medal on the stand a that becomes the priority. The parents,
coaches and teams put everything else aside in honor of the win. I
know this firsthand[.]
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I competed on broken bones, with black eyes, and went days without
food. I broke my femur and had the cast removed more than a few
weeks too early so that I could get back to training in time to
compete at the U.S. Championships. I broke the opposing legas
ankle in the process - but I competed and won. Two bum legs, but
I got the trophy. There was never any question about what Iad do.
Long-term damage didnat matter. My mental and emotional health
didnat matter. Winning did.818
After devoting their lives to the pursuit of excellence in the sport, few elite gymnasts would be
willing to risk foregoing the very things for which they had worked so hard and so long by saying
no to competing with injuries or otherwise speaking up or stepping back.
Moreover, because the selection procedure for major competitions is highly subjective and
the standing of even the best gymnasts is constantly being re-evaluated from competition to
competition, 819 many athletes believe that speaking up about anything could have negative
consequences for their gymnastics careers. As summarized in a legal complaint that a gymnast
filed against USAG: aThe perfectionist culture and the insular politics of the sport [mean] that the
consequences of speaking out are too great for these young girls with dreams of the National Teams,
as it could mean the difference between qualifying up or flunking out.a 820 As one witness
commented, it was a given that aif you speak out, you are done.a821 Athletes who did so were
aviewed as aproblems.aa822 As one witness explained, aThe nail that sticks up gets hammered
down. This is a sport based solely on judgments, there are no objective criteria. Your life, future
depends on the selection process. If you rock the boat, you are kicked off.a823
Beyond concerns for preserving oneas place on the team, several witnesses discussed other
potential risks that may elevate the pressure on athletes to maintain course and keep quiet to avoid
making waves. With specific reference to speaking up about abuse, a witness observed that many
athletes have a adeep concerna about how their decision to come forward awill affect [their]
teammatesa and how they will be treated by their teammates in response.824 She explained that

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this concern is well-founded abecause this type of thing can tear teams apart . . . [i]n terms of who
they believe and donat believe.a825 The experience of a survivor of Nassaras abuse suggests that
the question of whether and whom to believe also reverberates through the larger sports
community, only intensifying the pressure on athletes who may need help but fear the
consequences of seeking it out: aJust as I feared, many didnat believe me. Some of the comments
on social media were incredibly hurtful. I was accused of making the entire thing up for attention.
The most disappointing part was that many of the people saying these negative things were those
I had considered friends.a826 And because their abusers are often master manipulators who have
attained a level of cult status or recognition in the sports community,827 athletes often bear a very
real risk that they will similarly be shunned, shamed or disbelieved if they come forward.
B.

The Unique Cultural Influence of the Karolyis and the Karolyi Ranch

No discussion of the cultural conditions in womenas gymnastics in the United States during
the period of Nassaras abuse would be complete without addressing the influence of Mr. and
Ms. Karolyi on the sport, and the role they played in driving the cultural conditions in elite
gymnastics to further and further heights of intensity. As one journalist has observed, aThe way
most people tell it, the story of American womenas gymnastics has a before and after: Before the
Karolyis and After the Karolyis.a828 In the popular narrative, much of the phenomenal success
enjoyed by the Americans on the international gymnastics stage is attributable to the Karolyis,829
who together played a leading role a either as Head Coach or National Womenas Coordinator a in
every Olympic Games since 1988.830 And in the Olympic Games before that, in 1984, the Karolyis
were the personal coaches to the first American all-around champion, Mary Lou Retton.831 During
their tenure, the Americans secured a staggering 97 World and Olympic medals for womenas
artistic gymnastics.832 This remarkable track record gave the Karolyis outsize influence in the
sport, establishing their training methods as the gold standard for many years.
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The Karolyisa training methodology has been described in different ways by different
people, with some extolling its virtues and others condemning it as unduly harsh or even
abusive.833 But there appears to be a general consensus about certain of its fundamental attributes
a namely, an expectation of absolute perfection and a single-minded and exacting focus on an
athleteas training and performance-readiness to the exclusion of everything else. This heightened
level of perfectionism and intensity pushed elite gymnasts further still to succeed ano matter
what.a834 And when those pressures were coupled with the harsh and isolated conditions at the
Karolyi Ranch, they together gave rise to a perfect storm of circumstances that facilitated and
enabled Nassaras abuse of elite gymnasts during training camps at the Karolyi Ranch, where
Nassar had broad latitude to commit his crimes far from the girlsa parents and free of childprotective rules and effective oversight.835
1.

The Karolyisa Approach to Training

The Karolyisa training methods were cultivated in their native country of Romania and are
a product of the totalitarian Eastern Bloc mindset. 836 This system allowed for no dissent or
emotion, instead requiring absolute submissiveness and a singular focus on gymnastics to the
exclusion of family, school, the ordinary trappings of childhood or anything else. As Mr. Karolyi
has described the system: aYou get the child at an early age; you follow her; her life is directed
towards performance[.] They are living, breathing and eating the sport a in a special environment
directed to the highest quality of athletic preparation.a 837

In this vein, young children

demonstrating athletic promise were plucked out of kindergarten classes and enrolled in a
government training program, often alone and far from home, with the goal of competing at the
elite level before the astorm of pubertya hit. 838 A choreographer who worked alongside the
Karolyis in Romania recalled that nine- or ten-year-old children were subject to rigorous physical
training a alike the marine corps but more extremea a in daily morning and evening workout
128

sessions, each lasting several hours.839 He recalled that, in conjunction with this conditioning
regimen, the gymnastsa diets were carefully monitored and restricted to keep their weight
artificially low and delay puberty.840 In the words of one former Romanian national team gymnast
who trained with the Karolyis under that system, ahunger was our eternal enemya and athe methods
by which [we were kept] away from food probably could have killed us.a841 Under this system,
the athletes functioned as a means to an end a winning medals a and were discarded if they deviated
from the path that was laid out for them, demonstrated any weakness or failed to live up to their
perceived potential. As Mr. Karolyi himself described it: aYou were not good? Good-bye. If you
goofed off once, you were out in two minutes. As a coach, I had no obligation to you. That was
just the political system.a842
The central feature of the Eastern Bloc system of training was complete control over the
athlete. This control extended to every facet of the athleteas life. As one Romanian coach
explained to a reporter:
Here, as coach, for 24 hours I know what happens to my gymnast a
I know how she sleeps, what she eats. Itas difficult in other countries
to say to a family: aShe leaves home on Jan. 1 and comes back on
Dec. 25.a They say: aYou are crazy.a Here the family gives me 100
percent power to make what I want with this child. They say: aI
give you this girl and I come two or three times a year.a843
Many former participants in the Romanian gymnastics system have explained that this level of
control over the athletes was reinforced through a system of forced isolation from the outside world.
For example, after the Karolyis coached Ms. Comaneci to Olympic gold in 1976, they built a
training center in a remote location aaway from everythinga where they could cultivate more
champions.844 The training center was built at the bottom of a huge hill with a fortress at the top,
allowing ano escapea or access to outsiders a however the Karolyis chose to define the term.845
aParents were not allowed to even get close to the facilities.a846

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Beyond Romania, Ms. Comanecias success brought the Karolyis global recognition and
appeared to validate their training methods around the world. When they defected to the United
States several years later, in 1981, the Karolyis were already a brand name.847 Although they
struggled in the early days after their defection, established elite gymnasts from across the country
left their coaches and started to flock to a gym the Karolyis set up in Houston in 1982.848 And as
these gymnasts won more titles, the Karolyis received much of the credit, further reinforcing the
merits of their training methodology.849 For example, Mary Lou Retton had been training with the
Karolyis for only two years when she became the first American to win an all-around gold medal
in womenas gymnastics at the 1984 Olympics, scoring two perfect 10s along the way.850 Her
success was viewed as further proof of the efficacy of the Karolyisa training methods. And the
Karolyisa influence continued to grow.851
Although the Karolyis moderated many Eastern Bloc practices to better align with
American mores a and what American gymnasts and their families would tolerate a certain of their
practices remained as before. For example, as in Romania, the training regimen was exceptionally
rigorous and all-consuming. The Karolyis doubled the amount of hours that gymnasts were
expected to train every day, and in so doing, asingle-handedly refashioned the U.S. system of
gymnasticsa as gyms across the country replicated the new model. 852 Practices focused on
aseeking perfection every single time,a and some gymnasts reported that they were publicly
berated or kicked out of the gym a occasionally for good a when they failed to deliver.853 As
Mr. Karolyi explained, aGymnastics is not for fun[.] . . . It is not golf. I believe everything
worthwhile is hard. Mildness is not the proper approach. You always have to be demanding,
always asking for more. As long as you want to create something better, you have to be hard. If
you want to be the best, you have to get the most out of every minute.a854

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Similar to the model they had developed in Romania, the Karolyis built a training center a
the Karolyi Ranch a in a remote and isolated location, deep within the Sam Houston National
Forest in Texas, atwo hours away from nothing.a855 A gymnast recalled:
In the case of an emergency, the closest hospital is so far away,
youad need to be helicoptered there. To get to the ranch, you must
drive up a dirt road for what seems like an eternity[.] . . . On top of
that, there is no cell service. Itas completely isolated, and thatas no
mistake. That is how the Karolyis wanted it.856
During the early years, before the Ranch became a USAG-designated National Training Center,
parents were ostensibly permitted to observe regular practices, but their ability to do so was often
limited. As described by a staff member who then worked at the Ranch, there was a alittle viewing
area in the back of the gym,a but Mr. Karolyi aput up a blinda that could abe open[ed] or closed
from inside the gym.a857 One gymnastas mother was a constant presence at the gym; according to
the staff member, Mr. Karolyi awould smile at [her and] then close the blind.a858
Although there were many hallmarks of intensity, or even harshness, in American womenas
artistic gymnastics before the Karolyis entered the scene, 859 the Karolyisa success arguably
normalized and even exalted certain of these elements. As one gymnast recalled, aother coaches
saw that [the Karolyis] were winning and thought, aThis is the way you have to coach.aa 860
Another gymnast expressed a similar sentiment about other coaches: aThey wanted to win and
nothing else mattered. They took on the demeanor of those eastern European coaches who trained
the worldas best. They aspired to Bela Karolyias greatness, confident that if they mimicked his
approach, theyad produce girls as perfect as Nadia.a861 A coach agreed with these sentiments,
explaining: aI grew up in the culture of Bela and Martha and thought that they were it a because
they were it. And we all saw that and when they then became the leaders you had to follow that
leadership or you wouldnat have a place. And so we all did that for a period of time, me
included.a862
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Criticisms of the Karolyisa training methodology were often adrowned out by applausea as
their athletes kept winning medals.863 And in those rare instances when gymnasts did speak out
against the Karolyis, they were ostracized by the gymnastics community or derided by the public.
For example, after a member of the Magnificent Seven a the team that won gold in the 1996
Olympics in Atlanta a publicly accused Mr. and Ms. Karolyi of emotional and physical abuse
during the years she spent training with them from age 10 to 14,864 she was ashunned, blacklisted,
and criticizeda by the gymnastics community.865 In a magazine piece recalling the experience
years later, she wrote:
Hate mail came a from former fans who didnat want to hear what I
had to say and from high-ranking coaches in the system who accused
me of stabbing gymnastics in the back.
To USAG, I became a non-person. I stopped receiving financial
opportunities and referrals, I was no longer invited to speak at and
attend many events, and very few athletes came to my defense or
chose to corroborate what I had to say, even though they had seen
what I had seen.866
As another example, when a member of the 2000 Olympic team commented that Mr. Karolyi ahas
too much controla and unfairly atakes credit when we do good, and blames everyone else when
we do bad,a a popular sports journalist denounced the gymnastas aaccusatory, finger pointing trilla
and came to Mr. Karolyias defense:
Bela Karolyi is everything the United States needs[.] The problem
is not that Karolyi has too much control of U.S. gymnastics, but that
he hasnat had enough, and unless he is given full authority over the
program for the next four years, you can look for another scattered,
artless performance [at the next Olympics.]867
Another sports journalist similarly opined that a[t]he U.S. gymnastics program needs Karolyi, not
only as a team leader, but as a touchstone. The ones who donat agree need to either look at a mirror
or a scoreboard.a868

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2.

Establishing a Semi-Centralized Training System in the United States

The perception that the Karolyisa training methods were inextricably tied to the success of
the American team was bolstered by the medal-free years following their retirement after the 1996
Olympics. Following disappointing showings at two consecutive World Championships869 a and
with an eye toward achieving the organizationas self-proclaimed athree major objectivesa of
amedals, growth, and visibilitya870 a USAG brought Mr. Karolyi out of retirement in 1999 to serve
in the newly created position of aNational Team Coordinatora and to oversee a new semicentralized national team training system that had been designed by the Karolyis.871 From that
point on, members of the National Team (and their coaches) were required to participate in regular
training camps at the Karolyi Ranch under the direction of the National Team Coordinator, who
agreed not to train individual gymnasts to avoid conflicts of interest.872 These monthly check-ins
provided an opportunity for the National Team staff to evaluate and compare each gymnastas
physical fitness, technique, consistency and demeanor as part of a newly revised selection
procedure for the Olympic team.873 Whereas the composition of previous Olympic teams was
largely informed by individual rankings at certain competitions, the new selection procedure was
a more subjective, centralized, closed-door process that was intended to construct a team that
would maximize the chance of achieving the highest score on each apparatus.874
On the one hand, the new semi-centralized training system represented some positive
developments for athletes a and turned out the most successful womenas gymnastics teams in
American history. It provided an opportunity for athletes and coaches around the country to
develop relationships with one another and cultivated a new unity and cohesion in the sport.875
Because coaches were also given technical support and instruction to help them advance along
with their athletes, it made it less likely that athletes would need to leave their homes and local

133

coaches to pursue better training opportunities at other clubs.876 As one coach explained to a
reporter:
I just got an incredible amount of education from the national staff[.]
They see [my athlete], they see her talent, and they know that I didnat
have the tools necessarily to get her where she needed to be. So
instead of saying [to my athlete], ayou need to go to another gym,a
they said [to me], aweare going to teach you how to get her where
she needs to be.a I will forever be grateful for that because now I
feel like I am a coach of a world champion, not like I was somebody
who had talent that I let slip away because I was too afraid to get my
hands in there and work for it.877
And the new selection procedures ushered out the rigid rules that had previously been operative a
where, for example, subject to an exception for injured athletes, the Olympic team was to be
determined solely on the basis of a gymnastas scores at the Olympic trials.878 The new selection
procedures, while a complete black box to athletes, allowed for more open-ended consideration of
relevant factors, and thereby allowed for the possibility that one bad day at the Olympic trials or
other previously critical competitions would not disqualify an athlete from attaining her Olympic
dreams.879
On the other hand, however, the new semi-centralized training system effectively served
to consolidate the Karolyisa dominance over the sport and enshrine their intensive training
methodology as the new American way. Perfection was the expectation, and by many accounts,
nothing less was tolerated. As Ms. Karolyi herself explained, aItas a very serious atmosphere to
try to come as close as possible as perfection[.] You have to find out who are the best ones, who
are the best ones who are able to stand the pressure?a880 Athletes were closely scrutinized from
the moment they stepped into the gym a which, to demonstrate their commitment, was advisedly
at least fifteen minutes before the scheduled training session.881 Many arrived in make-up and
with their hair styled, just as they would for a competition, to signal that they were aready and
alert.a882 Beginning from the gymnastsa first line-up, everything from their abody posturea to the
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aexpression on their facea was closely monitored to assess awho has confidence and who has fallen
behind.a883 As one gymnast recalled, aEveryone is watching you; they watch every move you
make[.] You just want every move to be perfect.a884 Athletes were generally expected to keep up
with the rigorous training regimen regardless of whatever injuries or challenges they may have
been facing: aYou felt like you had to do everything they asked you to do, no matter what, no
matter how injured you were[.] . . . I remember a time when I had to come crawling back on the
vault runway because my shin was hurting so bad, but you had to keep going.a885
Many athletes have reported that the isolation of the Karolyi Ranch and its acomplete
detachment from the outside worlda ensured that there was little relief from its all-consuming
pressures even outside the gym.886 One gymnast described the experience as akin to a afishbowl,a
suggesting that she always had to be on because she never knew who was watching. 887 In
particular, she explained that mealtimes were stressful, and that aeveryone felt they were being
fully watcheda with every bite.888 To deal with this pressure, one athlete noted awe just donat
eat.a889 Another gymnast noted that aMartha would kinda look around, and she would comment
when people had like very little food on their plate, and shead be like, aeating so well.aa 890
Speaking more broadly about her experience at the Karolyi Ranch, one gymnast publicly explained:
Martha was the national team coordinator but the way I saw it, she
sort of had control over anything and everything that went on at the
ranch[.] . . . She knew what was going on every second in the gym.
She knew how many routines that we did. She knew what we were
eating. She knew our treatments. So it was just, when you go there,
you know that Martha is watching. Everything youare doing, sheas
watching.891
As one former USAG executive said in a private text message, awith [Ms. Karolyi], everyone was
afraid to sneeze.a892 In a telling anecdote, an Olympic gymnast publicly recalled that she and her
teammates were even afraid to ask for more soap when it ran out, explaining that a[n]obody wanted

135

to be the one who was difficult.a893 On a separate occasion, she explained, aI felt like I sometimes
did well out of fear.a894
Many athletes have also reported that the selection process for the Olympic team
exacerbated the pressures they felt. One gymnast explained that the general perception was that
aif you donat follow the rules, and you donat do what we say, then thereas pressure that youare not
going to make the Olympics team.a895 The team was chosen aat the last possible moment to ensure
that the athletes were always competinga and that their status was never ensured.896 One former
Olympic gymnast reflected:
[Y]ou feel like every move is like, this is me making the team or not,
you know? And that moment and that amount of pressure had been
building up since like, for years[.] . . . And they never say that
youare on the team. They never say that until youare there and
youave competed the first day. So theyare always just like awe can
switch you out, donat get big in your head.a897
Another former Olympian agreed, explaining that athe way the system was set up, . . . nothing was
guaranteed. Itas all about who can hit when it matters.a898 Another gymnast likened the process
to an episode of Survivor: aIt was just, aWeall just run you down, wait atil we find the last man
standing and weall see what the team is.aa 899 This high-pressure environment fueled constant
apprehension among athletes, who recognized that missteps in practice at the Karolyi Ranch could
have a direct impact on their Olympic dreams. As a former USAG executive told the media,
athletes were aprobably more nervousa in the camps athan they would be in a competition a and
thatas the goal.a900
C.

Cultural Priorities of Olympic Organizations

The USOCas and USAGas open emphasis on winning medals played a role in informing
athlete perceptions of the organizationsa priorities. As former CEO Scott Blackmun stated with
regard to the USOC, aWe are in the medal business.a901 Former USOC counsel Gary Johansen

136

echoed Mr. Blackmunas statement in a deposition, explaining that a[t]he USOC has a lot of
prioritiesa and a[c]hief among them is sending athletes to the Olympic, Pan American and
Paralympic Games and doing well at those Games.a902 USAGas leadership has expressed similar
sentiments over the years. Former CEO Robert Colarossi stated back in 2000 that USAG is guided
by three principles a amedals, growth, and visibility.a And Mr. Colarossi reported in his interview
with the Independent Investigators that, to this day, he believes that everything the organization
does is afunneleda to those ends.903 Consistent with these goals, Mr. Penny evaluated USAGas
success in terms of its medal count and bottom line. Boasting to a reporter in the spring of 2015,
just months before USAG would become embroiled in one of the worst sexual abuse scandals in
the history of sport, Mr. Penny remarked:
You want to take a picture of a prototypical NGB, you take a picture
of us[.] . . . Weare winning medals. Weare the No. 1 country in the
world in the medals count. We have probably one of the strongest
social media followings in the Olympic movement and the value of
our social media actions are as great as anything. Our sponsor
relationships are very solid. We do a great job of promoting our
events, our ticket sales. Every metric that I could provide you is
going up. We have money in the bank. We have a pretty decent
nest egg.904
According to Mr. Penny, aMy mission has always been to keep elevating the stature and brand
recognition and relevance of the organization.a905
Against this backdrop, many athletes have expressed frustration, dismay and concern that
USAG and the USOC are focused almost exclusively on winning, to the detriment of other values
in sport, and that their individual welfare is subordinate to the organizationsa medal-count mission.
For example, numerous athletes have publicly expressed the following sentiments:
i*

aTheir biggest priority from the beginning and still today is their reputation, the medals
they win and the money they make off of us.a906

i*

aI think U.S.A. Gymnastics for a very, very long time has focused on nothing but winning
gold medals.a907
137

i*

aIad like USA Gymnastics to overtly say they put the athlete first, but they donat put the
athlete first.a908

i*

aYoung athletes who dedicate mind, body and soul to their love and dreams in sport have
been primed for sexual abuse by USA Gymnastics through perpetual judgment and
punishment where they are treated as machines, not humans, conditioned to comply never
complain.a909

The perception that athletes are but a means to an end, even as they are the centerpiece of the sport
for brief moments in time, has been lamented by numerous athletes, including one former elite
gymnast, who observed that, as soon as athletes retire from competition, they are simply acut and
released.a910 From that point, she noted, the athlete becomes persona non grata to the organization,
with no alumni association or institutional acknowledgement of the athleteas contribution to the
sport.911 As a former elite gymnast put it: aWe were treated like a business plan.a912
On November 3, 2016, USAG engaged former federal prosecutor Deborah Daniels to
conduct an independent review of USAGas policies, procedures and bylaws regarding sexual
misconduct matters.913 Following a multi-month review, Ms. Daniels issued a report on June 26,
2017 concluding that USAG aneeds to undergo a complete cultural changea and adopt a culture in
which the organizationas atop priority is the safety and well-being of its athletes, not just their
success on the field of play.a914 The same day, USAGas Board of Directors unanimously agreed
to accept Ms. Danielas 70 recommendations to remediate the significant cultural problems that
permeated the organization.915 A number of her recommendations have yet to be implemented.916
The USOC determined that USAGas prospects for fully implementing the recommendations were
apoor,a a factor the USOC noted in its November 5, 2018 decision to initiate decertification
proceedings against USAG.917 xli

xli

USAG filed for Chapter 11 bankruptcy on December 5, 2018. Bankruptcy Petition, Court Filings on file with the
Independent Investigators.

138

V.

OLYMPIC GOVERNANCE STRUCTURE AND THE DISCONNECT BETWEEN
ADOPTED POLICIES AND EFFECTIVE ACTION
A.

A
A

A
A

A

A

A

A

United States Olympic Committee

SELECTEDA FINDINGSA

A

iSS

TheA USOCasA governanceA structureA evolvedA overA theA decadesA fromA aA dispersedA
committeeabasedA structureA towardA aA moreA traditionalA corporateA model.A

A

iSS

TheA USOCA adoptedA aA deferential,A serviceaorientedA approachA toA theA NGBs.A A

A

iSS

NoA laterA thanA 1999,A theA USOCA wasA alertedA toA theA riskA ofA childA sexualA abuseA inA
gymnastics;A inA 2004,A theA USOCA reportedlyA wasA similarlyA apprisedA ofA theA riskA ofA
childA sexualA abuseA inA theA sportA ofA swimming.A

A

iSS

TheA USOCA didA notA viewA itselfA asA aA youthaorientedA organizationA andA wasA delayedA inA
recognizingA theA needA toA adoptA globalA childaprotectiveA measures.A

A

iSS

WhenA theA USOCA beganA toA addressA theA threatA posedA byA childA abuseA inA lightA ofA theA
publicA reportingA ofA abuseA inA USAA SwimmingA inA 2010,A itsA responseA wasA slow.A A AndA
duringA theA delayedA implementationA ofA SafeSportA policies,A theA USOCA maintainedA aA
deferentialA approachA towardA theA NGBs,A resultingA inA aA continuationA ofA policiesA atA
theA NGBA levelA thatA wereA ineffectiveA inA protectingA athletes.A A

A

iSS

PatternsA ofA inadequateA policiesA andA practicesA emergedA acrossA theA NGBs,A includingA
overlyA formalizedA complaintA processes,A lackA ofA sufficientA trainingA forA employeesA
handlingA sexualA abuseA matters,A andA inadequateA attentionA toA theA riskA ofA retaliationA
againstA athletesA andA othersA forA raisingA complaints.A

A

iSS

TheA USOCasA deferentialA governanceA approachA affectedA theA structuresA thatA
enabledA NassarA andA hisA systemA ofA abuse.A A ForA example,A theA USOCA enteredA intoA aA
marketingA relationshipA withA theA KarolyiA Ranch,A theA USAGA NationalA TeamA TrainingA
Center,A wherebyA theA USOCA lentA itsA nameA andA brandA toA theA Ranch,A allowingA itA toA
callA itselfA anA OlympicA TrainingA Site,A butA tookA noA stepsA toA ensureA thatA USAGA andA theA
RanchA enactedA policiesA consistentA withA theA highA qualityA thatA theA OlympicA brandA
conveyed.A A TheA USOCA alsoA permittedA USAGA toA continueA toA credentialA NassarA forA
futureA OlympicA GamesA notwithstandingA theA negativeA reviewA NassarA receivedA fromA
theA USOCA atA theA LondonA Games.A

A

139

1.

The Ted Stevens Act Endowed the USOC with Broad Powers and General
Purposes

The USOC and the NGBs are part of the patchwork structure of the national and
international Olympic movement. The movement centers on elite athletes performing on the
Olympic stage once every two years, but it also encompasses a wide range of athletes, coaches,
trainers, officials, governing bodies, international organizations, clubs, teams, training facilities,
medical networks, partnerships and sponsors, among many other interested parties.

The

participants in the broader Olympic movement range from elite athletes perfecting their craft at
national training camps to young athletes participating in recreational activities at local clubs. Yet
unlike in other countries, in the United States there is no aministry of sporta responsible for
overseeing this broad swath of athletic activity. In addition, Congress does not provide the USOC
with annual funding.918 Instead, the USOC and the NGBs engage in fundraising and develop
Olympic sports in accordance with powers and responsibilities rooted in a statute passed in 1978,
the Ted Stevens Act.919 xlii
Congress drafted the Ted Stevens Act to address the issues then plaguing Olympic
organizations and amateur sports in general a in particular the disorganization in the sport
governing bodies and the arbitrary rules dictating which athletes could participate in the Olympic
movement. After reviewing the report of a commission appointed by President Ford and charged
with recommending solutions (the aCommissiona), the Senate Committee on Commerce, Science
and Transportation concluded that the Olympic organizationsa adifficulties lie in failing to join
together for the purpose of increasing athletic opportunities.a920 The Committee, implementing
the findings of the Commission, therefore recommended increasing the opportunities available to

xlii

On November 2018, Congress authorized $2.2 million in funding for the U.S. Center for SafeSport. Eddie Pells,
Govt Olympic funds not usable for abuse probes, ASSOCIATED PRESS (Nov. 8, 2018),
https://www.apnews.com/ce0508e3649b402aa2540bfa46712733.

140

athletes and decreasing the tension between competing organizations, by creating a avertical sports
structure, using the USOC as the coordinating body through which amateur sports organizations
could work to be responsive to the needs of the Nationas amateur athletes.a921 To achieve that
goal, the Commission recommended expanding the charter of the USOC to grant it additional
powers to (i) coordinate organizations and resolve factional disputes, (ii) better protect athletesa
ability to participate and (iii) ensure a sufficient level of funding from non-governmental sources
to achieve these aims.922
Congress adopted these recommendations in 1978 by passing the Ted Stevens Act. First,
the Act resolved the issue of inter-factional disputes by creating a vertical structure that provided
the USOC with the authority to grant essentially monopoly power to an NGB to develop athletes
for a specific Olympic sport. 923 There are currently 50 NGBs. 924 Second, the Act protected
athletesa ability to participate by recognizing an athleteas right to compete in amateur athletic
competitions and granting the USOC the authority to develop procedures to resolve disputes.925
Third, the Act endowed the USOC with exclusive rights to the Olympic trademark and associated
marks to provide the USOC with a means of generating revenue.926 In particular, the familiar Five
Rings mark has provided the USOC with the ability to form strong partnerships with sponsors and
to generate volunteer enthusiasm through what one former USOC employee colorfully referred to
as aFive Ring Fever.a927
Aside from vesting powers in the USOC, the Ted Stevens Act initially provided the USOC
with a list of 14 apurposes.a928 xliii These purposes ranged from establishing national goals for
amateur athletic activities, to promoting and encouraging physical fitness, to encouraging the
development of sports medicine and sports safety.929 The Act also included other key governance

xliii

In 2018, the Act was amended to add a fifteenth purpose, ato promote a safe environment in sports that is free from
abuse, including emotional, physical, and sexual abuse, of any amateur athlete.a Pub. L. No. 115-126 (2018).

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provisions, including the creation of the Athletes Advisory Council to aensure communicationa
between the USOC and the athletes, and the requirement that athletes hold at least 20 percent of
the voting seats on both the USOC and the NGB boards.930
The broad powers and general purposes in the Act shaped the development of the USOC,
which became a parent organization overseeing a wide range of athletic activity in the United
States, much of which was only loosely tied to the Olympic Games. And at its core, the USOC
continued to reflect the animating purposes behind the Ted Stevens Act: ensuring that the United
States was producing athletes who could compete at the highest level on the international stage by
decreasing internal tensions at NGBs, providing athletes with a fair process for selection and
providing NGBs and athletes with the resources necessary for the NGBs to develop and support
highly skilled athletes. The Ted Stevens Act, however, provided the USOC with little concrete
guidance concerning how to pursue these broad goals, and the USOC has consequently adopted
various approaches over the decades.
2.

The USOCas Evolution Toward a More Traditional Corporate Structure
Corresponded with an Increased Focus on Generating Revenue and Athlete
Success and a Diminishing Voice for Athletes in Governance

In general terms, the USOCas approach evolved from a governance structure with diffused
decision-making across a large aHouse of Delegatesa and various committees to a model akin to a
modern, professional non-profit. With this governance change, the USOC placed a heightened
emphasis on earning medals and generating revenue. These goals are necessarily connected as
athletic success attracts sponsors, who in turn provide the private funding necessary to support the
athletes of Team USA. Alongside these developments, however, the USOC did not incorporate
effective policies and structures to provide athletes with either a strong role in governance or an
effective avenue for raising complaints.

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In the years following the enactment of the Ted Stevens Act, ultimate authority at the
USOC resided in the House of Delegates. This was the body that adopted the USOCas initial
bylaws and that resolved to boycott the 1980 Moscow Games by a vote of its 275 members.931
Given its size, the House of Delegates governed through a committee system, but this governance
structure proved to be unwieldy and the USOC began a process of reform. In the late 1980s, a
George Steinbrenner-led committee issued a report recommending that the USOC reduce the
number of committees to 13 from close to 30, 932 and in 1990, the USOC replaced the thenapproximately 400-member House of Delegates with a 101-member board of directors.933 In 2004,
following an in-depth review from an independent commission, the USOC reduced the size of its
board to 11 directors to acreate a more efficient, effective and engaged organization.a934 Currently
there are 15 board members, with the CEO sitting as a sixteenth member.935
The revised governance model at the USOC led to the types of benefits that flow from the
ability of corporations to set clear direction and strategy. For example, in the 2000s, the USOC,
under the guidance of the Director of Medical Operations, Dr. Bill Moreau, modernized the sports
medicine department, including by updating the treatment facilities at the Olympic Training
Centers, which had previously been little more than sophisticated training rooms.936 Under the
leadership of the Chair of the Board, Larry Probst, the USOC improved its standing with the
international Olympic movement.937 And under the leadership of former CEO Scott Blackmun,
the USOC improved its relationship with the NGBs, which had grown tense over the previous
decade, resulting in a revolving door of USOC CEOs, each of whom had lasted an average of
approximately two years. 938 Mr. Probst and Mr. Blackmun also developed important sponsor
relationships, resulting in a steep increase in revenue.939

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The modernized USOC facilitated the development of Olympic teams that have garnered
unparalleled success at the Games a in the past four Olympics, Team USA has won cumulatively
100 more medals than the next closest country. 940 The USOC has also steadily increased its
revenue, generating more than $350 million in the most recent Olympic year.941 The success on
these metrics is partly a result of the benefits of enhanced organization at the USOC, but it also
reflects the modern USOCas focus on generating medals and the accompanying revenue as
overarching goals. Mr. Blackmun explained that aour approach was to make sure the athletes who
are medal capable get supported,a and the analysis in providing support was awhat is going to give
us the best chance for an American to win a medal?a942 Alan Ashley, Chief of Sport Performance,
provided further color by explaining that his job is to help NGBs create the environment where
athletes can succeed, and he believes that medals are a good indication of whether the USOC has
supported athletes in achieving their goals.943
The USOC exerted its influence, especially its monetary influence, over NGBs based on
success at the Olympic Games. In 2017, the USOC provided funding to each of the NGBs, but
this funding ranged from a few hundred to a few million dollars.944 And although the USOC
evaluates many factors when distributing funds, the foremost consideration is the NGBas ability
to generate medals, with the marketability of successful athletes serving as an important secondary
consideration.945 Indeed, the USOCas focus on athletic and monetary success was such that a
former USOC executive recalled that the words amoney and medalsa were probably uttered at
every staff meeting, typically more than once, with the effect of marginalizing other topics such
as athlete programming.946 As a result, the USOC evaluated athletes much like a professional
sports organization or any other company evaluating assets and examined the return in athletic
success on its monetary investments.947

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Developing in parallel with the new governance model and the increased focus on
generating money and medals was a diminishing opportunity for athletes to participate in the
governance of the USOC or to register their complaints. Former USOC employees recall that in
the 1980s, the diffuse governance structure encouraged grassroots participation and consequently,
athletes had a ahuge voicea948 and a asignificant presence.a949 But following the restructuring of
the organization, the relationship between athletes and the USOC became, as one former employee
commented, a ahierarchical business relationship.a950 A contributing factor to the nature of the
relationship between the corporate officers of the USOC and the athletes is the short amount of
time athletes spend on the Olympic stage a a factor inherent to Olympic sports. Athletes have
emphasized in their interviews the feeling of being a cog in the Olympic machine that churns
through athletes even as the administrators remain.951 Given this environment, athletes and their
legal representatives have expressed the need for easily available avenues for raising concerns.952
However, the structures that ostensibly provided athletes with an ability to impact the governance
of the USOC a the Athlete Advisory Council (aAACa), the Athlete Ombudsman, and the formal
complaint process a were geared narrowly toward one of the animating purposes of the Ted
Stevens Act, protecting athletesa rights to compete, and failed to give athletes a meaningful
mechanism for effecting change or raising complaints not directly related to athlete
participation.953
The AAC a The Ted Stevens Act created the AAC to serve as the athletesa voice in
governance, 954 but this body has had limited effectiveness. One reason is that the AAC is
structurally designed to provide policy feedback at a high-level, rather than to act as a decisionmaking authority.955 Another is that the AAC is comprised solely of volunteers, whereas the
USOC and NGB staff members are full-time employees.956 Therefore, although the leadership of

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the AAC consists of an active and well-informed group, Mr. Blackmun noted that it can be difficult
to fill the ranks with current athletes, who cannot easily devote the asignificant investment of timea
needed to become informed, given their rigorous training schedules.957 In combination, these
factors have impaired the AACas ability to act as a strong governing body. By way of example,
following the Rio Olympic Games, the Athlete Ombudsmanas office gave a presentation to the
AAC to explain the role of that office, but in a meeting approximately a year and a half later, the
majority of the AAC a the body charged by the Act to oversee the Athlete Ombudsmanas office958
a was reportedly confused as to what duties the Athlete Ombudsman performed. 959 As the
Associate Ombudsman commented, although the Athlete Ombudsman is required to areporta to
the AAC, anobody is certain what this means.a960 The chairman of the AAC, in his July 2018
testimony recommending more vigorous athlete representative bodies, further noted the
organizationas limitations, remarking that the AAC ais structurally limited,a and has narrow
powers to anominate representatives to various boards and serv[e] as a communication channel.a961
And a former chair of the AAC remarked that the AACas only areal powera is ato go to the
press.a962
The Athlete Ombudsman a The need to provide athletes with greater representation and
protections motivated in part the 1998 amendments to the Act, which, most notably, created the
position of the Athlete Ombudsman. 963 Like many other provisions of the Ted Stevens Act,
however, the section concerning the role and responsibilities of the Athlete Ombudsman is capable
of multiple interpretations. Due to the current structure of the position, the Athlete Ombudsmanas
office has been an insufficient resource for athletes to voice their complaints or to engage in
governance.

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The Athlete Ombudsman is tasked with providing aindependent advice to athletes at no
costa concerning the relevant statutes and bylaws, and at the same time is responsible for mediating
any disputes.964 As a result, the Athlete Ombudsman can, consistent with the Act, either be an
advocate for athletes or a neutral mediator. The first Athlete Ombudsman, John Ruger, came to
the position from his role as chair of the AAC, 965 and he approached both roles from the
perspective of championing athlete causes.966 By contrast, Mr. Rugeras successor, Kacie Wallace,
acts as both a confidential advisor to athletes and a facilitator between athletes and NGBs. 967
Therefore, while the Athlete Ombudsman continues to be an important resource for athletes who
are seeking to navigate the somewhat complicated statutes and bylaws, especially concerning
disputes that involve athlete participation, such as those arising out of team selection or doping,
the position has limited value in providing athletes a voice in governance.968 And the Athlete
Ombudsmanas office is likewise a poor fit for athletes seeking to raise complaints about sexual
misconduct matters, as the office adopted a practice a prior to the launching of the Center for
SafeSport a of rerouting sexual misconduct complaints back to the relevant NGB for processing.969
Ms. Wallace noted that athletes often do not know where to go with such complaints or larger
structural concerns,970 and the Associate Athlete Ombudsman observed that the athletes who do
reach out to the Athlete Ombudsmanas office come to realize that there is a gap between their
perception of the office as championing the athleteas cause and the officeas current role.971
Formal Complaint Process a Finally, as discussed in greater detail in Part V.A.5, the
formal complaint process at the USOC is likewise an insufficient mechanism for either giving
athletes a voice in governance or providing an opportunity to raise complaints on topics such as
sexual misconduct. An athlete has two options for filing a complaint directly with the USOC.
First, an athlete can assert that an NGB is failing to comply with the requirements in the Ted

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Stevens Act or the USOC Bylaws and bring a complaint under Section 10 of the Bylaws, seeking
the NGBas decertification or placement on probation. 972 The athlete must follow specific
procedures, including demonstrating that the athlete has exhausted available remedies at the NGB
level and has filed a signed, written complaint listing the allegations and the jurisdictional basis
for the complaint.973 The athlete cannot remain anonymous974 and needs to tie the complaint to a
specifically listed obligation in the Act or USOC Bylaws.975 Section 10 complaints are legally
complex, involving the navigation of NGB and USOC bylaws in addition to the Ted Stevens Act,
and athletes must either pay for their own legal counsel or rely on pro bono assistance.976 Section
10 complaints are extremely rare, with approximately only one or two cases proceeding to a
hearing panel each year.977 And given the Section 10 process, the typical complainant is not an
Olympic athlete, but rather a member of an NGB who is sufficiently aggrieved to devote the time
and resources to attempt to bring about the NGBas decertification or placement on probation978 a
sanctions that are available only where the NGB has ceased to function as a competent
organization.xliv
Second, an athlete can assert that he or she has been denied the right to participate under
Section 9 of the USOC Bylaws. These complaints are more frequent, about one a month is filed
with the USOC, and they often relate to team selection or athlete disqualification.979 The athlete
must file a written complaint stating the factual and legal basis for the claim regarding the denial
of an opportunity to compete.980 The athlete files such a complaint with the USOC, but if the
athlete wants an arbitrator to resolve the matter, the athlete must make such a claim within six

xliv

In a Section 10 Complaint, a hearing panel makes a finding of an NGBas compliance or non-compliance and, upon
a finding of non-compliance, submits the finding to the USOC Board, which then determines whether to place the
NGB on probation or to decertify the NGB. USOC Bylaws ASSASS 10.18, 10.19. aHowever, if the hearing panel finds
that the NGB[as] . . . non-compliance can readily be rectified, then, prior to making a recommendation to the Board,
the hearing panel may issue an order directing that the NGB . . . take such action as is appropriate to correct the
deficiency.a USOC Bylaws ASS 10.18.

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months of the alleged denial of the opportunity to participate; otherwise the claim is time-barred.981
Section 9 complaints apply narrowly to an athleteas ability to compete, and because the majority
of such complaints relate to selection for a team or athlete disqualification, the complaints typically
involve two affected athletes: the athlete who was not selected or failed a drug test or was otherwise
disqualified, and the replacement athlete. The Section 9 process is therefore geared to resolving
disputes involving two athletes in a fair and timely manner that permits NGBs discretion in
selecting the best possible team for competitions. As discussed in Part V.A.5, neither a Section 9
nor a Section 10 complaint is a useful tool for addressing issues relating to sexual misconduct.
Under a Section 10 complaint, the complainant would have to argue that sexual misconduct is so
pervasive that the NGB is not able to continue to function effectively. Under a Section 9 complaint,
the complainant would need to, first, bring the complaint to an arbitrator within six months, and
second, argue that the sexual misconduct resulted in a denial of the athleteas opportunity to
compete in an event.
3.

The USOC Adopted a Service-Oriented Governing Approach Toward the
NGBs

As the USOC was adapting its governance model and increasing its focus on generating
revenue and medals, the USOC was also adopting a service-oriented approach toward the NGBs
that involved providing resources without accompanying oversight. This shift in the USOCas
relationship with the NGBs was one of the fundamental changes that Mr. Blackmun implemented
following his appointment as CEO in 2010. In the years prior to his arrival, the relationship
between the USOC and the NGBs had grown tense, with one board member noting that there was
a acoup building within the NGBsa based on a perception that the USOC was meddling too much
in their affairs. 982 Mr. Blackmun wanted ato change the nature of the dialogue a bit.a 983 He
reasoned that having high-performing athletes ais much more dependent on a healthy NGB than it

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is a healthy USOC,a and oriented aUSOC to be more of a service culture to the NGBs a how can
we help them be successful?a984
Over the past year, many observers have identified the USOCas decision not to exert greater
authority over NGBs as a critical element in the USOCas inability to respond effectively to sexual
abuse in sports. For example, Ms. Lyons, then acting as the CEO of the USOC, testified before
Congress in May 2018 that the USOC adid not exercise the authority that I think the act gives us,a
and opined that aI think a change we need to make is for us to exercise that authority more
thoroughly.a985 Ms. Lyonsas view reflects one side of a long-running debate within the USOC
concerning the proper role of the USOC in managing NGB affairs, a view that is in ascendance
following the public exposure of Nassaras crimes.
One contributing factor to this debate is the vagueness of the Ted Stevens Act. As Rick
Adams, Chief of Sport Operations and Paralympics, summarized, a[T]here seems to be no shortage
of people with strong opinions about what the Act does and does not afford [the USOC] or require
[the USOC] or NGBs to do.a986 The general purposes of the Act contribute to this uncertainty, as
there are any number of ways for the USOC ato establish national goals for amateur athletic
activitiesa and ato coordinate and develop amateur athletic activity in the United States.a 987
Likewise, some of the broad powers granted to the USOC have limited practical effectiveness,
leading to the USOCas hesitancy to employ them. In particular, the USOCas greatest power is its
authority to decertify, but USOC employees referred to decertification as the anucleara option and
a apoor instrumenta for effecting change, because there is typically no alternative organization for
the USOC to choose as the replacement NGB following decertification. 988 As Mr. Blackmun
explained, a[I]t doesnat help to go take away [an NGBas] license,a because athen no one is going
to step in.a989 Ultimately, from Mr. Blackmunas perspective, the harm from decertification would

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fall on the athletes, who would be left without an organizing body and would have to rely on direct
support from the USOC, which is ill-equipped to act as the governing body for any specific
sport.990 Therefore, the USOC almost never exercised its authority to decertify an NGB, and over
the past 25 years, only two NGBs have been decertified: the National Rifle Association in 1994
and the U.S. Team Handball Federation in 2006.991 On November 5, 2018, the USOC began the
decertification process for USAG.992
One step removed from decertification is probation,993 and while the USOC has taken this
step more frequently than decertification, it has also exercised its probationary power cautiously.994
The USOC is ultimately hesitant to use this authority to effectuate change in an NGB, given that
through such interference, the USOC must become involved in the governance of an NGB. As
Mr. Blackmun remarked concerning actively controlling an NGB, aall of the sudden we are a
governing body.a995 Therefore, the USOC avoided exerting its powers in a manner that would
create too much oversight because the USOC does not have athe relationship with the athletesa or
insight into the acomplex culturesa of the various NGBs.996 And fundamentally, the aUSOC views
itself, consistent with the Act, as an organization comprised of organizational members and no
individual members,a997 or as the USOCas lawyer stated in a deposition, the USOC adoes not have
athletes.a998
As discussed above, however, the USOC did exercise a certain degree of authority with a
straightforward goal: provide NGBs with the resources to produce medal-winning athletes. And
the USOC applied many tools a aside from the blunt instruments of decertification and probation
a to promote athletic success at the NGBs. The USOCas most effective means of controlling and
rewarding NGBs is its monetary resources, which are significant a in the two most recent Olympic
years, 2014 and 2016, the USOC generated over $275 million and over $350 million,

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respectively.999 As Mr. Blackmun remarked, a[T]hey listen to us because we have the purse.a1000
The USOC wielded this authority to encourage athletic success by basing its funding decisions, in
part, on representations that the NGBs made in their aPerformance Partnership Agreementsa with
the USOC regarding expected medal counts in upcoming Olympic Games.1001 The USOCas other
powers over NGBs range from mandating peer-to-peer reviews, to increasing or decreasing
support for non-performance staff during Olympic Games, to determining how many athletes from
each sport are entitled to access USOCas Elite Athlete Health Insurance, a medical insurance plan
which Dr. Moreau described as a aBlack Card for medical care.a1002 The USOC likewise largely
based its non-monetary support decisions on the athletic success of the NGBs.1003 For example,
at the Olympic Games, the USOC has a certain number of athlete and coach credentials to
distribute to the NGBs; and as Mr. Penny observed, ait was an ongoing challenge to get the
credentials we needed, but when we started winning it became less of a challenge.a1004
The governance structure also reflects the difficulties involved in governing a diverse
collection of NGBs. Some NGBs are sophisticated non-profits that run programs in towns across
the country, such as the U.S. Soccer Federation, USA Hockey and the U.S. Tennis Association,
while others are responsible for niche sports, such as USA Team Handball and USA Pentathlon.
The NGBsa revenues vary dramatically. Some have partnerships with leading companies, while
others struggle to generate revenue and develop their membership. 1005 Another fundamental
difference, even between sophisticated NGBs, is the importance of the Olympic Games. For some
NGBs, such as USA Wrestling and U.S. Figure Skating, the Games are a central focus, while the
Games are less important to the mission of other NGBs.1006 The wide-ranging scope of the NGBs
raises important questions about the proper extent of the USOCas authority. Should the USOC,
which focuses on the development of elite athletes for Olympic teams, dictate policy for NGBs

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concerning low-level youth recreational sports or control the U.S. Soccer Federationas approach
to the World Cup or the U.S. Tennis Associationas organization of the US Open tennis tournament?
And how can the USOC implement policies that apply fairly to such a diverse collection of
organizations? Mr. Blackmunas answer was that a[f]itting a one-size-fits-all option is very
difficult,a and therefore the USOC should agive [NGBs] the assets and resources to make
themselves better.a1007
The USOC Board of Directors engaged on the question of the proper extent of the USOCas
authority. Some directors believed that the USOC should be careful not to become overly
enmeshed in NGB affairs and expressed skepticism of the tools available to effect change at the
NGBs,1008 while others thought the USOC ashould be more aggressive and use our leverage to
ensure [the NGBs] were more efficiently run.a1009 At least one board member expressed the view
that the USOC should consider setting up a consulting unit to work directly with the NGBs and
help them improve their operations.1010 The service-oriented view prevailed, however, and the
consulting unit was never formed. As the board member explained, the aapproach of the USOC
has always been to err on the side of NGB independence.a1011
As set forth more fully below, the USOCas decision to defer to the NGBs and exert minimal
oversight is highlighted by (i) the USOCas willingness to credential an NGBas preferred medical
provider, even if there were concerns about the provider, and (ii) the USOCas licensing of Olympic
Training Sites, which carried the branding of the USOC, but otherwise operated independently.
Credentialing Medical Providers Notwithstanding Concerns a As discussed in Part III.A.6,
following the 2012 Olympics, the USOC medical team filled out evaluations of the various NGB
medical staff that worked at the Games, and Nassar received low marks and a recommendation
that the USOC not invite him to future Games based on his inability to work well in a multi-sport

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environment.1012 But Dr. Moreau, when he reviewed the evaluation during his interview with the
Independent Investigators, commented that this recommendation would have had no effect on
whether Nassar attended a future Olympics.1013 Instead, if USAG selected Nassar, then he would
almost certainly attend the next Games.1014 And documents from the spring of 2015 indicate that
Nassar was indeed scheduled to attend the Rio Games, despite the negative review from 2012.1015
To underscore this point, Dr. Moreau recalled that one of the NGBs selected as its medical provider
a practitioner who believed that athletes should receive treatments on a amagnet bed.a 1016
Dr. Moreau engaged in heated arguments with the sports performance team at the USOC to try to
exclude this practitioner from the Games, but he was ultimately overruled on the basis that the
USOC wanted to keep the NGB and its athletes happy during the Games.1017
Olympic Training Sites a To train athletes for the Games, the Olympic organizations
operate various types of training centers. At one end of the spectrum, the USOC operates two
Olympic Training Centers (aOTCsa), located in Colorado Springs, Colorado, and Lake Placid,
New York, for summer and winter sports, respectively.1018 The OTCs are full-service facilities
that provide dormitories for athletes to train year-round,1019 and NGBs hold training camps at the
facilities or apply for space and time to train.1020 At the other end of the spectrum are National
Team Training Centers, where the USOC has no involvement, other than through the general
provision of funds to the NGBs.1021 In the middle are the Olympic Training Sites, which carry the
name and the Five Rings trademark of the USOC, but which function in every other respect like a
National Team Training Center.1022
To create an Olympic Training Site, the USOC grants a training facility use of the Olympic
brand. In return for the right to advertise itself with the familiar Five Rings, the training facility
provides access to an NGB at a steeply reduced, or free, rate. 1023 Several USOC officials

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characterized this relationship as essentially a marketing license.1024 By adopting this arrangement,
the USOC is implementing a strategy for supporting NGBs and elite athletes that is consistent with
its view of the Ted Stevens Act. Mr. Adams explained his impression that aCongress made clear
in 1978 that we are not going to give you money but [we] will give you exclusive jurisdiction over
the marks and we need you to go out and leverage those marks to generate revenue to support
athletes.a1025
When leveraging its marks in the context of Olympic Training Sites, however, the USOC
conducts almost no initial or ongoing review of the facilities. The USOC receives quarterly and
yearly reports, but these reports concern the number of athletes using the site, the performance
results of those athletes and media coverage of the site, among related topics.1026 Similarly, the
USOC maintains a general checklist for each training site, but the Senior Director for the Olympic
Training Centers noted by way of example that this checklist records information such as whether
the training site serves food rather than any color on what food is served.1027 Indeed, the USOCas
oversight almost entirely relates to whether the site is properly using the brand,1028 which the
USOC tightly protects through restrictive clauses in the operative contract.1029 The Independent
Investigation reviewed one email dated January 2014, in which a USOC employee stated that by
2017, the USOC would require the Karolyi Ranch to comply with SafeSportas minimum standards,
and aencourage[d]a USAG to adopt policies at the Ranch prior to 2017, 1030 but there is no
indication that the USOC conducted any other measure of SafeSport-related oversight. As
Mr. Blackmun acknowledged, the USOC had ano resources on the ground.a1031
By disclaiming any oversight of training sites that carry its brand, the USOC lost control
over maintaining standards that correspond with the excellence and high quality the Five Rings
convey. Mr. Blackmun acknowledged this threat by remarking that the USOCas brand was

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valuable in providing an Olympic seal of approval and recognized in his interview, aobviously the
danger is that if athletes come there thinking that it is a USOC facility that is overseen by us.a1032
Ms. Lyons, reflecting on the shortcomings of this arrangement, observed in her interview that ait
is confusing for people to draw the distinctiona that the USOC does not oversee the training
facility.1033
The USOCas designation of the Karolyi Ranch as an Olympic Training Site provides an
illustrative example of the danger of lending the Olympic brand without corresponding oversight.
The USOC did not perform any traditional due diligence such as conducting a site inspection or
otherwise investigating the conditions at the Ranch. Nor did it undertake any specific assessment
to determine whether the remote location was appropriate for a physically dangerous sport like
gymnastics.1034 Nevertheless, in a press release announcing the designation of the Karolyi Ranch
as an Olympic Training Site in 2011, Mr. Blackmun highlighted the relationship among the
Karolyi Ranch, the USOC and USAG, stating athe designation as an official training site
underscores the USOCas support of this relationship.a1035 And the USOCas branding worked to
create understandings and expectations among athletes and families. 1036 As the mother of a
gymnast remarked in an interview with a reporter, aWhere are the other adults that were at the
Olympic training center, allowing this to go on[?]a1037
4.

The Development of SafeSport Reflected the USOCas Service-Oriented
Approach

The USOCas decision to assume a deferential approach to the NGBs likely contributed to
its slow response to the dangers of sexual misconduct in Olympic sports and hampered its ability
to respond effectively when the organization first began to take action. Although NGBs raised the
issue of child sexual abuse in sports to the USOC, including as early as 1999, the USOC only
responded to the threat following a major public scandal at a large NGB in 2010.1038 The USOC

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ultimately took many steps to protect athletes, but it approached this work from within the selfimposed constraints of its limited ability and willingness to impose governance changes on NGBs,
as well as its observance of certain due process considerations that were structured to protect an
athleteas ability to compete rather than to protect minors from sexual abuse. Moreover, the USOC
never created an auditing process by which it would become aware of sexual abuse allegations at
NGBs1039 and never required NGBs to track this information.1040 The USOC therefore did not
know, for example, that USAG had received a high number of complaints or anything about the
nature of those complaints.1041 At most, the USOC implemented a high level check-the-box audit
to ensure that NGBs had a basic policy, but without any accompanying review of the actual
policy.1042
The USOCas Slow Response to a Growing Awareness of Sexual Misconduct a Over the
past few decades, there has been a growing societal awareness of the pervasiveness of sexual abuse
in youth-oriented organizations. Large-scale sexual abuse crises have hit many organizations, such
as the Catholic Church, the Boy Scouts, schools and hospitals. Stories of abuse in youth sports
have likewise grabbed headlines. For example, the cover page of the September 13, 1999 issue of
Sports Illustrated stated aWhoas Coaching Your Kid,a with a center story concerning coaches who
used their position to gain the trust and loyalty of children and then abuse them.1043
In 1999, USAGas then-CEO Robert Colarossi sent a letter to William Hybl, Dick Schultz
and Mr. Blackmun, the USOCas then-President, Executive Director and General Counsel,
respectively, concerning the issue of sexual misconduct, specifically referencing and attaching the
Sports Illustrated article.1044 Although the topic of the letter related to a procedural issue, the letter
underscored the threat of sexual misconduct in sports, including specifically in gymnastics, and
urged the USOC to aposition itself as a leader in the protection of young athletes,a warning that

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otherwise the USOC would be aforced to deal with the problem under much more difficult
circumstances.a1045 xlv Similarly, five years later, USA Swimming reportedly reached out to the
USOC raising concerns about the risk of child sexual abuse in swimming, and requested that the
USOC take a leadership role in developing protective policies that NGBs could implement on the
local level.1046
Despite this growing recognition of the threat of sexual abuse, the USOC and many NGBs
failed to adopt updated policies and practices. Mr. Blackmun stated that when he joined the USOC
as CEO, the subject of child sexual abuse in sport was anot on my radar.a1047 He stated that awhen
I started in 2010 if someone said what are the top fifteen priorities for the USOC, I wouldnat have
had sex abuse on the list.a1048 And the USOC had not taken any steps to position the organization
to better understand the nature and seriousness of the issue, such as by collecting information from
NGBs on the topic.1049 Moreover, the decreasing voice of athletes in the governance process and
the ineffectiveness of the available avenues for raising complaints further isolated the USOC and
delayed the USOC from recognizing the pervasiveness of the problem. The delayed leadership
from the USOC on this issue permitted NGBs to continue to choose their own policies, some of
which were not conducive to athlete safety. For example, NGBs, including USA Archery, U.S.
Figure Skating, USA Water Polo and USA Water Ski, required complaints to be filed within 60 or
180 days of the violation,1050 and at least U.S. Figure Skating reportedly cited this requirement in
dismissing a complaint of sexual misconduct.1051 Other NGBs enacted procedural requirements
that operated to prevent the NGBs from taking effective action; for example, USA Swimming
xlv

In a recent affidavit, former USAG President Kathy Scanlan stated, aDespite communicating concerns about sexual
misconduct in the sport (specifically by adult professional members of USAG) to USOC, the USOC discouraged
USAG from using its established process to investigate and ban these members.a Scanlan Decl., Court Filings on file
with the Independent Investigators. During her interview with the Independent Investigators, Ms. Scanlan recalled
one conversation with representatives from the USOC concerning the appropriate procedures to follow when
disciplining a coach. Ms. Scanlan noted, aIt is fair to say I was extremely frustrated with USOC, but that frustration
under my watch did not prevent us from doing what was right.a Scanlan Interview.

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required a formal complaint before responding, even after receiving credible reports of ongoing
abuse.1052
When the 2010 sexual abuse scandal erupted at USA Swimming with an ABC television
report detailing numerous relationships between coaches and young swimmers, and revealing that
36 coaches had been banned over the previous decade,1053 USA Swimming was caught in a media
firestorm. The crisis was compounded by a statement made during a televised interview with ABC
by the then-CEO for USA Swimming, Chuck Wielgus. When asked a question about the survivors
of abuse, he responded indignantly by asking: aYou feel I need to apologize to them?a1054
The survivors did not limit their criticism to USA Swimming, with one of the survivors
explicitly stating that athis is not just USA Swimming.a1055 Other NGBs took notice. As the
former president and chairwoman of USA Track & Field (aUSATFa) remarked, aOnce the
allegations and the findings came out at swimming, the [USATF] board felt like we needed to
acceleratea checks at the elite level.1056 But many NGBs were behind the curve, and the USOC
faced the challenge of helping the diverse NGBs create new and proactive policies to address this
now recognized danger.
The USOC initially reacted quickly to the USA Swimming news,1057 and Mr. Blackmun
convened an initial working group in June 2010 shortly after the USA Swimming allegations
surfaced in the media.1058 The group was aformed to assess the issue and make recommendations
regarding child protection in U.S. Olympic and Paralympic sportsa to the USOC Board.1059
The USOCas SafeSport Working Groups a The findings of the initial SafeSport working
group were consistent with the USOCas service-centered outlook. The group noted that aAs the
NGBs are separate entities from the USOC, the Working Group determined that the USOC should
encourage (though not require) NGBs to adopt policies, practices, programs and tools to address

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sexual and physical misconduct and that the USOC should encourage NGBs, in turn, to encourage
their clubs and other grassroots organizations in their sport to do the same.a1060 The working
groupas recommendation included that the USOC aplay a leadership role in promoting safe training
environments,a that the USOC alead by example,a and that the USOC a[e]ncourage NGBs to
[a]dopt Safe Sport [t]ools.a 1061 The Working Group concluded that a[e]ach sport will be
responsible for putting safeguards in place and meting out punishments.a1062
Mr. Blackmun acknowledged that awe came to the game too late,a but emphasized that
awhen we got there we addressed it in earnest and with more resources than ever has been given
to this issue.a 1063 He explained that the USOCas hesitancy to force through policies at the
grassroots level was due to resistance from the NGBs, which took the position that athat is their
group and their sport and they donat want a USOC presence there.a1064 Some NGBs did push back
against increased USOC oversight and the associated costs of SafeSport, especially certain NGBs
less focused on the Olympics,1065 but as indicated by the letters from USAG and USA Swimming
in 1999 and 2004, other NGBs welcomed the USOCas involvement. 1066 In particular, USAG
expressed great interest in creating an outside body that could handle sexual misconduct
matters.1067
As part of the USOCas efforts, Mr. Blackmun hired Malia Arrington to the newly-created
position of Director of Ethics and SafeSport in April 2011.1068 Ms. Arrington explained that the
job description amade it clear that initially [the USOC] envisioned a resource-based role that would
provide resources to the NGBs,a 1069 and ait was very clear that my role was to provide
resources.a1070 Ms. Arrington summarized the USOCas approach by explaining that when she
arrived ain April 2011, it was all resources, resources, resources.a1071 Consistent with this mindset,

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it was the USOCas policy that if Ms. Arrington learned of a misconduct issue, athe obligation was
to get [the complainant] to the right person within the NGB.a1072
Ms. Arrington, however, soon recognized that aNGBs need to get out of the business of
addressing these issues,a1073 and the USOCas outlook began to evolve. In July 2012, the USOC
organized an NGB task force for minimum SafeSport standards,1074 and following discussions at
the December 2012 Board meeting, the USOC issued its minimum standards requirements for the
first time.1075 These minimum standards included requiring that each NGB establish a reporting
procedure and a grievance process, among other basic requirements. 1076

Mr. Blackmun

commented that this was athe big stepa in USOCas SafeSport initiative.1077
But the minimum standards requirements, while important, were nevertheless insufficient.
Despite recognizing that NGBs were not well positioned to address issues of sexual misconduct in
their own sports, the USOC ensured that there would be aa lot of room for each NGB to customize
its program.a 1078 The USOC summarized its approach in a December 2012 NGB meeting,
explaining that, aHow far each of the NGBs [goes] into each of these [elements of the SafeSport
program], weave given some guidance, but ultimately itas up to the NGB to do their best to
incorporate those elements into the program.a1079 In recognition of the limitations of this initial
requirement, the USOC assured NGBs at the end of 2013 that it ahas not mandated the adoption
of uniform or specifically drafted policies or practices but instead has provided the Minimum
Standards Policy for Athlete Safety Programs as a baseline guide.a1080
As it was developing these aminimum standards,a the USOC formed a second working
group to study the issue in greater detail. This group had the task of adeliver[ing] an informed
recommendation to the USOC concerning possible models to manage cases of misconduct in
sport.a1081 This working group went further than the first and drew up plans for a new independent

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SafeSport entity tasked with addressing all sexual misconduct-related matters.1082 The working
group recommended that the USOC empower the SafeSport entity with authority over all sexual
misconduct investigations and discipline, and most strikingly, recommended that participation by
NGBs should be mandatory.1083 In January 2014, the AAC unanimously voted to endorse the
SafeSport working groupas recommendation, and in June 2014, the USOC board approved the plan
to create an independent SafeSport entity.1084
Delay in Opening Center for SafeSport a USOC eventually implemented the findings of
the 2013 working group by opening the independent Center for SafeSport. In September 2014,
approximately a year after the working groupas report, the USOC planned on a 2015 launch for
the Center.1085 A year later, the USOC had pushed the projected launch out to Q2-Q3 2016,1086
and by December 2015, the USOC had settled on a July 2016 launch.1087 The Center for SafeSport
eventually opened in March 2017,1088 almost seven years after the USOC had formed its initial
SafeSport working group and over three and a half years after the second working group had
presented its findings recommending the establishment of the Center.xlvi
Among the reasons for the delay were fundraising challenges,1089 limited resources given
that the USOCas SafeSport adepartmenta was a single person for much of this period,1090 and
difficulties obtaining insurance.1091 In addition to these resource and logistical difficulties, the
USOC continued to face structural challenges, including difficulties reorienting from a service- to

xlvi

The SafeSport policies, while an improvement, continued to have flaws reflective of USOCas outlook. Specifically,
the Center for SafeSport considered the impact of the allegations on the reputation of USOC as a factor in determining
the punishment for an offense. In the grievance hearing process for a complaint against an individual, the review
panel issues a finding and imposes sanctions by taking into account, among other factors, any ongoing risk, the age of
the parties, and the effects on the USOCas reputation. USOC, Policy on U.S. Center for SafeSport,
https://www.teamusa.org/-/media/TeamUSA/Media/USOC-SafeSport-Policy-62917.pdf. Ms. Lyons recognized at
the May 23, 2018 Congressional hearing that this final factor adoes not belong on that list.a Ms. Pfohl, the Chief
Executive Officer for the Center for SafeSport, sought to clarify the provision in her testimony, explaining that if the
conduct areflects poorly on the sport . . . then that can be used in terms of making an appropriate sanction.a Transcript,
House Energy and Commerce Committee Hearing (May 23, 2018).

162

an oversight-centered approach1092 and moving the NGBs away from an ingrained interpretation
of the Act that was based on protecting athletesa right to compete.1093 But during all of the delays
in opening the Center for SafeSport, the USOC did not enact basic protective measures, such as
ensuring that the Olympic Training Sites established sufficient athlete safety policies or requiring
NGBs to comply with best practices during travel involving adults and children. One notable
illustration of the USOCas failure to enact on-the-ground measures was the USOCas lack of
attention to improving the process by which athlete complaints were being handled and resolved.
5.

Concerns about the Complaint Process Across Olympic Sports

In canvassing policies and procedures across the NGBs and interviewing numerous athletes
who had raised complaints of misconduct over the years, certain patterns emerged. A number of
interviewees discussed the concern that even as the SafeSport working groups were developing
high-level policies between 2010 and 2017, the USOC failed to update its own processes for
handling complaints.1094 These witnesses also noted that the policies in place at many NGBs were
ineffective.1095 Indeed, the USOC continued its practice of declining to intervene at the level of
individual complaints and, at the same time, remained largely in the dark with respect to NGBlevel complaint processes. Many NGBs lacked employees with expertise in handling complaints
of abuse, and some athletes and other participants feared that making a complaint directly to the
NGB for their sport would result in retaliation and permanent harm to their athletic careers.1096
Interviewees, including survivors of sexual misconduct and other forms of abuse and their
legal counsel, described a formal complaint process that reinforced the power disparity between
the NGBs and individual amateur athletes.1097 Given that the USOC does not provide attorneys
for athletes and the Athlete Ombudsman does not currently act as an advocate for the athlete during
the complaint process, athletes described a cumbersome process that was difficult to navigate on

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their own, and for which it was too expensive to engage outside assistance.1098 xlvii Some also
described frustration with structural elements of the complaint process that required the exhaustion
of certain administrative procedures.1099 Finally, concerns were raised about the integrity and
fairness of the dispute resolution process.1100 Counsel who have represented a number of survivors
of sexual abuse in Olympic sport reported that at least certain NGBs engage in a practice whereby
the NGBas legal counsel initially works with the athlete during the NGBas internal review of the
allegations at the outset of the complaint process, only to later oppose the athlete if the complaint
proceeds to arbitration or civil litigation.1101 In one instance, an NGBas lawyer, acting first in an
investigative role, prepared an affidavit for a complaining athleteas signature.1102 Yet after the
athlete brought a civil lawsuit against the NGB, that same lawyer entered an appearance on behalf
of the NGB in the court proceeding. 1103 Such aduala roles, first as investigators and then as
litigators in adversarial proceedings, allow counsel to an NGB to gain early access to the strengths
and weaknesses of a complainantas allegations for potential use in subsequent confrontational
proceedings, and also afford the NGB an opportunity to develop evidence during an early stage of
the proceedings, such as sworn statements from the athlete, in a manner that may serve the interests
of the NGB over those of the athlete.
In addition, and as detailed above, the USOCas formal complaint process does not naturally
accommodate sexual misconduct matters. A contributing factor to this deficiency is that the USOC
Bylaws are rooted in the animating purposes behind the Ted Stevens Act from the 1970s a
protecting athletesa rights to participate. As Ms. Arrington explained, athe Act to my mind grew
out of a rights-based movement about individual rights to compete and to participate.a1104 In that
respect, the various protections that are part of the process a either as codified in the Bylaws or in

xlvii

Unlike in other civil enforcement schemes, providing for example adamages and reasonable attorneys fees,a 18
U.S.C. ASS 1595, the USOC does not provide legal costs or fees to a successful complainant. 36 U.S.C. ASS 220500.

164

the long-observed USOC aDue Process Checklista a are important, including, for example, the
six-month statute of limitations to bring an arbitration claim when an NGB is looking to move
forward with a settled team. But such requirements are not always appropriate in the context of
sexual misconduct or other complaints involving child survivors of abuse.
Outside of the formal complaint process, prior to the creation of the Center for SafeSport,
complaints raised by athletes alleging misconduct were routinely rerouted back to the associated
NGB.1105 The Chair of the AAC characterized this practice as cases being athrown back over the
walla to the NGBs without any clear guidance to either the complainant or the NGB as to next
steps.1106 For example, when an athlete who had reported sexual abuse by a famous speed skater
met with Mr. Blackmun in March 2013 to demand that US Speedskating revoke the perpetratoras
membership, the reporting athlete recalls Mr. Blackmun responding, aThereas nothing I can do,a
and that he had ano control over the NGBs.a1107 In November 2015, Ms. Arrington, following
USOC policy at the time, responded to a report of misconduct by a member of an NGBas
administrative team by directing the complainant to make a report to that administrative team,
writing, aI wanted to advise you that you have reached the U.S. Olympic Committeeas safe sport
inbox and that allegations of misconduct are addressed through the relevant national governing
body.a1108 Similarly, in June 2016, Ms. Arrington, again following USOC policy, informed a
complainant who wanted to areport multiple instances of bullying, emotional and physical
harassmenta that aany report needs to go to your sport national governing body.a1109
By directing complainants back to the relevant NGB, the USOC failed to appreciate the
concern that the complainant could face retaliation from the NGB. Athletes and coaches expressed
a fear of bringing complaints about a popular coach or administrator to a tight-knit NGB,1110 with
one coach reporting that she was terminated after raising concerns about an abusive swim

165

coach,1111 and an athlete reporting that she received a designation as a troublemaker after making
a complaint about a speedskating coach.1112 This same athlete, fearing further retaliation, later did
not file a complaint after learning that a popular coach was engaging in a sexual relationship with
a teammate. Instead, this athlete had to endure what she termed a ariggeda selection process,
where the coach favored the athlete with whom he was engaged in a sexual relationship.
Many other athletes raised concerns about NGBsa tolerance for coach-athlete relationships,
with a former track and field athlete recalling that atrack coaches dated their athletes: from the
beginning of time that is what happened,a1113 and an Olympic swimmer recalling that the culture
of the sport aallowed young girls to be molested under the guise of adating.aa1114 The USOC
recognized this threat by including a ban on coach-athlete relationships in its Minimum Standards
Policy for Athlete Safety Programs.1115 But the USOC took no effective steps to ensure that NGBs
were following this ban. And after USAG received this Minimum Standards Policy from the
USOC in 2014, it interpreted the mandatory definitions concerning misconduct as arecommended,a
and atoned them down several notches,a including by removing the required ban on romantic
relationships between athletes and coaches at the club level.1116

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B.

United States of America Gymnastics

SELECTEDA FINDINGSA

A

iSS

USAGA wasA awareA ofA theA dangerA ofA sexualA abuseA inA itsA sport,A tookA highalevelA stepsA toA
helpA protectA gymnastsA andA promotedA itselfA asA aA leaderA inA athleteA protectionA issues.A A
However,A USAGA erectedA numerousA proceduralA obstaclesA inA theA complaintA resolutionA
processA thatA keptA USAGA fromA effectivelyA addressingA serious,A credibleA allegationsA ofA
childA sexualA abuse.A

A

iSS

TheseA obstaclesA includedA requiringA aA complaintA toA comeA fromA aA survivorA orA aA
survivorasA parent;A refusingA toA investigateA complaintsA whereA theA reportingA partyA
wishedA toA remainA anonymousA toA theA perpetrator;A refusingA toA investigateA complaintsA
whereA theA reportingA partyA didA notA submitA aA signed,A writtenA complaint;A limitingA
availableA sanctionsA ifA theA allegedA conductA wasA notA acriminalaA inA nature;A failingA toA
followA upA onA complaintsA ofA misconduct;A andA losingA trackA ofA importantA informationA
aboutA accusedA coaches.A

A

iSS

USAGA didA notA takeA stepsA toA ensureA effectiveA oversightA ofA NassarA throughoutA theA
periodA ofA hisA serialA sexualA assaultA ofA gymnasts,A includingA atA nationalA andA internationalA
competitions,A inA hotelA roomsA whenA theA NationalA TeamA wasA traveling,A andA atA theA
NationalA TeamA TrainingA CenterA atA theA KarolyiA Ranch.A

A

iSS

USAGasA lackA ofA oversightA allowedA NassarA toA consolidateA andA entrenchA hisA positionA
withinA aA largerA structuralA environmentA thatA lackedA effectiveA athleteaprotectionA
policiesA andA practicesA andA operatedA toA discourageA reportingA ofA misconduct.A

167

A

Historically, USAG enjoyed substantial success as an NGB. As Mr. Penny proudly stated
in the spring of 2015, if a[y]ou want to take a picture of a prototypical NGB, you take a picture of
us.a1117 Mr. Penny observed that USAG was winning medals, gaining sponsors, selling out events,
building a vast social media following and generating ever-increasing revenues.1118 Indeed, based
on the repeated successes over the past two decades, especially by the Womenas National Team,
aUSA Gymnasticsa came to be associated with Olympic excellence, and USAG used what it called
its aBig Time Branda to form partnerships with key sponsors and expand its membership across
the country.1119 USAGas many successes, however, masked an organization that had developed
major, fundamental weaknesses.
In particular, USAG failed to conduct oversight over powerful personalities charged with
important responsibilities at the National Team level, most notably the Karolyis and Larry Nassar.
Likewise, USAG failed to exert its substantial authority over its membership to better protect
gymnasts across the country. And although USAG took many steps over the past decades to
implement policies and practices aimed at keeping members safe (including the development of
educational brochures1120 and the creation of a apermanently ineligible lista1121), USAG adopted a
role primarily as a resource-provider rather than an enforcer to its member clubs. Despite USAGas
unique position to take effective action, USAG restricted its response to allegations of misconduct
due to a constrained view of its role, a mistaken perception of due process limitations and,
ultimately, an unwillingness to become involved in complicated matters of misconduct.
1.

USAG Conducted Limited Oversight of Nassar

USAG is a not-for-profit, membership organization comprised of gyms, athletes and
professional members such as coaches and judges. 1122

xlviii

xlviii

USAG maintains requirements for

As noted in Part IV.C, USAG filed for Chapter 11 bankruptcy on December 5, 2018. Bankruptcy Petition, Court
Filings on file with the Independent Investigators.

168

membership, endorses or asanctionsa competitions, maintains records and databases about its
membership, provides educational material to its membership, and hosts national conferences,
called USAG Congresses, among other activities.1123 And in addition to managing its membership,
USAG, most recognizably, is responsible for selecting and training the national teams and
coordinating participation in national and international competitions.1124
USAG, however, has historically conducted minimal oversight over certain aspects of the
development of its national teams, including the Womenas National Team training camps at the
Karolyi Ranch. And USAGas decision not to exert its authority over Nassar or his management
of the organizationas medical care contributed to Nassaras ability to abuse hundreds of athletes.
Nassar was able to carve out, and reinforce, a role in the organization where he had unrestricted
access to young gymnasts with almost no oversight.
As explained in Part II.A, Nassar was able to create a reputation for himself as an advocate
for athletes, and he gained the trust of gymnasts and their families. But Nassar was equally
successful in establishing an area of influence and power at USAG. From his volunteer position
as National Medical Coordinator, Nassar had a role in almost every aspect of USAG medical care
for close to two decades. Nassar organized medical care for USAGas events,1125 coordinated with
medical providers when the National Team was on tour,1126 approved which medical staff attended
which events,1127 provided input on whether individual athletes could bring their own medical
providers1128 and served as the point person for approving any such outside medical providers.1129
And USAG relied on Nassar to store and organize medical records.1130 Nassar also regularly
provided feedback to USAG on other medical personnel. For example, after Nassar learned that a
trainer had taken ainappropriate pictures . . . of athletes,a he wrote to a USAG administrator that
this was aa major violation that USAG needs to be aware of and should be investigated to see if

169

he should be banned from having professional membership and banned from all USAG sanctioned
events.a1131 And concerning a doctor who worked at one event, Nassar wrote: aI question his
morals and medical ethics and I would not trust him for a minute since he is trying to conceal
something since he is not being open about his procedure.a1132 xlix
USAG also relied on Nassar to draft the policies and procedures for the medical department.
As a result, Nassar was not only in a position to evade review, but also well-positioned to further
entrench his position. Most strikingly, Nassar himself participated in drafting the rules concerning
sexual misconduct, which he did by (i) including one bullet point under aprohibited conduct,a
which listed asexual misconducta without further explanation, and (ii) providing protections
against false accusations.1133 The section in his initial draft on adisciplinary actiona begins with a
statement, aIn order to protect our athletes from harm and protect our staff from false accusations,
a criterion for disciplinary action has been developed,a and provides that a[i]f [a] staff member
was falsely accused, then an apology will be submitted to the staff member.a1134 The final version
of the July 2014 Guidelines does not adopt this language and states that a[i]n the event a medical
staff memberas treatment or care is called into question,a USAG can consult with medical
professionals, including members of the USAG medical staff. 1135 Notably, when Nassar next
edited the Medical Guidelines as part of a yearly update, he commented on this language, aHow
is this peer review decided? This needs to be discussed further. I am not comfortable with the
way this is stated.a1136

xlix

In addition to providing feedback on medical providers, Nassar was in a position of authority to provide his opinion
on other USAG members, including coaches facing allegations of misconduct. For example, in 2011, when a club
coach approached Nassar regarding sexual misconduct-related concerns she had about Marvin Sharp, a gymnastics
coach who later committed suicide in his jail cell following his arrest on four counts of child molesting and three
counts of sexual misconduct with a minor, Nassar advised the coach not to report the conduct because she did not
need anymore headaches in her life. RGID-3347161-0000003139; Associated Press, Gymnastics coach accused of
child molestation found dead, ESPN (Sept. 20, 2015), http://www.espn.com/olympics/gymnastics/story/_/id/
13700729/gymnastics-coach-marvin-sharp-accused-child-molestation-found-dead-jail-cell.

170

Nassar also effectively consolidated his position at USAG by earning the trust of key
members of USAG, including by leveraging sensitive injury information about gymnasts. Nassar
included National Team Coordinator Martha Karolyi, Assistant Womanas National Team Coach
Steve Rybacki, and athletic trainer Ms. Van Horn in his ainner circle of confidence,a with whom
he shared details of gymnastsa injuries.1137 Nassar noted that sharing this information could result
in a breach of trust and, therefore, in the spring of 2015, shortly after Rhonda Faehn was appointed
to lead the Womenas Team, he emailed Ms. Faehn to inform her that she was now part of this
ainner circle,a and warned her that a[a]ll it takes is for one national team child to tell the others
that aLarry can not be trusteda and then my work with the team is ruined.a1138 Nassaras approach
was successful, and he developed strong relationships with key USAG personnel, including what
he termed a arelationship with trusta with Ms. Karolyi.1139
For the vast majority of Nassaras career, USAG acted essentially as an administrator,
helping Nassar with his work a arranging for his travel, helping him coordinate medical supplies
and providing him with the opportunity to treat, and ultimately sexually abuse, gymnasts. USAG
employees largely seemed thankful that such a talented doctor had decided to devote so much time
as a volunteer.l Former Director of the Womenas Program and Director of the National Team
Training Center, Gary Warren, remarked that he had aalways admired your dedication to the
athletes and coaches. Your energy level, your compassion and your commitment is unsurpassed
by anyone I know.a1140 And Ms. Kelly commented that aeveryone knows how much you have
contributed to the sport and how much you care about the athletes.a1141
USAG never examined Nassaras medical records and never asked any detailed questions
regarding exactly how Nassar conducted his treatments or what was the exact nature of the consent

l

USAG covered certain travel expenses for Nassar and provided him with a stipend for attending certain events, such
as World Championships. USAG_00009761; RGID-3347161-0000005197; USAG_00360955.

171

he received from the athletes and their parents. In addition to failing to have any protocols in place
regarding best practices for documenting and charting medical care,1142 USAG similarly did not
have any protocols in place concerning best practices for how to treat patients, such as whether,
and how, trainers and doctors could treat patients in hotel rooms on the road, which is a practice
Nassar often employed. 1143 Summarizing USAGas oversight of Nassar, Ms. Kelly, Nassaras
ostensible supervisor, wrote to him in 2011 that she asomehow never thought that I was your
supervisor.a1144
USAG also had no staff member who was in charge of overseeing Nassaras delivery of
medical care to gymnasts while they were training at the Ranch. At most, USAG had one staff
member at the Karolyi Ranch, who was referred to as a ajack of all trades,a and who, in addition
to serving as a liaison for acquiring and managing training equipment, fixed mechanical and
plumbing issues, ran errands for supplies and removed snakes and insects.1145 As a result, Nassar
had broad latitude to conduct medical treatments and commit serial sexual abuse at the Karolyi
Ranch.
In January 2013, USAG belatedly began implementing policies to provide the organization
with greater control over the medical department.1146 As Mr. Penny commented, he afelt like we
needed to just have a higher level of oversight and a higher level of accountability as to what we
were doing in that area to provide care.a1147 Mr. Penny, therefore, convened a medical task force
to centralize and systematize decision-making concerning medical care.1148 Mr. Penny stated to
the Independent Investigators that he did not create this task force due to a concern over any abuse,
but rather to create aa higher level of administrative oversight than just having everything go
through Larry Nassar.a 1149 As Mr. Penny observed in a January 2013 email to Mr. Ashley

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concerning delays in establishing a partnership with St. Vincentas, an outside medical provider, aif
Larry Nassar is the gate-keeper, then we have a real issue.a1150
At first, Nassar expressed excitement over the creation of the task force,1151 and as noted
above, he participated in the drafting of new Medical Guidelines. Nassar, however, eventually
grew frustrated with his inability to control the groupas decision-making.

The task force

recommended that USAG partner with St. Vincentas over Nassaras strenuous objections and
attempts to forge a partnership with MSU instead,1152 and in February 2014, the task forceas work
resulted in the consolidation and centralization of medical staffing decisions at USAGas
headquarters. 1153 As the task force continued its work, Nassar received an even more direct
indication that he would have a diminished role at the organization. In the summer of 2014, USAG
decided to appoint Dr. David Kruse as the aAthlete Care Coordinator,a1154 essentially removing
Nassar from his position at the center of the medical team. Following these decisions, in a July
2014 email, Nassar offered his resignation to Mr. Galimore, but Nassar ultimately agreed to
continue working with the Womenas National Team, where he would remain until the summer of
2015.1155 li
2.

USAG Failed to Exert Its Authority over Its Membership and Adopted
Practices that Served as an Impediment to Addressing Credible Allegations
of Abuse, While Maintaining a Public Reputation as a Leader in Protecting
Athletes

As explained in Part IV.A, there is an acute danger of sexual misconduct in the sport of
gymnastics. USAG was better positioned than any other organization to take steps to confront and
minimize this threat. USAG had the power to decide who could participate in official competitions;

li
In addition to his work for USAG, Nassar also worked with athletes in other Olympic sports. Email records reflect
that Nassar served as the team doctor for Taekwondo at the 2008 Olympics, MSU-USOC-0004935, and worked with
athletes from Figure Skating, Diving, Track & Field, and other NGBs in the 2012 time period.
USAG_SEN_SCP_00006176. The Independent Investigators have not been able to confirm whether Nassar abused
athletes from these NGBs.

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the authority to bestow its brand a strengthened by repeated Olympic triumphs a on qualified gyms
and coaches; and a national voice and the ability to communicate with every member across the
country. Given its position in the sport, USAG was uniquely situated to provide its membership
with educational material, develop and enforce protocols and policies to ensure a safer gymnastics
experience, learn of abusive coaches and improper conduct by other members, take effective action
that could prevent such predators from moving from gym to gym, and otherwise build a positive
culture conducive to promoting the safety of athletes. The importance of USAG taking such
actions is magnified by the relative position of other participants in the sport, who often lacked the
tools to independently address issues of sexual misconduct. Many of the member club gyms are
small, family-run organizations

1156

with little experience concerning sexual misconduct

matters.1157
Over the past few decades, USAG took many positive steps with an eye toward protecting
athletes, including creating what was likely the first permanently ineligible membership list in
Olympic sports, promulgating sexual abuse prevention policies, and providing education for its
membership. Those steps, which USAG proudly advertised, generated a reputation for USAG as
an organization focused on athlete safety. But at the same time that USAG was taking these
publicized steps, it was also processing complaints of misconduct in a manner that permitted
abusive adults to continue to have access to young children. The disconnect between USAGas
public actions and private handling of complaints, between its asserted cutting-edge protective
policies and its haphazard and disorganized approach when confronted with concrete reports of
abuse, resulted from a cramped perspective of USAGas ability to take effective action combined
with an unwillingness to take necessary steps.

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a.

USAGas Efforts to Protect Gymnasts

Permanently Ineligible List a In or about 1990, USAG became one of the first NGBs to
maintain a list of persons permanently banned from membership and consequently any
participation in a USAG-sanctioned competition. 1158 Since the 1990s, USAG publicized this
banned list through its magazines Technique and USA Gymnastics and later placed the list on its
website.1159 The consequences of being named on the permanently ineligible list, aside from the
notoriety and lack of membership in USAG, include not being permitted on the competition floor
at a sanctioned event.1160 In 2011, after USAG learned that a banned coach continued to coach at
a gymnastics club, USAG updated its policies to prohibit any organization or individual hosting
or participating in a USAG-sanctioned event from affiliating with a permanently ineligible
member.1161 By 2012, Ms. Jamison noted that USAG had added 69 names to the permanently
ineligible list over the past ten years.1162 In that same year, Mr. Penny and Ms. Jamison also began
advocating with the USOC for a banned coaching list across the NGBs.1163
Sexual Abuse Prevention and Response Policies a USAG also promulgated many policies
over the years aimed at protecting gymnasts, beginning in 1994 with the creation of the USAG
Code of Ethics, which USAG updated over the years.1164 USAG took another big step forward in
2008 in response to negative press coverage concerning former gymnastics coach Steve Infante.
USAG had placed Mr. Infante on the permanently ineligible list in 1998,1165 but did not alert law
enforcement or take any other action at that time, and Mr. Infante continued to have access to
gymnasts for the next decade.1166 Following media coverage of this episode, Mr. Penny retained
the services of attorney Suzette Bewley to review USAGas child-abuse prevention and response
policies.1167

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As Ms. Bewley noted, USAG was aincreasingly facing issues concerning member and nonmember misconduct, particularly sexual misconduct, in the sport of gymnastics,a1168 and USAG
had therefore requested that Ms. Bewley (i) review the policies and procedures of other
organizations that regularly face member sexual misconduct issues a which Ms. Bewley did by
reviewing policies at other NGBs; the British, Irish and Scottish gymnastics organizations; various
churches; and other youth-oriented organizations1169 a and (ii) explain USAGas legal requirements
after becoming aware of alleged sexual misconduct.1170 Following Ms. Bewleyas report, USAG
enacted the Participant Welfare Policy in 2009, 1171 which outlined USAGas commitment to
promoting a safe environment, as well as the requirements and expectations of its members.1172
The Participant Welfare Policy included definitions of physical and sexual abuse, reporting
procedures for suspected abuse, misconduct and grievance procedures, member obligations and
recommendations, standards of behavior, and education and communication about the policy.1173
USAG also implemented various other policies in response to Ms. Bewleyas recommendations,
including creating an Event Sanction Certification, through which the director of a sanctioned meet
was required to certify that no persons on the permanently ineligible list would be associated with
the meet in any manner.1174 And in the following years, USAG continued to implement new
policies for its membership, including requiring member clubs to have a written policy regarding
standards of behavior for staff and a policy for handling complaints of misconduct.1175
Even as USAG developed new policies designed to protect gymnasts, however, the
organization did not draft comprehensive, internally consistent protocols, which resulted in a
patchwork of policies that, as written, did not reflect a child-centric focus. For example, even after
USAG created the Participant Welfare Policy to address matters related to sexual misconduct,
USAG did not update the policy in the Code of Ethics laying out the process for filing a complaint.

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In both the 1996 and 2016 versions of the Code of Ethics, a complainant raising any allegation of
a violation of the Code, ranging from sexual abuse to cheating, must first address the concern to
the offending member, and if that effort was ineffective, must provide a written, signed, specific
complaint to the President of USAG or another appropriate staff member.1176 Although there is
no record of USAG using the obligation to directly confront an abuser as the basis for denying a
complaint, a program director of an accused member coachas gym used this clause to defend the
coach against a proposed boycott, arguing that the boycotters were violating USAG policy by
refusing to directly confront the coach. 1177 And, as detailed below, USAG implemented the
requirement that a complainant provide a written, signed, specific complaint in a manner that
became one of the many obstacles to raising complaints about sexual misconduct.lii
Educational Efforts a In addition to implementing policies, USAG also provided its
membership with educational resources for protecting athletes from sexual misconduct. In 1998,
USAG mandated that all professional members, including coaches, judges and other officials, take
the Safety/Risk Management Course, which included a subsection on child abuse prevention.1178
The accompanying Risk Management handbook contains suggestions, such as to make all classes
and practices transparent by encouraging parents and guardians to attend and watch.1179 By 2005,
USAG adopted a policy to hold sexual misconduct seminars at every regional and national
congress.1180 And in 2012, USAG launched the Clubs Care/We Care educational campaign aimed
at member clubs and the parents of athletes to raise awareness regarding sexual abuse.1181 As part
of this effort, USAG created risk matrices listing various risk factors for clubs to consider.1182
lii

In a similar vein, the Womenas National Team Manual defines unacceptable coaching behavior for events sanctioned
by USA Gymnastics, including, among other violations, averbal, emotional, sexual, or physical abuse of a gymnast.a
USAG_HR_O00001838; USAG_HR_O00000919. This policy provides for the same punishment for any violation
of the policy, and the first penalty is a averbal warning.a USAG_HR_O00001838; USAG_HR_O00000919. Again,
there is no indication that USAG provided a verbal warning as the official punishment for sexual abuse, but USAG
did provide coaches accused of misconduct with a letter of warning when USAG was unable to process the complaint
due to the procedural hurdles it had implemented, as discussed in greater detail in Part V.B.3.

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Since April 2012, USAG has also run yearly programs in honor of Child Abuse Prevention Month
by making SafeSport courses available for free and distributing information to professional
members and parents of athletes.1183
b.

USAGas Reputation as a Leader in Protecting Athletes

In conjunction with USAGas efforts to protect athletes from sexual misconduct, USAG
cultivated a reputation as a leader in athlete safety and built a brand around its standard of care. In
1997, former president Kathy Scanlan wrote to a concerned parent that aUSA Gymnastics has in
fact been a leader among National Governing Bodies in the development of a Code of Ethics and
in our vigorous pursuit of policies and programs to protect athletes.a1184 In 2008, Mr. Penny struck
a similar chord in an editorial in Technique magazine, stating in part that USAG ahas been a leader
among national sports governing bodies for its proactive efforts in the areas of safety certification
and other educational initiatives.a1185 And in 2011, Mr. Penny wrote an open letter to the USAG
community in the wake of a negative press article regarding verbal, emotional, physical and sexual
misconduct by gymnastics coach Doug Boger, stating that a[a]thlete safety is the #1 priority for
USA Gymnastics.a1186
USAG was successful in its promotion, and became a recognized leader among the NGBs.
An article in USA Today from 2010 concerning allegations against USA Swimming noted that
a[o]f the Olympic sport organizations, USA Gymnastics is among the most progressive in having
[sexual abuse prevention] policies in place.a1187 Another outside observer wrote in 2013 that
USAG was aa role model among NGBs.a1188
As a result, when the USOC began developing its own SafeSport policies and practices,
USAG was deeply involved.1189 Mr. Penny, in particular, freely shared his perspective of best
practices regarding child-protective policies with the USOC, NGBs and other organizations. For

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example, after viewing a television special on sexual abuse at the Naval Academy, Mr. Penny
emailed the reporter, noting that he felt compelled to reach out because athe military is not
following best practices on the issue of sexual misconduct investigations and adjudications.a
Mr. Penny noted that he has adedicated [himself] and USA Gymnastics to being bold in its
leadership on this topic,a and ait shocks me . . . that the military feels it should remain insulated
on the topic.a1190 As is apparent, USAG felt proud of its efforts, especially in comparison to other
NGBs, and repeated the same message in other communications that aUSA Gymnastics has always
been the most proactive among the Olympic sports in attempting to safeguard athletes,a1191 and
that a[o]ur proactive measures are second to none in the Olympic movement.a1192
USAG actively marketed this reputation to parents and athletes to assure them of the highlevel of safety at USAG member gyms. Mr. Penny explained in the foreword of a 2012 USAG
newsletter, a[o]ur goal is for the USA Gymnastics brand to represent a level of prestige and
credibility to the gymnastics club and sanctioned events. This adds value and reassurance to
athletes and parents that the club is subscribing to a set of reliable standards.a1193 The branding
was effective in causing parents of elite gymnasts to place their trust in USAG. As one parent of
an elite gymnast remarked in an interview with a reporter, they atold us they were taking care of
our daughter,a1194 and awe had to fully turn over trust.a1195
c.

Disconnect Between USAGas Reputation and Effective Action

As detailed in Part V.B.3, below, discussing USAGas response to complaints about
misconduct, USAG did not exercise its authority over member clubs and took many actions that
failed to effectively respond to credible allegations of sexual assault, especially for an organization
that viewed itself as a and had a reputation for being a a leader on the issue. There are many
contributing factors to this disconnect, but two main causes emerge. First, USAG viewed itself as

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a resource-provider and imposed limitations on its role in actively managing its membership.
Second, USAG misconstrued principles of due process in a manner that led USAG to refuse to
take action in response to credible allegations of sexual misconduct. And as demonstrated by
USAGas response to the Indianapolis Staras investigation into the mishandling of the Marvin
Sharp complaint, USAG fiercely guarded its reputation as a leader in child-protective measures,
thereby widening this disconnect.
USAGas Role a USAG viewed itself akin to organizations similar to the American Medical
Association and the American Bar Association.1196 By assuming this position, USAG a much like
the USOC a positioned itself as an organization responsible for educating its members, setting
protocols for its membership and implementing general policies, rather than serving as an
enforcement body, responsible for ensuring that members complied with best practices. USAG
leaders, such as Mr. Penny, expressed the position that a[w]e can promote and encourage best
practices, but we are not an enforcement agency.a1197 More directly still, in a 2013a14 Athlete
Member Advisement, USAG stated that it ais not responsible for actions or inactions that may
occur at any local gymnastics club . . . [because] it does not . . . have any control or authority over
what happens at the local level.a1198
USAG, however, had the power, if the leadership chose to exercise it, to mandate and
enforce child-protective measures as a condition of membership. USAGas ability to withhold its
brand and its exclusive authority to sanction elite gymnastics events afforded it significant power
within the sport, given that competitive gymnasts needed to participate in such events if they were
to advance toward National Team membership or the Olympic Trials or Games, and a local
gymnastics club would have tremendous difficulty attracting talented coaches or athletes if they
could not participate in USAG events. And even if USAG was not responsible for managing

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affairs at the club level, USAG could still implement comprehensive and effective reporting
policies so that it could promptly learn of misconduct at the club level and act decisively to protect
gymnasts from abuse.
Misconstrued Principles of Due Process a One major reason that USAG publicly cited for
its inability to act in response to reports of misconduct was the Ted Stevens Act.1199 In May 2012,
Ms. Jamison responded to a Facebook petition asking USAG to take more affirmative action by
explaining that a[w]e continue to evaluate our policies and procedures against the industryas best
practices, but as we go forward we need to make sure that changes we make are allowable within
the parameters of the Amateur Sports Act. As a result, we are not always able to move as quickly
as some would like.a1200 And in August 2016, Mr. Penny circulated a draft of a response to the
Indianapolis Staras story on USAGas failure to report coaches accused of abuse by explaining that
a[t]here have been times when the organization has been hamstrung by a hearing process mandated
by its compliance with the Ted Stevens Olympic and Amateur Sports Act.a 1201 Such vague
concerns regarding the requirements of the Ted Stevens Act had a trickle-down effect on the
employees who were responsible for implementing USAGas policies, and these employees passed
along factually incorrect statements concerning the due process limitations.

For example,

Ms. Kelly explained to a parent reporting misconduct that, aAs part of the Olympic sport family,
we are also bound by the Amateur Sports Act (Federal Law) which forbids barring anyone from
pursuing participation in the Olympic Movement.a1202
The source of USAGas specific concerns regarding the Ted Stevens Actas limitations is
unclear. As explained above, in Part V.A.1, the Act establishes that an NGB must provide basic
due process to any participant and does so by requiring aan equal opportunity to amateur athletes,
coaches, trainers, managers, administrators, and officials to participate . . . [and] fair notice and

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opportunity for a hearing to any amateur athlete, coach, trainer, manager, administrator, or official
before declaring the individual ineligible to participate.a 1203 The Act also requires NGBs to
aprovide[ ] procedures for the prompt and equitable resolution of grievances of its members.a1204
Therefore, as long as USAG provided accused coaches with a fair procedure before banning them,
the Act would not interfere with USAG taking forceful and timely action in response to misconduct.
As Mr. Blackmun explained in his interview with the Independent Investigators, anothing in the
Ted Stevens Act prevents . . . prompt and effective action,a1205 further explaining that aany NGB
who wants to suspend a coach can have a hearing on short notice and do that.a1206
Indeed, the Independent Investigation identified only one example concerning tension
between USAG wanting to effect a policy aimed at protecting athletes from sexual misconduct
and the USOC pushing back on the ground of due process. In the 1990s, USAG attempted to
implement a policy in which any member who had been convicted of certain criminal charges or
been placed on an official sex offender list would receive an automatic ban from the sport. The
USOC raised the issue of the Actas requirement that an NGB must provide an opportunity for a
hearing before enacting a ban, and USAGas CEO at the time, Mr. Colarossi, responded by writing
a strongly worded letter to the USOC explaining his frustration with the hearing requirement as
unnecessary process.1207 USAG and the USOC ultimately resolved the matter after Mr. Blackmun,
who was then serving as General Counsel at the USOC, was able to work with USAGas lawyer to
create a system whereby USAG held a prompt hearing and could suspend a coach expeditiously
while complying with the requirements of the Act.1208 A similar issue reappeared in 2006,1209 and
USAG and the USOC reached a resolution whereby USAG implemented changes to its bylaws by
enumerating the criminal convictions that could trigger a ban without a hearing.1210

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Marvin Sharp a The disconnect between USAGas internal policies and its outward-facing
reputation is strikingly illustrated by USAGas response to allegations concerning former
gymnastics coach Marvin Sharp. USAG not only failed to act in a responsible manner after
receiving these allegations, instead relying on excessive process requirements, but also vigorously
defended its public reputation after the Indianapolis Star began inquiring into this episode.
In October 2011, Mr. Penny and Mr. Vidmar received an email from a coach detailing
concerns about Mr. Sharpas behavior.1211 Specifically, the email recounted that in 1995, the coach
witnessed Mr. Sharp giving an inappropriate massage to a 10-year-old gymnast; in 2009, the coach
heard from numerous athletes that they quit because aMarvin was weird and they didnat want any
part of ita; and now, in 2011, she learned that Mr. Sharp asked a 13-year-old gymnast to come into
his office, had her remove her leotard and then massaged her pelvic area.1212 Email records suggest
that the coach and Mr. Penny thereafter spoke and later that evening, the coach sent a follow-up
message to Mr. Penny memorializing her understanding that athe Mom must step to the platea and
make a complaint before USAG would act.1213 The following day, the coach emailed Mr. Penny
to explain that she had not yet spoken with the mother and then closed the email by emphatically
stating, in capital letters, aProtect these girls, they deserve it!a1214 Two weeks later, the coach
reached back out to Mr. Penny to ask whether the mother had contacted him, but Mr. Penny does
not appear to have responded to this message.1215 Given that USAG never received a first-hand
account of misconduct from a survivor or a survivoras parent, pursuant to its policies discussed in
greater length below, USAG took no action to contact authorities or to further investigate the
allegations.1216
Almost four years later, on August 24, 2015, Mr. Sharp was arrested on charges of child
molestation and was later charged with possession of child pornography. 1217 That same day,

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Mr. Penny emailed himself the 2011 warning regarding Mr. Sharp,1218 which he later shared with
law enforcement at the Indianapolis Metropolitan Police Department (aIMPDa).1219 The police
did not fault USAG for not previously disclosing this notice.1220 The following year, however, the
Indianapolis Star reached out to USAG concerning its historical failures to report misconduct to
law enforcement and specifically referenced the 2011 email regarding Marvin Sharp. 1221
Mr. Penny thereafter took actions emblematic of USAGas efforts to maintain its public reputation,
including by relying on a personal relationship with an IMPD detective to try to akill the story.a1222
Throughout the summer of 2016, Mr. Penny engaged in regular communication with
Lieutenant Bruce Smith, a supervisor at the Indianapolis Police Departmentas Child Abuse
Unit,1223 concerning USAGas failure to act on the 2011 notice.1224 Detective Smith appears to
have been on friendly terms with Mr. Penny.1225 Although the communications show that both
Mr. Penny and Detective Smith seem to have shared a personal belief that the 2011 email was too
vague to implicate USAGas duty to report or to conduct a further investigation, their text messages
reflect a seemingly single-minded focus on protecting USAGas public reputation.1226 In particular,
a text message in the exchange, reflecting on actions by the Indianapolis Star reporters, states that
aitas disgusting that someone would do this when USA Gymnastics is such a positive for a country
which is frankly in real crisis.a1227 Thereafter, Detective Smith, in consultation with Mr. Penny,
defended USAG by engaging in individual outreach with Indianapolis Star reporters, including in
off-the-record conversations, 1228 and by drafting a favorable press release from the IMPD
concerning USAGas reporting of Mr. Sharp,1229 which the police department never released.1230
Mr. Penny and Detective Smithas outlook on the importance of the issue of whether USAG
properly reported the 2011 email in comparison with the importance of protecting USAGas

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reputation is summarized in a text message from their exchange reading, aWe need to body slam
the other sources.a1231
During this time, Mr. Penny continued to portray USAG as following best practices,
including in his communications with the USOC. In late July 2016, he emailed senior officials at
the USOC, including Mr. Blackmun and Mr. Ashley, concerning the Indianapolis Staras upcoming
article, stating that ato reassure each of you, we have been told by local law enforcement that we
handled that situation above and beyond any organization with which they have worked, and that
there were no liabilities in our reporting.a1232 This characterization is similar to USAGas press
statement regarding its report of Nassaras conduct to law enforcement: a[T]he FBI . . . assured
USA Gymnastics that the FBI was the appropriate agency to make the report and that USA
Gymnastics had handled the matter correctly.a1233
3.

USAGas Processing of Complaints Highlights Its Failure to Implement
Athlete-Focused Policies and Practices

USAG implemented a process for handling complaints that reflected, in USAGas view, a
a[s]trong desire to deal with misconduct in an effective way,a and that a[p]rioritiz[ed] safety.a1234
In a presentation provided to the USOC to assist with the development of SafeSport, USAG
explained that this process included atake the issue seriously, address all complaints, investigate
facts, consult with legal counsel and other trusted advisors, stand behind decisions, continually
review best practices [and] follow the policy.a1235 In the spring of 2015, Mr. Penny confidently
remarked, a[W]e have policies and procedures that I rely on every step of the way[.] . . . And if
youare asking yourself aWhatas the right thing to do?a you go back to the policy and say you
followed the policy.a1236 Yet, as illustrated by the Marvin Sharp example above and others below,
despite the external statements and the surface appearance of thoughtful policies, USAGas process

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for handling complaints of misconduct failed to help protect athletes and contributed to additional
harm.
Historically, USAG did not have robust protocols in place for handling complaint files, and
throughout the 1990s, it alet a lot of this stuff languish.a1237 Mr. Penny noted that when he was
named CEO in 2005, he a[i]nherited [a] stack of unresolved files.a1238 To sort through these files,
as well as any new reports, Mr. Penny largely deputized Ms. Kelly, former-Vice-President of the
Womenas Program, and Ms. Jamison, then-Executive Office Manager and Mr. Pennyas personal
assistant, to handle misconduct matters, although neither had relevant education or training to help
them understand the nuances of sexual misconduct matters.1239 Both Ms. Kelly and Ms. Jamison
also had many other duties at USAG, and therefore could not focus on misconduct issues with the
attention the subject demanded. In March 2017, for example, Ms. Jamison wrote to Mr. Penny
that she was aunder water with [SafeSport] issues and need[ed] some help . . . [it] is too much for
any one person to manage.a1240
First-Hand Reporting Requirement a USAGas employees, who lacked proper expertise,
enforced numerous policies that stifled appropriate responses to reports of misconduct. One
notable policy was the requirement that any complaint must come from a survivor or the parent of
a survivor before USAG would take any action, regardless of the seriousness or credibility of the
report. For example, as noted in Part V.B.2.c, when Mr. Penny and Mr. Vidmar received the email
expressing concerns about Mr. Sharp, Mr. Penny did not report the misconduct because the mother
did not astep to the platea and directly make a report. 1241 When the mother did not contact
Mr. Penny, USAG took no action in response to the report of misconduct.1242 Similarly, in 2009,
a complainant reported to USAG that a gymnastics coach had sexually harassed the complainantas
wife by entering the bathroom where she was showering, opening the shower curtain and staring

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at her, and also had been fired from a previous job for a relationship with an underage athlete.1243
Ms. Kelly responded that USAG cannot address athese issues between Professional Membersa
because its policies only applied to minor athletes.1244 After the complainant pushed back on that
reasoning and restated that the coach had targeted underage athletes in the past, Ms. Kelly stated,
aIf you are able to have the underage athlete file a complaint, then we will pursue investigating
that allegation.a1245 And in 2010, after a gym owner reported that a coach had previously engaged
in an intimate relationship with a minor gymnast, had claimed amental illnessa as a defense for the
relationship and was now was in the process of opening a new gym, Ms. Jamison responded that
athere is nothing to prohibit [the coachas] continued membership in our organization,a because
a[w]e must receive a complaint from an athlete (or a parent on behalf of an athlete) to open an
investigation.a1246
Email correspondence reflects that Mr. Penny, and possibly other senior leaders, believed
that the Ted Stevens Act justified the policy requiring a written complaint from a survivor or
parent. 1247

The Act, however, does not prohibit investigating second-hand complaints of

misconduct, and USAG noted in 2017 in response to media inquiries, aThere is nothing in USA
Gym rules, policies or Bylaws that precludes us from looking into concerns brought to our attention,
regardless of the source.a1248 Indeed, aUSAG has the ability to initiate a complaint against a
member (with or without an outside complaint) pursuant to section 10.2 of the Bylaws.a1249
Requirements for Signed Complaint a USAG rejected other complaints due to policies that
similarly restrained USAG from taking action where the relevant reports were unsigned. In 1998,
USAG received a detailed, but unsigned, complaint alleging that a coach, who was already on
probation for molesting gymnasts in a hotel room, had given inappropriate massages and made
sexual comments to young gymnasts.1250 USAG reached out to the accused coach for a response,

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but explained, aPlease be assured that USA Gymnastics does not take action based on unsigned
letters.a1251 Similarly, in 2010, USAG received an anonymous complaint regarding a coach, which
attached a 2008 police report concerning the coach and detailing aforcible fondling.a1252 Soon
thereafter, Ms. Kelly contacted the accused coach, explaining that aour procedures require a signed
complaint letter before we begin an investigation. So until that occurs, we will not take any action.a
Ms. Kelly then advised the coach to atake any steps necessary to discredit these allegation[s] before
that happens.a1253
Refusal to Process Complaints Where Complainant Requested Anonymity a USAG also
repeatedly refused to process even corroborated complaints where the reporting party, who was
known to USAG, requested anonymity. For example, USAG received a complaint from a former
gymnast regarding a coachas sexual abuse of her, including touching her aback and bottom,a
arranging her bra straps and kissing aon the cheek and crook of my neck.a1254 But USAG refused
to take any action because the complainant wanted to stay anonymous.1255 USAG, therefore, sent
the accused coach a letter explaining that USAG had received allegations, but because the gymnast
had requested anonymity, aUSA Gymnastics cannot move forward with its member misconduct
process or an investigation.a1256 Similarly, in February 2015, USAG received signed letters from
a gym owner and a parent detailing a coachas abusive style of training, which had resulted in one
gymnast reporting the coachas physical abuse to the police.1257 The complaining parties, however,
requested anonymity and expressed fear of retaliation.1258 Ultimately, the gym owner asked to
postpone the matter until after an upcoming competition due to a fear of unspecified
arep[e]rcussions,a but there is no indication that USAG ever attempted to reach out following that
competition to reengage with the complaining parties, or otherwise moved forward with the
allegations.1259 USAG decided to codify these policies in the Participant Welfare Policy, which

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required USAG staff members who received telephone inquiries regarding abuse to a[i]nform the
caller that a written and signed complaint must be received for USAG to initiate its grievance
procedures against a member of USAG pursuant to Article 10 of the USAG Bylaws.a1260
Membership Requirements a USAG further limited its response to allegations of
misconduct by implementing policies that required reports to come from a member of USAG and
required the report to concern a member of USAG. USAG justified these restrictions by citing to
its limitations as a membership organization; Ms. Jamisonas understanding was aas a membership
organization . . . the limit to our jurisdiction is the membership, period.a1261 And although USAG
had limited powers that extended largely to its own membership, the general rule that USAG could
only take action when a report originated from a member and implicated a member restricted the
USAG from acting on credible allegations of misconduct. For example, in 2013, a woman alleged
that a USAG member had videotaped her in a bathroom stall eight years earlier ain a most
vulnerable position.a1262 Ms. Jamison responded that aour database shows you are not a member
of the organization,a and encouraged the complaining witness to reach out to other witnesses, who
were members, so that they could make reports.1263 USAG also did not place former members
accused of misconduct on the Permanently Ineligible list if their memberships had lapsed, which
permitted these coaches to continue to participate in gymnastics without any warning to the public
of their past misdeeds, a practice that USAG has begun correcting in recent years.1264
Overreliance on Criminal Justice Process and Criminal Definitions of Abuse a USAG also
relied on the legal systemas adjudication of a coachas conduct as a substitute for engaging in a
thorough examination to protect its membership. As Mr. Penny and Ms. Jamison stated in a joint
memorandum, aOur mantra is alet the law lead,aa 1265 which a former USAG representative
expounded upon by explaining that USAG awaits until the evidence has been presented and a

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judge/jury gives us their findings.a1266 Where the legal system ultimately adjudicated a coach
guilty of criminal acts of abuse, USAG responded by banning that coach, as the 1999 letter from
Mr. Colarossi to the USOC and ensuing discussions between the USOC and USAG establish, as
discussed in Part V.A.4. The flipside of this approach, however, was that USAG relied upon an
acquittal or a decision not to press charges as a basis for limiting the punitive options available to
USAG, and thereby adopted heightened standards of proof that were unwarranted in the context
of permitting a coach to retain membership credentials and, through these credentials, access to
young children. In 1997, USAG placed a coach on probation despite determining the report of
child molestation to be credible because probation was aas much as we could do in light of the
outcome of the court case,a which ended in acquittal.1267 In a letter to the parents of the survivor,
Ms. Scanlan expressed her ahopea that the probation will cause the coach to anot again abuse the
trust an athlete and family give to him.a1268 And in 2015, USAG did not take any action after
receiving a report that a coach had been terminated from his position for inappropriate texting with
minors and drinking alcohol with minors because the police aconcluded their investigation and no
charges have been filed.a1269 Similarly, USAG did not suspend a member until there was an
indication that law enforcement had taken action; in 2008, Mr. Penny wrote after receiving notice
that a coach was accused of recording athletes changing in a locker room that awe do not suspend
someoneas membership based on this level of informationa and a[n]ormally we wait until someone
has been arrested or indicted.a1270
USAG similarly failed to take action against coaches on the related basis that their actions
were not acriminala or failed to rise to a certain unspecified level of misconduct. In 1997, USAG
suspended, but did not permanently ban, a coach who spent the night in a hotel room with gymnasts
and touched them underneath their clothing because the behavior was aan isolated incident and

190

has ended.a 1271 In 2009, USAG imposed only a warning against a coach for inappropriately
touching a minor because the conduct, while anot acceptable coaching practices,a was not
acriminal.a1272 In 2010, Ms. Kelly wrote to a parent who had reported that a coach told her 13year old daughter that he loved her, aThis is a difficult case as it seems [the coach] had
inappropriate conversations with your daughter, which is unacceptable, [but] it is not criminal,a
and USAG therefore only issued a warning letter and placed the coach on probation for a year.1273
And in 2013, USAG did not take any actions against a 38-year-old coach who entered into a sexual
relationship with a young gymnast and then lied to the gym owner about the relationship because
USAG was not able to substantiate that the relationship began before the gymnast was 18.1274
Disorganization a In addition to adopting policies that limited responses to credible
allegations of misconduct, USAG also repeatedly failed to follow-up on complaint matters, and
the files contain inexplicable gaps in the investigations. For example, in April 2011, USAG
received a letter stating that a coach was terminated from a gym due to his ainvolvement with a
minor gymnast.a The complainant expressed concern that the coach was still working with
children and asked USAG to investigate.1275 USAG did not take any action for over four years
until Ms. Jamison reviewed the file as part of an auditing process and then reported the conduct to
the Texas Department of Family and Protective Services.1276 USAG did not suspend the coach
until June 2018. 1277 Similarly, in 2002, an investigator employed by USAG corroborated
allegations that a coach had engaged in a romantic relationship with a 13-year-old gymnast,
including kissing and writing love letters, 1278 and had kissed a 14-year-old cheerleader. 1279
Mr. Colarossi wrote to the coach asking whether he would like to have a hearing panel resolve the
allegations,1280 and the coach responded by asking Mr. Colarossi to adjudicate the matter on his
own and attributed his actions to a failure of scripture study and prayer, writing, aWhenever I have

191

got lax on both of those two vital things I have been more vulnerable to temptation.a 1281
Notwithstanding this correspondence, it does not appear that USAG took any action against the
coach, as three years later, in 2006, USAG received a complaint that the coach had been rehired at
his original gym.1282 In response, Ms. Kelly explained to the complainant that, aSince you have
no personal knowledge about this, (only the information your friend told you), you cannot file a
complaint.a1283 After the complainant argued that USAG should already have all the information
it needed to review the coachas actions,1284 USAG eventually, after a nine-month delay, reached
out to the coach for his response.1285 In 2007, five months after receiving the coachas reply,1286
USAG placed him on probation for one year.1287 Five years later, USAG conducted a review of
its files and realized it had made the 2007 decision to place the coach on probation without
evaluating the 2002 investigatoras report.1288 Still, USAG took no further action until 2017, when
USAG reached back out to the coach, stating that the coach would be placed on the permanently
ineligible list.1289 After the coachas lawyer objected, the coach and USAG appear to have reached
an agreement whereby the coach elected not to renew his membership and was never placed on a
public list.1290
Mandatory Reporting a Finally, USAGas policies not only constrained the organizationas
approach when disciplining its membership, but also appear to have influenced whether USAG
filed reports with the police or civil child protection authorities, given USAGas understanding that
the aduty to report lies with those who have first-hand knowledge.a1291 USAG does not have
comprehensive records indicating when it made reports to the proper authorities, and USAG did
make some such reports, but Ms. Jamison estimated that USAG only made afive or sixa reports
prior to reporting Nassar to the FBI.1292 liii

liii

The Independent Investigation did not engage in an analysis of whether USAG violated mandatory reporting laws.
The Independent Investigators are submitting this Report to the Indiana Department of Child Services.

192

***
Nassar was only the most notorious product of the systemic deficiencies at USAG that
placed children in danger over many years. And in addition to the numerous examples above,
USAGas response to allegations against former coaches Bill McCabe and Doug Boger underscores
how USAG a in myriad ways through its culture, structure, governance and processes a simply
did not adopt a child-protective approach. USAGas response to the reports of misconduct against
Mr. McCabe illustrates how USAG was uniquely positioned to take effective action, but instead
chose to rely on policies and practices that limited its response. And USAGas response to the
reports of misconduct against Mr. Boger reveals the many obstacles USAG implemented that
delayed and obstructed effective action.
Bill McCabe a In October 1997, a club owneras star coach moved out of state, and she
looked to hire a suitable replacement.1293 A coach named Bill McCabe applied, and after the owner
reviewed his resume, contacted a reference he had provided on his resume, and confirmed that
Mr. McCabe was not on USAGas ineligible list, she hired him.1294 Soon thereafter, however, the
gym owner realized there was something about Mr. McCabe that she did not like, including how
he seemed to play favorites with certain gymnasts for reasons unrelated to their gymnastics
abilities.1295
The following spring, in or about March 1998, Mr. McCabe attended a state competition
on behalf of the gymnastics club. After this competition, the gym owner received a call from the
owner of a separate gym, who stated that he had recognized Mr. McCabe at the competition and
wanted to relate that he had fired Mr. McCabe after Mr. McCabe bragged about inappropriate
behavior with underage gymnasts.1296 Following this notice, the gym owner began investigating
Mr. McCabeas background, including by contacting other gym owners and speaking with her

193

gymnasts.1297 She learned from the other gym owners that Mr. McCabe had bounced from gym
to gym, had lied about his background and that the reference on his resume that she had relied
upon in hiring him was a aset-up.a 1298 The gym owner also learned from her gymnasts that
Mr. McCabe had been exposing himself to them by wearing loose-fitting shorts without underwear.
The gym owner called Mr. McCabe into her office and instructed him to cease exposing himself
to gymnasts.

Following this meeting, she believed that Mr. McCabe would stop his

misbehavior.1299
Soon thereafter, however, an 18-year-old cheerleader contacted the gym owner to state that
Mr. McCabe had been sexually harassing her. The gym owner asked the cheerleader to record
these allegations in writing, which the woman did in October 1998, shortly before the woman
obtained a judicial restraining order against Mr. McCabe.1300 The gym owner then confronted
Mr. McCabe with the full results of the investigation, including her communications with other
gym owners and asked Mr. McCabe to resign, which he did.1301
The following day, the gym owner faxed the results of her investigation to USAG.1302 This
packet of information included (i) detailed information with dates, names and contact information
for multiple gym owners who had terminated their relationships with Mr. McCabe in recent years
due to his sexual and other misconduct, and (ii) a letter from the 18-year-old target of
Mr. McCabeas harassment detailing his misconduct.1303 A few days later, the gym owner who had
raised concerns the previous spring sent a letter to USAG explaining that he had terminated
Mr. McCabe because ahe was bragging about the fact that he had one of the 15 yr old cheerleaders
in her underwear and said he thought he would be able to F--- her very soon.a1304 The gym owner
concluded his letter by writing that Mr. McCabe ashould be locked in a cage before someone is
raped.a1305

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USAG does not appear to have responded to the first gym owneras packet of information,
and Ms. Kelly responded to the second gym owneras letter by writing: aI am awaiting an official
letter of complaint from a parent and athlete. I will add your letter to the file in the event we
receive the letter and an investigation is commenced.a1306
In the months following Mr. McCabeas resignation in October 1998, he started working in
a new gym, and some of the gymnasts decided to move gyms to continue training with him. As
the gym owner remarked, aMcCabe promised the parents the moon and the stars, so they believed
him and followed him.a 1307 After the gym owner attended an event where Mr. McCabe was
coaching, she again sent a letter to USAG emphasizing the need for USAG to take action, and then
followed up by phone.1308 During this phone call, Ms. Kelly explained to the gym owner that her
investigation had been based on ahearsay,a and therefore USAG could take no action.1309 On
December 1, 1999, USAG renewed Mr. McCabeas professional membership.1310
In 2002, Mr. McCabe opened a new gym near Savannah, Georgia.1311 A newspaper story
from that time noted that Mr. McCabe was a aUSA Gymnastics Professional member and USA
Gymnastics safety-certified.a1312 In 2005, however, copies of the letters sent to USAG concerning
Mr. McCabeas misconduct were anonymously placed on cars in the parking lot of the Savannah
gym. 1313 One concerned parent contacted USAG to ask about these allegations, but was
incorrectly told that USAG had not received any complaints about Mr. McCabe; the parent was
also assured by USAG that Mr. McCabe was a coach in good standing. 1314 This parent was
reassured by her conversation with USAG and permitted her daughter to continue to train with
Mr. McCabe for months, until the parent noticed troubling emails between Mr. McCabe and her
daughter that eventually resulted in Mr. McCabeas arrest, conviction, and 30-year prison sentence
on a multitude of counts related to child pornography and the sexual exploitation of children.1315

195

Doug Boger a In contrast to the allegations against Mr. McCabe, the allegations against
Mr. Boger resulted in his placement on the permanently ineligible list and a change to the USAG
Bylaws to prohibit any gymnastics club or individual hosting USAG events from associating with
anyone on the permanently ineligible list.1316 Rather than showcasing the effectiveness of USAGas
policies and practices, however, the process by which Mr. Boger was banned from the sport
underscores the slow-moving nature of the process, the many procedural obstacles, the necessity
for persistent and multiple complainants, and the effectiveness of media coverage in ultimately
spurring change. As the woman who spearheaded the efforts to ban Mr. Boger remarked, USAG
told her, ayou are not enough, you need more people,a1317 reinforcing the message expressed by
others that aone letter is not enough and one person is not enough.a1318 This woman, and her
fellow former gymnasts, needed to overcome a series of roadblocks and persevere through years
of repeatedly detailing their abuse before USAG took any action.
In the early 1980s, multiple young gymnasts reported to their parents that their gymnastics
coach, Mr. Boger, routinely punched and kicked gymnasts, resulting in criminal charges. 1319
Following a trial, however, a jury acquitted Mr. Boger of four criminal counts of child abuse and
battery. 1320 Twenty-six years later, in June 2008, one of the gymnasts who had trained with
Mr. Boger in the early 1980s sent a letter to Mr. Penny detailing her first-hand account of
Mr. Bogeras extensive abuse of gymnasts, and asked USAG to take action.1321 Four months later,
Ms. Kelly responded by calling the reporting gymnast and telling her that USAG needed more
witnesses to come forward before it could process the matter.1322
The reporting witness then reached out on her own to women, some of whom she had not
spoken to for decades and some of whom she had never met.1323 Initially nine women signed a
joint letter in February 2009 detailing how Mr. Boger had physically and verbally abused all of

196

them and sexually abused some of them from 1977 to 1981.1324 USAG responded to this letter by
requesting more detailed statements from the signatories of the letter.1325 In response, the women
who had signed the February 2009 letter, as well as three additional women, wrote individual
follow-up letters to USAG between July and September 2009, covering a total of 21 pages,
explaining in detail how Mr. Boger slapped, pushed, choked, kicked and verbally abused gymnasts
on a regular basis, with one woman detailing Mr. Bogeras sexual abuse.1326 Again, USAG took
no immediate action in response to these letters; instead, in the fall of 2009, while the detailed,
first-hand complaints of abuse were pending, Mr. Boger was named USAG Trampoline and
Tumbling Coach of the Year, and in November 2009, Mr. Boger attended the World
Championships as a USAG National Team coach.1327
In December 2009, in response to a further request by USAG, the group of women who
had reported the abuse by Mr. Boger met with Mr. Penny and others from USAG, including two
USAG lawyers.1328 The meeting was convened in offices near the Los Angeles airport, with each
former gymnast responsible for paying her own travel costs, including flights into and out of Los
Angeles for those traveling from distant geographies.1329 Thereafter, in January 2010, Mr. Penny
followed up with the complainants to inform them that USAG would reach out to Mr. Boger with
the details of their allegations and would provide Mr. Boger with their names, which was contrary
to a request for anonymity from at least one of the women.1330 After Mr. Boger provided a blanket
denial, USAG retained the services of an investigative firm to take sworn statements in one-onone interviews with each of the 12 women who made complaints about Mr. Boger.1331 And USAG
then asked the investigative firm to locate and interview other former gymnasts who trained with
Mr. Boger and who had not previously reached out with complaints. 1332 After the survivors
persevered through this costly, time-consuming and emotionally wrenching process, and after at

197

least five other women, who had not chosen to affirmatively share their stories, provided further
corroboration, USAG finally placed Mr. Boger on the permanently ineligible list in June 2010,
two years after first receiving a detailed account of Mr. Bogeras misconduct.1333
The following spring, Ms. Kelly received an email stating that despite Mr. Bogeras
placement on the permanently ineligible list, he was continuing to coach at a gym in Colorado and
that this gym was permitted to compete in USAG-sanctioned events.1334 Ms. Kelly responded by
stating that USAG ahas no authority over the club businessa and therefore could take no action.1335
In July 2011, Ms. Jamison received another complaint that Mr. Boger was permitted to remain in
gymnastics, and she provided a similar response that USAG was powerless to take any additional
action.1336 But in October 2011, the Orange County Register ran a story detailing how Mr. Boger
was permitted to continue coaching gymnasts, and included accounts from interviews with many
of the same gymnasts who had filed complaints with USAG. 1337 That article resulted in
Mr. Bogeras resignation from the Colorado gym,1338 and in November 2011, USAG updated its
bylaws to prohibit any club participating in USAG-sanctioned events from hiring anyone on the
permanently ineligible list.1339 In the end, it took three and a half years of concerted, dedicated
effort by dozens of women, together with the power of the press, to reach a result that a solitary,
private complaint rarely achieved.

198

CONCLUSION
During Nassaras sentencing hearing, a survivor poignantly stated: athis is what it looks like
when the adults in authority do not respond properly to disclosures of sexual assault. This is what
it looks like when institutions create a culture where a predator can flourish unafraid and unabated,
and this is what it looks like when people in authority refuse to listen, put friendships in front of
the truth, fail to create or enforce proper policy, and fail to hold enablers accountable.a1340
Together with many others, this survivor has captured eloquently, and searingly, the
complex array of factors underpinning Nassaras nearly 30-year run of serial sexual assault. In
seeking to understand what happened, there is no single answer. What happened cannot be
explained by Nassar, whose conduct, however reprehensible, was a manifestation of a far broader
constellation of factors and conditions in elite gymnastics and Olympic sport that left young
athletes vulnerable to abuse and led Olympic organizations astray from the priority of athlete safety.
In setting forth in detail in this Report the multi-layered and multi-faceted set of
contributing factors a from casual disregard to affirmative inaction, from cultural conditions to
governance choices, from inadequate policies and procedures to the delayed response overall to
the risk of sexual abuse in sport a it was our aim to get to the bottom of what went wrong, and it
remains our sincere hope that these factual findings will inform efforts going forward to protect
young athletes and will help to ensure that a predator like Nassar can never again find so
accommodating a home in sport.

199

1

Compendium of Survivor Statements Maintained By Ropes & Gray; Eric Levenson, MSU reaches $500 million
settlement with Larry Nassar victims, CNN (May 17, 2018), https://www.cnn.com/2018/05/16/us/larry-nassarmichigan-state-settlement; Catherine Shaffer, Number of Nassar accusers approaches 500, MICH. RADIO (Oct. 19,
2018), http://www.michiganradio.org/post/number-nassar-accusers-approaches-500
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Compendium of Survivor Statements Maintained By Ropes & Gray; Matt Mencarini, Inside the investigation and
prosecution of Larry Nassar, LANSING STATE J. (Apr. 7, 2018), https://www.lansingstatejournal.com/story/news/
local/2018/04/05/larry-nassar-inside-prosecution-investigation/472506002
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Compendium of Survivor Statements Maintained By Ropes & Gray
4
Compendium of Survivor Statements Maintained By Ropes & Gray
5
Compendium of Survivor Statements Maintained By Ropes & Gray
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8
Compendium of Survivor Statements Maintained By Ropes & Gray
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Compendium of Survivor Statements Maintained By Ropes & Gray
10
What is Osteopathic Manipulative Treatment?, AM. OSTEOPATHIC ASSaN, https://osteopathic.org/what-isosteopathic-medicine/osteopathic-manipulative-treatment/ (last visited Dec. 5, 2018)
11
Tim Evans et al, How Larry Nassar abused hundreds of gymnasts and eluded justice for decades, INDIANAPOLIS
STAR (Apr. 4, 2018), https://www.indystar.com/story/news/2018/03/08/larry-nassar-sexually-abused-gymnastsmichigan-state-university-usa-gymnastics/339051002; Compendium of Survivor Statements Maintained By Ropes &
Gray; USAG_HR_O00006085
12
Tim Evans et al, How Larry Nassar abused hundreds of gymnasts and eluded justice for decades, INDIANAPOLIS
STAR (Apr. 4, 2018), https://www.indystar.com/story/news/2018/03/08/larry-nassar-sexually-abused-gymnastsmichigan-state-university-usa-gymnastics/339051002
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40
Indictment, United States v. Nassar, No. 1:16-cr-242 (W.D. Mich. Dec. 14, 2016); Dec. 21, 2016 Arraignment Tr.,
United States v. Nassar, No. 1:16-cr-242 (W.D. Mich. Dec. 23, 2016)

200

41

U.S. Sentencing Mem., United States v. Nassar, No. 1:16-cr-242 (W.D. Mich. Nov. 30, 2017)
Civil Complaint, Court Filings on file with the Independent Investigators
43
Marisa Kwiatkowski et al., A blind eye to sex abuse: How USA Gymnastics failed to report cases, INDIANAPOLIS
STAR (Jan. 31, 2018), https://www.indystar.com/story/news/investigations/2016/08/04/usa-gymnastics-sex-abuseprotected-coaches/85829732
44
Mark Alesia et al., Sexual abuse trial: Larry Nassaras downfall started with an email to IndyStar, INDIANAPOLIS
STAR (Jan. 19, 2018), https://www.indystar.com/story/news/nation-now/2018/01/19/larry-nassars-downfall-startedemail-tip-newspaper-indystar/1047203001; Article on file with the Independent Investigators
45
Mark Alesia et al., Sexual abuse trial: Larry Nassaras downfall started with an email to IndyStar, INDIANAPOLIS
STAR (Jan. 19, 2018), https://www.indystar.com/story/news/nation-now/2018/01/19/larry-nassars-downfall-startedemail-tip-newspaper-indystar/1047203001
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Munford Aff., People v. Nassar, No. 17-20217-FC (Eaton Cty., Mich. Feb. 21, 2017); Munford Aff., People v.
Nassar, No. 17-526-FC (Ingham Cty., Mich. Feb. 21, 2017)
48
MSU-USOC-0007077; MSU-USOC-0007081; Mark Alesia et al., Timeline: Former USA Gymnastics doctor Larry
Nassar, INDIANAPOLIS STAR (Feb. 14, 2017), https://www.indystar.com/story/news/2016/09/20/larry-nassar-timeline/
90733320; MSU-USOC-0007080
49
Dec. 21, 2016 Arraignment Tr., United States v. Nassar, No. 1:16-cr-242 (W.D. Mich. Dec. 23, 2016); 2016 Larry
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50
2016 Larry Nassar Police Interrogation, YOUTUBE (June 13, 2018), https://www.youtube.com/watch?v=
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51
2016 Larry Nassar Police Interrogation, YOUTUBE (June 13, 2018), https://www.youtube.com/watch?v=
BgPtIQGCPzE
52
2016 Larry Nassar Police Interrogation, YOUTUBE (June 13, 2018), https://www.youtube.com/watch?v=
BgPtIQGCPzE
53
2016 Larry Nassar Police Interrogation, YOUTUBE (June 13, 2018), https://www.youtube.com/watch?v=
BgPtIQGCPzE
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USAG_00259242; USAG_00313584
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Tim Evans, Larry Nassar was sometimes arrogant, sometimes nervous, during only interview on sex abuse,
INDIANAPOLIS STAR (Jan. 24, 2018), https://www.indystar.com/story/news/2018/01/23/larry-nassar-sometimesconfident-sometimes-arrogant-sometimes-nervous-during-only-interview-sex-abus/1054686001
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Tim Evans, Larry Nassar was sometimes arrogant, sometimes nervous, during only interview on sex abuse,
INDIANAPOLIS STAR (Jan. 24, 2018), https://www.indystar.com/story/news/2018/01/23/larry-nassar-sometimesconfident-sometimes-arrogant-sometimes-nervous-during-only-interview-sex-abus/1054686001
63
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arrogant, sometimes nervous, during only interview on sex abuse, INDIANAPOLIS STAR (Jan. 24, 2018),
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Marisa Kwiatkowski et al., How the USA Gymnastics scandal unfolded, INDIANAPOLIS STAR (Mar. 2, 2017),
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Munford Aff., People v. Nassar, No. 17-20217-FC (Eaton Cty., Mich. Feb. 21, 2017)
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Tim Evans et al., Former USA Gymnastics doctor accused of abuse, INDIANAPOLIS STAR (Jan. 24, 2018),
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Kim Kozlowski, MSU coach backed Nassar nearly until the end, DETROIT NEWS (Mar. 29, 2018),
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77
John Barr & Dan Murphy, Nassar surrounded by adults who enabled his predatory behavior, ESPN (Jan. 16, 2018),
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Tim Evans et al., Doctor disputes USA Gymnastics claim, INDIANAPOLIS STAR (Sept. 13, 2016),
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Court Filings on file with the Independent Investigators
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Letter from Congress to USAG (Jan. 25, 2018)
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Letter from Michigan House of Representatives to MSU (Jan. 25, 2018)
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sexual abuse at Karolyi Ranch in Texas, CNN (June 29, 2018), https://www.cnn.com/2018/06/29/us/larry-nassarindicted-in-texas
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Article on file with the Independent Investigators; MSU-USOC-0001291; MSU-USOC-0002740
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Curriculum Vitae of Larry Nassar, on file with the Independent Investigators; Article on file with the Independent
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USAG_SEN_SCP_00014022
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USAG_04548458
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USAG_00015829
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MSU-USOC-0004895
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USAG_00012465
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MSU-USOC-0004709
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USAG_04548458
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MSU-USOC-0001995
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story/news/local/michigan/2017/08/10/rise-fall-larry-nassar/104491508/
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GYMNASTICS
DOCTOR
AUTISM
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USAG_00795581
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Larry Nassar Facebook Post, on file with the Independent Investigators
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USAG_01048588
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USAG_HR_O00006085
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Civil Complaint, Court Filings on file with the Independent Investigators
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USAG_00258885; Compendium of Survivor Statements Maintained By Ropes & Gray
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Mila Murray & Jack Ryan, More than 100 new Nassar survivors come forward, upcoming deadline to file claims,
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Kate Wells, MSU Suspends Head Gymnastics Coach, MICHIGAN RADIO (Feb. 13, 2017)
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Article on file with the Independent Investigators
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Compendium of Survivor Statements Maintained By Ropes & Gray
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Gymnastics scandal: 8 Times Larry Nassar Could Have Been Stopped, NBC NEWS (Jan. 25, 2018),
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KATHY KLAGES ARREST WARRANT (Aug. 23, 2018), available at http://media.graytvinc.com/documents/
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KATHY KLAGES ARREST WARRANT (Aug. 23, 2018), available at http://media.graytvinc.com/documents/
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Civil Complaint, Court Filings on file with the Independent Investigators
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Civil Complaint, Court Filings on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Articles on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Article on file with the Independent Investigators
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Tim Evans et al., How Larry Nassar Abused Hundreds of Gymnasts and Eluded Justice for Decades, INDIANAPOLIS
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Article on file with the Independent Investigators
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Articles on file with the Independent Investigators
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Will Hobson, Police Investigated Larry Nassar for Abuse 13 Years Ago. Hereas How He Got Away, WASH. POST
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Tracy Connor & Rehema Ellis, Michigan Police Department Apologizes for Doubting 2004 Larry Nassar Accuser,
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USOC-R&G-00031006; USAG_00307213
316
USAG_00264680
317
USAG_00264680
318
Tracy Connor & Sarah Fitzpatrick, Gymnastics scandal: 8 Times Larry Nassar Could Have Been Stopped, NBC
NEWS (Jan. 25, 2018), https://www.nbcnews.com/news/us-news/gymnastics-scandal-8-times-larry-nassar-couldhave-been-stopped-n841091
319
USAG_00264680
320
USAG_00264680
321
USAG_00264680
322
USAG_00264680
323
USAG_00264704; USAG_00264680
324
USAG_00264680
325
USAG_00271384
326
USAG_00271384
327
Compendium of Survivor Statements Maintained By Ropes & Gray
328
USAG_02149778; Matt Mencarini, 2014 Police Report Sheds Light on How Nassar Avoided Criminal Charges,
LANSING STATE JOURNAL (Jan. 26, 2018), https://www.lansingstatejournal.com/story/news/local/2018/01/26/larrynassar-michigan-state-investigation/1064914001
329
Matt Mencarini, 2014 Police Report Sheds Light on How Nassar Avoided Criminal Charges, LANSING STATE J.
(Jan. 26, 2018), https://www.lansingstatejournal.com/story/news/local/2018/01/26/larry-nassar-michigan-stateinvestigation/1064914001
330
Larry Nassar Facebook Post, on file with the Independent Investigators
331
USAG_01152556; USAG_00010814; USAG_00008661; USAG_00015829
332
Larry Nassar Facebook Post, on file with the Independent Investigators
333
Witness 98 Interview; Witness 24 Interview
334
Case Summaries, Court Filings on file with the Independent Investigators; Eli Meixler, Former USA Gymnastics
Trainer Who Worked With Larry Nassar Arrested on Sexual Assault Charge, TIME (Sept. 7, 2018), http://time.com/
5389591/debbie-van-horn-arrest-nassar-gymnastics-sexual-assault; Tony Marco, Former USA Gymnastics trainer
who worked with Larry Nassar arrested; sheas accused of sexual assault of a child, CNN (Sept. 7, 2018),
https://www.cnn.com/2018/09/06/us/debbie-van-horn-larry-nassar-arrest/index.html
335
USAG_04057420; USAG_00270006; MSU-USOC-0007267; MSU-USOC-0007258
336
MSU-USOC-0007258
337
USAG_00270006
338
USAG_00270006
339
Kelly Interview

208

340

Penny Interview
Penny Interview
342
Kelly Interview
343
Moreau Interview; Witness 24 Interview
344
Moreau Interview
345
Moreau Interview
346
Moreau Interview
347
Moreau Interview
348
Moreau Interview; USOC-R&G-00071464
349
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. A; Faehn Interview
350
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. A; Faehn Interview
351
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. A
352
Faehn Interview
353
Faehn Interview
354
Faehn Interview
355
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. B
356
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. B
357
Penny Interview; Faehn Interview
358
Penny Interview
359
Penny Interview
360
Penny Interview; Article on file with the Independent Investigators
361
Penny Interview; Article on file with the Independent Investigators
362
Letter from Christopher Schneider, counsel to USAG, to the Independent Investigators (Oct. 4, 2018), on file with
the Independent Investigators; Penny Interview
363
Parilla Interview
364
Parilla Interview; Witness 94 Interview
365
Parilla Interview; Witness 94 Interview
366
Witness 94 Interview
367
Witness 94 Interview
368
Witness 94 Interview
369
Parilla Interview; Witness 94 Interview
370
Parilla Interview; Witness 94 Interview
371
USAG_00386873
372
USAG_00386873
373
Faehn Interview
374
Letter from Section Chief of the Information Management Division of the FBI to the Independent Investigators
dated Oct. 15, 2018, on file with the Independent Investigators
375
Kelly Interview; Penny Interview
376
Kelly Interview
377
Kelly Interview
378
Penny Interview, Compendium of Survivor Statements Maintained By Ropes & Gray; Letter from F. Sepler to the
Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators
379
Penny Interview
380
USAG_01204174
381
USAG_00391874
382
Penny Interview; USAG_00355427; Statement of Fran Sepler to Dateline NBC (Apr. 12, 2018), http://media1.snbcnews.com/i/TODAY/z_Creative/Statement%20of%20Fran%20Sepler%204.12.18.pdf
383
USOC-R&G-00030745
384
USOC-R&G-00030745
385
Penny Interview
386
USAG_00360929
341

209

387

Penny Interview
USAG_00360929
389
MSU-USOC-0007221
390
USAG_02276622
391
USAG_HR_O00006412
392
USAG_HR_O00006412
393
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. F
394
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. A; Faehn Interview
395
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. F
396
Faehn Interview; Article on file with the Independent Investigators
397
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Exhibit B-1; USAG_00386873
398
Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators
399
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. A; Faehn Interview
400
USAG_04015059
401
USAG_04015059
402
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018); Faehn Interview
403
Faehn Interview
404
USAG_04015059
405
Compendium of Survivor Statements Maintained By Ropes & Gray; Letter from F. Sepler to the Independent
Investigators (Sept. 5, 2018), on file with the Independent Investigators
406
USOC-R&G-00030745
407
USOC-R&G-00030745
408
Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators;
USOC-R&G-00030745
409
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. D; Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on
file with the Independent Investigators
410
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. D-F; Faehn Interview; USOC-R&G-00030745
411
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. D
412
USAG_00306919, Faehn Interview
413
Faehn Interview
414
USAG_00410989; USAG_00402812; Article on file with the Independent Investigators
415
Penny Interview
416
Penny Interview
417
USAG_00128083; USAG_00306916
418
Article on file with the Independent Investigators
419
Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators
420
Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators
421
Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators;
USOC-R&G-00030745
422
USOC-R&G-00030745
423
USOC-R&G-00030745
424
Letter from F. Sepler to the Independent Investigators (Sept. 5, 2018), on file with the Independent Investigators
425
Parilla Interview; Penny Interview
426
Parilla Interview; Penny Interview
427
USOC-R&G-00024044; Ashley Interview
428
USOC-R&G-00024044
429
USOC-R&G-00024044
388

210

430

Ashley Interview
Penny Interview
432
Blackmun Interview
433
Blackmun Interview; Penny Interview
434
Blackmun Interview
435
Blackmun Interview
436
Blackmun Interview
437
Penny Interview
438
Penny Interview; Blackmun Interview
439
Blackmun Interview
440
Blackmun Interview
441
Penny Interview
442
Penny Interview
443
Ashley Interview; USOC-R&G-00022689
444
Blackmun Interview
445
Blackmun Interview
446
Probst Interview
447
Probst Interview
448
USAG_00070586
449
USAG_00070586
450
Blackmun Interview; Ashley Interview
451
Blackmun Interview
452
Blackmun Interview; Blackmun Interview
453
Email from B. Trout to the Independent Investigators (Nov. 21, 2018)
454
Blackmun Interview; Blackmun Interview
455
Blackmun Interview
456
Blackmun Interview
457
Blackmun Interview
458
Blackmun Interview
459
Blackmun Interview
460
Blackmun Interview
461
Blackmun Interview
462
Blackmun Interview; USOC-R&G-00034814
463
Blackmun Interview; Ashley Interview
464
Blackmun Interview
465
Arrington Interview
466
Blackmun Interview; Blackmun Interview
467
Witness 63 Interview; Witness 64 Interview; Witness 65 Interview; Witness 66 Interview; Witness 67 Interview;
Witness 68 Interview; Witness 71 Interview; Witness 77 Interview; Witness 90 Interview; Witness 91 Interview;
Witness 116 Interview; Witness 118 Interview; Witness 120 Interview; Witness 121 Interview
468
USAG_00130285
469
USAG_00130285
470
Buendorf Interview
471
Buendorf Interview
472
Buendorf Interview
473
Buendorf Interview
474
USAG_HR_O00006174, USOC-R&G-00030744 & USOC-R&G-00030745
475
USAG_HR_O00006174, USOC-R&G-00030744 & USOC-R&G-00030745
476
Buendorf Interview
477
Buendorf Interview
478
Buendorf Interview
479
Buendorf Interview
480
Buendorf Interview; Mosley Interview
481
Appendix, Exhibit B.; USOC-R&G-00029102; USOC-R&G-00040757
482
Blackmun Interview
483
Email from B. Trout to the Independent Investigators (Nov. 21, 2018)
431

211

484

Blackmun Interview
Blackmun Interview
486
Blackmun Interview
487
Blackmun Interview
488
Blackmun Interview
489
Email from B. Trout to the Independent Investigators (Nov. 21, 2018)
490
Blackmun Interview
491
Buendorf Interview
492
USOC-R&G-00056624
493
Parilla Interview
494
Parilla Interview
495
Parilla Interview; Chris Bavender, Indianapolis Special Agent in Charge W. aJaya Abbot to Retire, FBI (Dec. 1,
2017), https://www.fbi.gov/contact-us/field-offices/indianapolis/news/press-releases/indianapolis-special-agent-incharge-w-jay-abbott-to-retire; FBI sex trafficking operation leads to South Bend arrest, SOUTH BEND TRIBUNE (Oct.
18, 2017), https://www.southbendtribune.com/news/publicsafety/fbi-sex-trafficking-operation-leads-to-south-bendarrest/article_ac489072-b429-11e7-b5b2-2b0aff5c671e.html; Penny Interview; Jeremy Brilliant, 13 Investigates:
Forced into prostitution, WTHR (Apr. 14, 2016), https://www.wthr.com/article/13-investigates-forced-intoprostitution
496
Penny Interview
497
USAG_HR_O00006358; Penny Interview; Parilla Interview
498
SP0000166
499
USAG_HR_O00006144
500
USAG_HR_O00006144
501
USAG_HR_O00006144
502
USAG_00361066
503
USAG_00411008
504
USAG_00411008
505
USAG_00070648
506
USAG_00070648
507
USAG_00070648
508
USAG_00070651
509
USAG_00070653
510
USAG_00070661
511
USAG_00070661
512
USAG_00070661
513
USAG_00070661
514
USAG_00409037
515
USAG_00409037
516
USAG_00432999
517
USAG_00432999
518
USAG_00428060
519
USAG_00014760
520
USAG_00014760
521
USAG_00303880
522
Penny Interview
523
USAG_00303880
524
USAG_00303880
525
USAG_00303880
526
Penny Interview
527
Compendium of Survivor Statements Maintained By Ropes & Gray; Articles on file with the Independent
Investigators
528
USAG_00014629
529
USAG_00361066
530
USOC-R&G-00030745; USAG_HR_O00006150
531
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. E; Faehn Interview; Jamison Interview
485

212

532

Penny Interview; USAG_00070616
USAG_00070616
534
Penny Interview
535
USOC-R&G-00030745
536
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. D; Faehn Interview
537
USAG_00070616
538
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018), Ex. F
539
Faehn Interview
540
Faehn Interview
541
Faehn Interview
542
Faehn Interview
543
USOC-R&G-00030745; USAG_HR_O00006150
544
USOC-R&G-00030745
545
USAG_HR_O00006150; Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection,
Product Safety, Insurance and Data Security (June 1, 2018), Ex. F
546
USAG_HR_O00006150
547
USAG_HR_O00006150
548
USAG_HR_O00006150
549
USAG_HR_O00006150; USAG_00306909
550
USAG_00306909
551
USAG_HR_O00006150
552
HR_O00006150; USAG_00264704
553
Compendium of Survivor Statements Maintained By Ropes & Gray; USAG_00264704; USAG_00264704; Matt
Mencarini, Former gymnast recounts Nassar story, calls for change, LANSING STATE JOURNAL (Mar. 27, 2017),
https://www.lansingstatejournal.com/story/news/local/2017/03/27/former-gymnast-recounts-nassar-story-callschange/99681568; Tim Evans et al., How Larry Nassar abused hundreds of gymnasts and eluded justice for decades,
INDIANAPOLIS STAR (Apr. 4, 2018), https://www.indystar.com/story/news/2018/03/08/larry-nassar-sexually-abusedgymnasts-michigan-state-university-usa-gymnastics/339051002;
554
USAG_HR_O00006150
555
USAG_HR_O00006150
556
USAG_HR_O00006150
557
USAG_HR_O00006150
558
USAG_HR_O00006150
559
USAG_HR_O00006150
560
USAG_HR_O00006150
561
USAG_HR_O00006150
562
USAG_HR_O00006150
563
USAG_HR_O00006160
564
USAG_HR_O00006160
565
USAG_HR_O00006160
566
USAG_HR_O00006150
567
USAG_HR_O00006150
568
USAG_HR_O00006150
569
USAG_HR_O00006150
570
USAG_HR_O00006150
571
USAG_HR_O00006150
572
USAG_HR_O00006157
573
USAG_HR_O00006157
574
USAG_HR_O00006157
575
USAG_HR_O00006160
576
USAG_HR_O00006408
577
USAG_HR_O00006408
578
USAG_00404811
579
USAG_00008437
533

213

580

USAG_HR_O00006171
USAG_HR_O0006171
582
USAG_00020958
583
USAG_HR_O00006417
584
USAG_HR_O00006417
585
USAG_HR_O00006416; USAG_HR_O00006417
586
USAG_02276622
587
USAG_HR_O00006171
588
USAG_00020958; Witness 81 Interview
589
USAG_00020958; Witness 81 Interview
590
USOC-R&G-00076966
591
USOC-RG-00076966
592
USOC-RG-00076966; Moreau Interview
593
USOC-RG-00076966; Moreau Interview
594
USAG_HR_O00006085
595
USAG_HR_O00006085
596
USAG_01204927; Faehn Interview
597
USAG_01204927
598
USAG_00014629
599
USAG_04295051;
USAG_04078273;
USAG_04286205;
USAG_00020967;
USAG_00080656;
USAG_00020975; USAG_04290163
600
USAG_00086654
601
USAG_00086654
602
USAG_00077152
603
USAG_00077152; USAG_01306077
604
USAG_01306077
605
USAG_01306077
606
USAG_01307016
607
USAG_00077152
608
MSU-USOC-0007014
609
MSU-USOC-0007014
610
USAG_00003162
611
USAG_00003162
612
USAG_00003162
613
USAG_00086534; USAG_04295051; Julie Mack, Larry Nassar saw patients for more than 2 years while under
criminal investigation, MICHIGAN NEWS (Jan. 15, 2018), https://www.mlive.com/news/index.ssf/2018/01
/dr_larry_nassar_saw_patients_f.html
614
https://www.lansingstatejournal.com/story/news/local/2018/01/26/larry-nassar-groomed-entire-community-holtresident-says/1059774001
615
Compendium of Survivor Statements Maintained By Ropes & Gray; MSU-USOC-0007294; Justin Hinkley, Holt
schools to investigate after victims say Nassar assaulted them on school property, LANSING STATE J. (Jan. 24, 2018),
https://www.wzzm13.com/article/news/local/lansing/holt-schools-to-investigate-after-victims-say-nassar-assaultedthem-on-school-property/69-511149340;
616
Tim Evans & Marisa Kwiatkowski, Larry Nassar and USA Gymnasticsa cover story: aCan we just say I am sick?a,
INDIANAPOLIS STAR (May 24, 2018), https://www.indystar.com/story/news/2018/05/24/larry-nassar-beinginvestigated-sexual-abuse-usa-gymnastics-agreed-cover/599381002
617
Mark Alesia et al., Former USA Gymnastics doctor accused of abuse, INDIANAPOLIS STAR (Sept. 12, 2016),
https://www.indystar.com/story/news/2016/09/12/former-usa-gymnastics-doctor-accused-abuse/89995734
618
USAG_HR_O00006358
619
USAG_00360946
620
USAG_00360946
621
USAG_00360946
622
Compendium of Survivor Statements Maintained By Ropes & Gray
623
Compendium of Survivor Statements Maintained By Ropes & Gray
624
USAG_00014760
625
Buendorf Interview; USOC-OGR-11044
581

214

626

USAG_01207301
USAG_00130290
628
Penny Interview
629
USAG_00130290
630
Penny Interview
631
USAG_00360732; Parilla Interview; Penny Interview
632
USAG_00360732
633
Parilla Interview
634
USAG_01353644
635
Parilla Interview
636
Parilla Interview
637
USAG_HR_O00006179
638
USAG_HR_O00006179
639
Julie Mack, FBI under scrutiny for its role in Larry Nassar investigation, MICHIGAN NEWS (Sept. 5, 2018),
https://www.mlive.com/news/index.ssf/2018/09/fbi_under_scrutiny_for_its_rol.html
640
USAG_00306908
641
USAG_00306908; Parilla Interview
642
Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance
and Data Security (June 1, 2018); Article on file with the Independent Investigators
643
USAG_00409061; USAG_00409061 USAG_00409061; USAG_00409061; USAG_00409061; USAG_00036718;
USAG_HR_O00006150
644
Faehn Interview; Rhonda Faehn, Testimony Before the Senate Subcommittee on Consumer Protection, Product
Safety, Insurance and Data Security (June 1, 2018)
645
Penny Interview; USAG_00788459
646
USOC-R&G-00030745; USAG_HR_O00006150
647
USAG_HR_O00006157
648
USAG_01218011
649
USAG_00130782
650
USAG_00130782
651
USAG_00130335
652
USAG_00130782
653
USAG_00130782
654
USAG_00130784
655
USAG_00130784
656
USAG_00130784
657
USAG_00130335
658
USAG_00130335
659
USAG_00130335
660
USAG_00070598
661
SP0000006
662
USAG_05538614
663
SP0000013
664
SP0000014
665
SP0000015
666
SP0000029
667
SP0000034
668
SP0000037
669
SP0000039
670
SP0000041
671
USAG_00131012
672
Civil Complaint, Court Filings on file with the Independent Investigators
673
Civil Complaint, Court Filings on file with the Independent Investigators
674
Letter from USAG to Senate Committee on Consumer Protection Product Safety, Insurance and Data Security (Feb.
9, 2018)
675
Witness 63 Interview
676
Witness 63 Interview
627

215

677

Witness 63 Interview; Witness 98 Interview
Witness 63 Interview
679
Witness 63 Interview
680
Witness 63 Interview
681
Witness 63 Interview
682
Witness 63 Interview; Witness 98 Interview
683
Witness 63 Interview
684
Witness 63 Interview
685
Witness 63 Interview
686
Witness 63 Interview
687
Witness 63 Interview
688
Witness 63 Interview
689
Witness 63 Interview
690
Witness 63 Interview
691
Witness 63 Interview
692
Witness 63 Interview
693
Witness 63 Interview
694
Witness 63 Interview
695
Witness 63 Interview
696
Witness 63 Interview
697
Witness 63 Interview
698
Witness 63 Interview
699
Witness 63 Interview
700
Witness 63 Interview; Witness 98 Interview
701
Witness 63 Interview; Witness 98 Interview
702
Witness 63 Interview
703
Witness 63 Interview; Witness 98 Interview
704
Witness 98 Interview
705
Witness 98 Interview
706
Witness 98 Interview; Witness 63 Interview
707
Witness 98 Interview
708
Witness 98 Interview
709
Witness 98 Interview
710
Christopher Schneider, counsel to USAG, to the Independent Investigators (Oct. 4, 2018)
711
USAG_00237790aUSAG_00250216
712
USAG_00237790aUSAG_00250216
713
Penny Interview
714
USAG_00307074
715
Witness 62 Interview
716
Faehn Interview
717
Indictment, Court Filings on file with the Independent Investigators
718
Nadia Comaneci Takes Gymnast Title on 4th, 5th Perfect Scores, N.Y. TIMES (July 22, 1976),
https://www.nytimes.com/1976/07/22/archives/nadia-comaneci-takes-gymnast-title-on-4th-5th-perfect-scoresshes.html; Robert Lindsey, Nadia Comaneci Still Glows as Images of 1976 Recede, N.Y. TIMES (July 29, 1984),
https://www.nytimes.com/1984/07/29/sports/nadia-comaneci-still-glows-as-images-of-1976-recede.html
719
Roslyn Kerr, The Impact of Nadia Comaneci on the Sport of Womenas Artistic Gymnastics, LA84 FOUNDATION
(2006), https://pdfs.semanticscholar.org/befe/4b6dfd02f73dc4bf3495281088c1719e642a.pdf
720
JerA(c) Longman, Phelps Tops Another Olympian, but at 77, She Grins, N.Y. TIMES (July 31, 2012)
https://www.nytimes.com/2012/08/01/sports/olympics/gymnast-larisa-latynina-is-elegant-reminder-of-olympicshistory.html; Larissa Latynina dominated female gymnastics, collecting a record 18 Olympic medals between 1956
and 1964, OLYMPICS, https://www.olympic.org/larisa-latynina (last visited Dec. 5, 2018)
721
Roslyn Kerr, The Impact of Nadia Comaneci on the Sport of Womenas Artistic Gymnastics, LA84 FOUNDATION
(2006), https://pdfs.semanticscholar.org/befe/4b6dfd02f73dc4bf3495281088c1719e642a.pdf
722
Michelle Kaeser, Donat fear failure: Why quitting gymnastics taught me the true meaning of success, GLOBE AND
MAIL
(Feb.
3,
2018),
https://www.theglobeandmail.com/opinion/michelle-kaeser-failure-is-golden-too/
article37828663
678

216

723

Liz Clarke, For Olympic gymnasts, itas usually one and done, WASH. POST (Nov. 9, 2012),
https://www.washingtonpost.com/sports/olympics/for-olympic-gymnasts-its-usually-one-and-done/2012/11/09/
c3dc8788-2ab9-11e2-96b6-8e6a7524553f_story.html; Article on file with the Independent Investigators
724
Jeff Jacobs, Fame Can Be Fleeting In World Of Gymnastics, HARTFOD COURANT(Aug. 21, 2012),
https://www.courant.com/news/connecticut/hc-xpm-2012-08-21-hc-jacobs-gymnastics-0822-20120821-story.html
725
Dvora Meyers, Five myths about gymnastics, WASH. POST (Aug. 5 2016), https://www.washingtonpost.com/
opinions/five-myths-about-gymnastics/2016/08/05/9af8988a-5a66-11e6-9767-f6c947fd0cb8_story.html;
Megan
Dolski, For gymnasts, age matters a and comes with a cost, GLOBE AND MAIL (Aug. 2, 2016),
https://www.theglobeandmail.com/sports/olympics/for-gymnasts-age-matters-and-comes-with-acost/
article31200953
726
USA Gymnastics announces 2018 U.S. Womenas World Championships Team, USA GYMNASTICS (Oct. 12, 2018),
https://usagym.org/pages/post.html?PostID=22714
727
Scott M. Reid, Out of Balance: A look inside USA Gymnasticsa culture of abuse, ORANGE CTY. REGISTER (Jan. 23,
2018), https://www.ocregister.com/2018/01/23/out-of-balance-a-look-inside-usa-gymnastics-culture-of-abuse/
728
Alina Williams, Contact Sports: Teaching Touch and Consent to Young Athletes, THE GYMTERNET (Jan. 5, 2018),
https://thegymter.net/2018/01/05/contact-sports-teaching-touch-and-consent-to-young-athletes/
729
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017)
730
Witness 22 Interview
731
Witness 22 Interview
732
Compendium of Survivor Statements Maintained By Ropes & Gray
733
Megan Dolski, For gymnasts, age matters a and comes with a cost, GLOBE AND MAIL (Aug. 2, 2016),
https://www.theglobeandmail.com/sports/olympics/for-gymnasts-age-matters-and-comes-with-acost/
article31200953
734
Witness 49 Interview
735
Megan Dolski, For gymnasts, age matters a and comes with a cost, GLOBE AND MAIL (Aug. 2, 2016),
https://www.theglobeandmail.com/sports/olympics/for-gymnasts-age-matters-and-comes-with-acost/
article31200953
736
Witness 49 Interview
737
Witness 109 Interview
738
Megan Dolski, For gymnasts, age matters a and comes with a cost, GLOBE AND MAIL (Aug. 2, 2016),
https://www.theglobeandmail.com/sports/olympics/for-gymnasts-age-matters-and-comes-with-acost/
article31200953
739
Compendium of Survivor Statements Maintained By Ropes & Gray
740
Witness 84 Interview
741
Witness 84 Interview
742
Witness 24 Interview
743
Witness 24 Interview
744
Chloe Angyal, Everything I Wish Iad Said To My Abusive Gymnastics Coach, HUFFINGTON POST (Mar. 9, 2016),
https://www.huffingtonpost.com/entry/everything-i-wish-id-said-to-my-abusive-gymnasticscoach_us_56df47dee4b03a40567a804a
745
Compendium of Survivor Statements Maintained By Ropes & Gray
746
Compendium of Survivor Statements Maintained By Ropes & Gray
747
Compendium of Survivor Statements Maintained By Ropes & Gray
748
Article on file with the Independent Investigators
749
Compendium of Survivor Statements Maintained By Ropes & Gray
750
Compendium of Survivor Statements Maintained By Ropes & Gray
751
Compendium of Survivor Statements Maintained By Ropes & Gray
752
Witness 49 Interview
753
Witness 112 Interview
754
Witness 112 Interview
755
Witness 22 Interview
756
Compendium of Survivor Statements Maintained By Ropes & Gray
757
Compendium of Survivor Statements Maintained By Ropes & Gray
758
Article on file with the Independent Investigators
759
Witness 62 Interview

217

760

Civil Complaint, Court Filings on file with the Independent Investigators
Book on file with the Independent Investigators
762
Witness 24 Interview
763
Witness 24 Interview
764
Witness 24 Interview
765
Article on file with the Independent Investigators
766
Compendium of Survivor Statements Maintained By Ropes & Gray
767
Compendium of Survivor Statements Maintained By Ropes & Gray
768
Book on file with the Independent Investigators
769
Book on file with the Independent Investigators
770
Compendium of Survivor Statements Maintained By Ropes & Gray
771
Witness 49 Interview
772
Witness 109 Interview; Witness 84 Interview; USAG_01197823
773
Witness 109 Interview
774
Article on file with the Independent Investigators
775
USAG_04330262; Mimi Swartz, Whiners Go Home (March 2, 2008), https://www.nytimes.com/2008/03/02/
sports/playmagazine/02play-talkingpoints.html
776
Witness 63 Interview
777
Witness 63 Interview
778
Witness 24 Interview
779
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017)
780
Article on file with the Independent Investigators; Video on file with the Independent Investigators
781
Book on file with the Independent Investigators
782
Article on file with the Independent Investigators
783
Article on file with the Independent Investigators
784
Article on file with the Independent Investigators
785
Article on file with the Independent Investigators
786
Compendium of Survivor Statements Maintained By Ropes & Gray
787
Civil Complaint, Court Filings on file with the Independent Investigators
788
Article on file with the Independent Investigators
789
Book on file with the Independent Investigators
790
Article on file with the Independent Investigators
791
Book on file with the Independent Investigators
792
Witness 49 Interview
793
Witness 20 Interview
794
Article on file with the Independent Investigators
795
Witness 24 Interview
796
Article on file with the Independent Investigators
797
Article on file with the Independent Investigators
798
Article on file with the Independent Investigators
799
Compendium of Survivor Statements Maintained By Ropes & Gray
800
Nadia Comaneci Takes Gymnast Title on 4th, 5th Perfect Scores, N.Y. TIMES (July 22, 1976),
https://www.nytimes.com/1976/07/22/archives/nadia-comaneci-takes-gymnast-title-on-4th-5th-perfect-scoresshes.html; Robert Lindsey, Nadia Comaneci Still Glows as Images of 1976 Recede, N.Y. TIMES (July 29, 1984),
https://www.nytimes.com/1984/07/29/sports/nadia-comaneci-still-glows-as-images-of-1976-recede.html; Article on
file with the Independent Investigators
801
Article on file with the Independent Investigators
802
Article on file with the Independent Investigators
803
Book on file with the Independent Investigators
804
Witness 125 Interview
805
Book on file with the Independent Investigators
806
Book on file with the Independent Investigators
807
Book on file with the Independent Investigators
808
Book on file with the Independent Investigators
809
Witness 25 Interview
761

218

810

Witness 25 Interview
Article on file with the Independent Investigators
812
Article on file with the Independent Investigators
813
Article on file with the Independent Investigators
814
USAG_03947102
815
Marissa Payne, Itas been 20 years since Kerri Strug landed her gold medal-winning Olympic vault, WASH. POST
(July 23, 2016), https://www.washingtonpost.com/news/early-lead/wp/2016/07/23/its-been-20-years-since-kerristrug-landed-her-gold-medal-winning-olympic-vault/; Joseph D. Lyons, Remember When Kerri Strug Competed With
A Broken Ankle? It Was One Of The Gamesa Most Memorable Feats, BUSTLE (Aug. 10, 2016),
https://www.bustle.com/articles/177852-remember-when-kerri-strug-competed-with-a-broken-ankle-it-was-one-ofthe-games-most
816
Dvora Meyers, What Really Happened Before and After Kerri Strugas Famous Vault, ELLE (July 28, 2016),
https://www.elle.com/culture/a38123/oral-history-of-the-magnificent-seven
817
Scott M. Reid, Out of Balance: A look inside USA Gymnasticsa culture of abuse, ORANGE CTY. REGISTER (Jan. 23,
2018), https://www.ocregister.com/2018/01/23/out-of-balance-a-look-inside-usa-gymnastics-culture-of-abuse
818
Article on file with the Independent Investigators
819
Compendium of Survivor Statements Maintained By Ropes & Gray
820
Civil Complaint, Court Filings on file with the Independent Investigators
821
Witness 12 Interview
822
Witness 109 Interview
823
Witness 12 Interview
824
Witness 112 Interview
825
Witness 112 Interview
826
Compendium of Survivor Statements Maintained By Ropes & Gray
827
William Nack, Every Parentas Nightmare The child molester has found a home in the world of youth sports, where
as a coach he can gain the trust and loyalty of kids--and then prey on them, SPORTS ILLUSTRATED (Sept. 13, 1999),
https://www.si.com/vault/1999/09/13/266260/every-parents-nightmare-the-child-molester-has-found-a-home-in-theworld-of-youth-sports-where-as-a-coach-he-can-gain-the-trust-and-loyalty-of-kids--and-then-prey-on-them; Dvora
Meyers, How Bela and Martha Karolyi Made America Great, SLATE (Aug. 5, 2016), https://slate.com/culture/2016/
08/how-bela-and-martha-karolyi-transformed-u-s-womens-gymnastics.html
828
Dvora Meyers, How Bela and Martha Karolyi Made America Great, SLATE (Aug. 5, 2016), https://slate.com/
culture/2016/08/how-bela-and-martha-karolyi-transformed-u-s-womens-gymnastics.html
829
Johnette Howard, How Karolyi Ranch became secret weapon for U.S. womenas gymnasts, ABC NEWS (Aug. 3,
2016),
https://abcnews.go.com/Sports/karolyi-ranch-secret-weapon-us-womens-gymnasts/story?id=41090723;
Ashley Ross, The Couple That Changed Gymnastics: 3 Decades of Karolyi Highlights, TIME (Aug. 8, 2016),
http://time.com/4434463/history-bela-martha-karolyi/
830
Olympic Games - U.S. Womenas Team Rosters, USA GYMNASTICS, (2018), https://usagym.org/pages/pressbox/
history/olympics_rosters_women.html; Karolyi Named National Team Coordinator for USA Women, USA
GYMNASTICS (Nov. 16, 1999), https://usagym.org/pages/post.html?PostID=1354
831
Mary Lou Retton, OLYMPICS, https://www.olympic.org/mary-lou-retton (last visited Dec. 5, 2018)
832
Racehel Axon, Bela, Martha Karolyi say they didnat know gymnasts had suffered sexual abuse, USA TODAY (Apr.
20, 2018), https://www.usatoday.com/story/sports/olympics/2018/04/20/bela-martha-karolyi-say-they-didnt-knowsexual-abuse-usa-gymnastics/535355002
833
Article on file with the Independent Investigators
834
Dvora Meyers, The U.S. Gymnastics System Wanted More Medals, And Created A Culture Of Abuse To Get Them,
DEADSPIN (May 1, 2017), https://deadspin.com/the-u-s-gymnastics-system-wanted-more-medals-and-crea1794525855
835
Tony Marco, Former USA Gymnastics trainer who worked with Larry Nassar arrested; sheas accused of sexual
assault of a child, CNN (Sept. 7, 2018), https://www.cnn.com/2018/09/06/us/debbie-van-horn-larry-nassar-arrest/
index.html
836
Book on file with the Independent Investigators; Skip Hollandsworth, I Have Made Their Lives Miserable, TEXAS
MONTHLY (Dec. 1991), on file with the Independent Investigators
837
Alex Hannaford, BA(c)la KA!rolyi: The somersault Svengali, THE TELEGRAPH (Mar. 27, 2012),
https://www.telegraph.co.uk/sport/olympics/gymnastics/9160224/Bela-Karolyi-The-somersault-svengali.html
838
Skip Hollandsworth, I Have Made Their Lives Miserable, TEXAS MONTHLY (Dec. 1991), on file with the
Independent Investigators; Witness 25 Interview
811

219

839

Witness 25 Interview
Witness 25 Interview
841
The Karolyi Scandal: A Few Contributions by Adrian Goreac, Ecaterina Szabo and Rodica Dunca, TRIPLE FULL
(Nov. 19, 2008), http://triplefull.blogspot.com/2008/11/karolyi-scandal-quotes-by-adrian-goreac.html; Mitch Weiss
& Holbrook Mohr, U.S. gymnasts say sport rife with verbal and emotional abuse, CHICAGO TRIBUNE (Feb. 23, 2018)
https://www.chicagotribune.com/g00/sports/international/ct-us-gymnasts-verbal-emotional-abuse-20180223story.html
842
Skip Hollandsworth, I Have Made Their Lives Miserable, TEXAS MONTHLY (Dec. 1991), on file with the
Independent Investigators
843
Jane Perlez, GYMNASTICS: ROAD TO ATLANTA; Romanian Coach Keeps Up the Fight, N.Y. TIMES (July 13,
1995),
https://www.nytimes.com/1995/07/13/sports/gymnastics-road-to-atlanta-romanian-coach-keeps-up-thefight.html
844
Bob Ottum, The Search for Nadia, SPORTS ILLUSTRATED (Nov. 19, 1979),https://www.si.com/vault/1979/11/19/
824185/the-search-for-nadia-the-author-plunges-into-the-mists-of-transylvania-in-quest-of-the-worlds-favoritegymnast-nadia-comaneci-she-had-been-perfect-then-she-had-faded-from-view-now-it-develops-there-is-a-newnadia; Skip Hollandsworth, I Have Made Their Lives Miserable, TEXAS MONTHLY (Dec. 1991), on file with the
Independent Investigators
845
Witness 25 Interview
846
Witness 25 Interview
847
Johnette Howard, How Karolyi Ranch became secret weapon for U.S. womenas gymnasts, ESPN (Aug. 3, 2016),
http://www.espn.com/olympics/gymnastics/story/_/id/17203781/how-martha-bela-karolyi-their-ranch-turned-uswomen-gymnastics-powerhouse
848
Book on file with the Independent Investigators; Bela Karolyi, Gymnastics Coach, ABC NEWS (Nov. 13, 2008),
https://abc7chicago.com/archive/6504270
849
Holly Yan, Karolyi Ranch produced champions and a culture of fear, ex-gymnasts say, CNN (Feb. 2, 2018),
https://www.cnn.com/2018/02/02/us/karolyi-ranch-gymnastics-abuse-allegations/index.html; Johnette Howard, How
Karolyi Ranch became secret weapon for U.S. womenas gymnasts, ESPN (Aug. 3, 2016), http://www.espn.com/
olympics/gymnastics/story/_/id/17203781/how-martha-bela-karolyi-their-ranch-turned-us-women-gymnasticspowerhouse; John Powers, A Conversation With Mary Lou Retton, AMERICAN CUP, https://www.americancup.com/
2016/03/conversation-mary-lou-retton
850
Mary Lou Retton to Move Back to W.Va., WSAZ NEWS (Aug. 9, 2009), https://www.wsaz.com/home/headlines/
52835542.html; Mary Lou Retton, OLYMPICS, https://www.olympic.org/mary-lou-retton
851
Johnette Howard, How Karolyi Ranch became secret weapon for U.S. womenas gymnasts, ESPN (Aug. 3, 2016),
http://www.espn.com/olympics/gymnastics/story/_/id/17203781/how-martha-bela-karolyi-their-ranch-turned-uswomen-gymnastics-powerhouse; Holly Yan, Karolyi Ranch produced champions and a culture of fear, ex-gymnasts
say, CNN (Feb. 2, 2018), https://www.cnn.com/2018/02/02/us/karolyi-ranch-gymnastics-abuse-allegations/
index.html
852
Books on file with the Independent Investigators
853
Book on file with the Independent Investigators; Skip Hollandsworth, I Have Made Their Lives Miserable, TEXAS
MONTHLY (Dec. 1991), on file with the Independent Investigators
854
Linda Robertson, Little Girls And Gymnastics: What Price Glory?, SEATTLE TIMES (Sept. 13, 1992),
http://community.seattletimes.nwsource.com/archive/?date=19920913&slug=1512770
855
Witness 22 Interview; John C. Moritz & Rick Jervis, Texas governor orders rangers to investigate Karolyi Ranch,
USA TODAY (Jan. 31, 2018), https://www.usatoday.com/story/news/2018/01/30/texas-governor-orders-rangersinvestigate-karolyi-ranch/1080589001
856
Compendium of Survivor Statements Maintained By Ropes & Gray
857
Witness 25 Interview
858
Witness 25 Interview
859
Witness 49 Interview
860
Article on file with the Independent Investigators
861
Book on file with the Independent Investigators
862
Episode 322, GYMCASTIC (Sept. 18, 2018)
863
Ann Killion, At last, gymnast vindicated for speaking out against abuse, SAN FRANCISCO CHRONICLE (Mar. 10,
2018), https://www.sfchronicle.com/sports/article/At-last-gymnast-vindicated-for-speaking-out-12743982.php
864
Article on file with the Independent Investigators
865
Article on file with the Independent Investigators
840

220

866

Article on file with the Independent Investigators
Sally Jenkins, Without Karolyi, U.S. Gymnasts Take a Tumble, WASH. POST (Sept. 21, 2000),
https://www.washingtonpost.com/archive/sports/2000/09/21/without-karolyi-us-gymnasts-take-a-tumble/13f1c5ab0b1f-47f6-83c9-b4e0dc682610
868
Bill Plaschke, Bela Too Far Away for a Magic Touch, L.A. TIMES (Sept. 20, 2000), http://articles.latimes.com/
2000/sep/20/news/ss-24057
869
Dvora Meyers, The U.S. Gymnastics System Wanted More Medals, And Created A Culture Of Abuse To Get Them,
DEADSPIN (May 1, 2017), https://deadspin.com/the-u-s-gymnastics-system-wanted-more-medals-and-crea1794525855
870
USAG_00130915
871
Karolyi Named National Team Coordinator for USA Women, USA GYMNASTICS (Nov. 16, 1999),
https://usagym.org/pages/post.html?PostID=1354; Witness 92
872
Karolyi Named National Team Coordinator for USA Women, USA GYMNASTICS (Nov. 16, 1999),
https://usagym.org/pages/post.html?PostID=1354
873
Dvora Meyers, The U.S. Gymnastics System Wanted More Medals, And Created A Culture Of Abuse To Get Them,
DEADSPIN (May 1, 2017), https://deadspin.com/the-u-s-gymnastics-system-wanted-more-medals-and-crea1794525855
874
Dvora Meyers, The U.S. Gymnastics System Wanted More Medals, And Created A Culture Of Abuse To Get Them,
DEADSPIN (May 1, 2017), https://deadspin.com/the-u-s-gymnastics-system-wanted-more-medals-and-crea1794525855; Christopher Clarey, Olympics; Top Gymnasts Seek to Skip Olympic Trials, N.Y. TIMES (June 18, 1996),
https://www.nytimes.com/1996/06/18/sports/olympics-top-gymnasts-seek-to-skip-olympic-trials.html
875
Compendium of Survivor Statements Maintained By Ropes & Gray; Witness 125 Interview; Podcasts on file with
the Independent Investigators
876
Witness 92 Interview
877
Dvora Meyers, The U.S. Gymnastics System Wanted More Medals, And Created A Culture Of Abuse To Get Them,
DEADSPIN (May 1, 2017), https://deadspin.com/the-u-s-gymnastics-system-wanted-more-medals-and-crea1794525855; Dvora Meyers, How Bela and Martha Karolyi Made America Great, SLATE (Aug. 5, 2016),
https://slate.com/culture/2016/08/how-bela-and-martha-karolyi-transformed-u-s-womens-gymnastics.html
878
Christopher Clarey, Olympics; Top Gymnasts Seek to Skip Olympic Trials, N.Y. TIMES (June 18, 1996),
https://www.nytimes.com/1996/06/18/sports/olympics-top-gymnasts-seek-to-skip-olympic-trials.html
879
Christopher Clarey, Olympics; Top Gymnasts Seek to Skip Olympic Trials, N.Y. TIMES (June 18, 1996),
https://www.nytimes.com/1996/06/18/sports/olympics-top-gymnasts-seek-to-skip-olympic-trials.html
880
Rachel Axon & Nancy Armour, Martha, Bela Karolyi defend training environment, say they didnat know about
abuse, USA TODAY (Apr. 22, 2018), https://www.usatoday.com/story/sports/olympics/2018/04/22/martha-belakarolyi-defend-training-environment-usa-gymnastics/540869002
881
Aimee Boorman and Maggie Haney: The Olympic Experience, GYMCASTIC (Sept. 20, 2017),
https://gymcastic.com/aimee-boorman-and-maggie-haney-the-olympic-experience; Shawn Johnson, Shawn Johnson
takes us inside training camp, ESPN (Apr. 5, 2012), http://www.espn.com/espnw/athletes-life/article/7780204/shawnjohnson-takes-us-training-camp
882
Alice Park, Inside Camp Karolyi: Building the U.S. Womenas Olympic Gymnastics Team, TIME (July 16, 2012),
http://olympics.time.com/2012/07/16/camp-karolyi-how-and-why-martha-karolyi-defines-u-s-womens-gymnastics/4
883
Alice Park, Inside Camp Karolyi: Building the U.S. Womenas Olympic Gymnastics Team, TIME (July 16, 2012),
http://olympics.time.com/2012/07/16/camp-karolyi-how-and-why-martha-karolyi-defines-u-s-womens-gymnastics/4
884
Alice Park, Inside Camp Karolyi: Building the U.S. Womenas Olympic Gymnastics Team, TIME (July 16, 2012),
http://olympics.time.com/2012/07/16/camp-karolyi-how-and-why-martha-karolyi-defines-u-s-womens-gymnastics/4
885
Dvora Meyers, The U.S. Gymnastics System Wanted More Medals, And Created A Culture Of Abuse To Get Them,
DEADSPIN (May 1, 2017), https://deadspin.com/the-u-s-gymnastics-system-wanted-more-medals-and-crea1794525855
886
Article on file with the Independent Investigators
887
Article on file with the Independent Investigators
888
Article on file with the Independent Investigators
889
Compendium of Survivor Statements Maintained By Ropes & Gray
890
Compendium of Survivor Statements Maintained By Ropes & Gray
891
Jean Casarez, CNN exclusive: In depositions, Karolyis say they knew nothing of Nassaras abuse at their ranch,
CNN (Mar. 29, 2018), https://www.cnn.com/2018/03/28/us/karolyi-depositions/index.html
892
USAG_04377359
867

221

893

Article on file with the Independent Investigators
Article on file with the Independent Investigators
895
Article on file with the Independent Investigators
896
Witness 12 Interview
897
Compendium of Survivor Statements Maintained By Ropes & Gray
898
Compendium of Survivor Statements Maintained By Ropes & Gray
899
Article on file with the Independent Investigators
900
In her last Olympics, Martha Karolyi leaves gymnastics legacy tinged in gold, WUSA9 (Aug. 8, 2016),
https://www.wusa9.com/article/news/in-her-last-olympics-martha-karolyi-leaves-gymnastics-legacy-tinged-in-gold/
291179248
901
USOC-RG-00044211
902
Will Hobson, Victims say the USOC deserves blame for Americaas Olympic sex abuse problem, WASH. POST (Feb.
23, 2018), https://www.washingtonpost.com/sports/olympics/victims-say-the-usoc-deserves-blame-for-americasolympic-sex-abuse-problem/2018/02/23/b5afe70a-1270-11e8-9065-e55346f6de81_story.html
903
USAG_00130915; Witness 92 Interview
904
Rachel Axon, USA Gymnastics CEO said aweare pretty gooda as sex abuse crisis was nearing, USA TODAY (June
12, 2018), https://www.usatoday.com/story/sports/olympics/2018/06/12/usa-gymnastics-ceo-steve-penny-werepretty-good-sex-abuse-crisis-neared/691140002
905
THE DAILY Goes One-On-One With USA Gymnasticsa Steve Penny, SPORTS BUSINESS DAILY (June 19, 2008),
https://www.sportsbusinessdaily.com/Daily/Issues/2008/06/19/Sports-Industrialists.aspx
906
Compendium of Survivor Statements Maintained By Ropes & Gray
907
Compendium of Survivor Statements Maintained By Ropes & Gray
908
Article on file with the Independent Investigators
909
Compendium of Survivor Statements Maintained By Ropes & Gray
910
Witness 109 Interview
911
Witness 109 Interview
912
Article on file with the Independent Investigators
913
Former Federal Prosecutor Daniels will spearhead independent review of USA Gymnasticsa handling sexual
misconduct issues, USA GYMNASTICS (Nov. 3, 2016), https://usagym.org/pages/post.html?PostID=19437
914
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017)
915
Letter to the Gymnastics Community, USA GYMNASTICS (June 27, 2017), https://usagym.org/pages/
post.html?PostID=20437
916
Deborah Danielsa Report Update, USA GYMNASTICS, http://www.usagymprogressreport.com/recommendations/
(last visited Dec. 7, 2018)
917
Section 8 Complaint, USOC v. USA Gymnastics (USOC Nov. 5, 2018)
918
Team USA Fund, TEAM USA, https://www.teamusa.org/us-olympic-and-paralympic-foundation/team-usa-fund
(last visited Dec. 6, 2018)
919
Ben Fischer, Team USA fundraising arm targets individuals, Sports Business Daily (Jan. 8, 2018),
https://www.sportsbusinessdaily.com/Journal/Issues/2018/01/08/Olympics/USOC-Foundation.aspx; U.S. Olympic &
Paralympic Foundation, Philanthropy, Fundraising and NGBs (2015), https://www.teamusa.org/-/media/
USA_Table_Tennis/Images/News/06-17/Presentation---Martha-Johnson-USOC.pdf
920
S. Rep. No. 95-770 (1978), https://heinonline.org/HOL/Page?collection=leghis&handle=hein.leghis/
legamasp0001&id=31&men_tab=srchresults
921
S. Rep. No. 95-770 (1978), https://heinonline.org/HOL/Page?collection=leghis&handle=hein.leghis/
legamasp0001&id=31&men_tab=srchresults
922
S. Rep. No. 95-770 (1978), https://heinonline.org/HOL/Page?collection=leghis&handle=hein.leghis/
legamasp0001&id=31&men_tab=srchresults
923
36 U.S.C. ASS 220505(c)(4), 220521
924
Participating NGBs, Team USA, https://www.teamusa.org/About-the-USOC/Programs/Coaching-Education/
American-Development-Model/NGBs (last visited Dec. 6, 2018)
925
36 U.S.C. ASS 220505(c) (2006); 36 U.S.C. ASS 220522 (2006)
926
36 U.S.C. ASS 220506 (2006)
927
Witness 12 Interview
928
36 U.S.C. ASS 220503 (2006)
929
36 U.S.C. ASS 220503 (2006)
894

222

930

36 U.S.C. ASS 220504 (2006); 36 U.S.C. ASS 220522 (2006)
USOC Bylaws; DeFrantz v. United States Olympic Comm., 492 F. Supp. 1181 (D.D.C. 1980); Barry Lorge, A
Major Victory for Carter, WASH. POST (Apr. 13, 1980), https://www.washingtonpost.com/archive/politics/1980/04/
13/a-major-victory-for-carter/38f0f316-c443-4819-bf9e-169090b4112a
932
Michael Janofsky, Olympics; U.S.O.C. Goes to Work on Steinbrenneras Report, N.Y. TIMES (Feb. 21, 1989),
https://www.nytimes.com/1989/02/21/sports/olympics-usoc-goes-to-work-on-steinbrenner-s-report.html
933
Michael Janofsky, U.S.O.C. Aims at More Efficiency and Profitability, N.Y. TIMES (Feb. 12, 1990),
https://www.nytimes.com/1990/02/12/sports/usoc-aims-at-more-efficiency-and-profitability.html; USOC Bylaws
934
USOC-Colorado Springs History, TEAM USA, http://www.teamusa.org/~/media/bod%20manual/
historical%20information/a%20historical%20overview.pdf (last visited Dec. 6, 2018); Report And Recommendations
Of The Independent Commission On Reform Of The United States Olympic Committee (2003)
935
Board of Directors, TEAM USA, https://www.teamusa.org/About-the-USOC/Leadership/Board-of-Directors (last
visited Dec. 6, 2018)
936
Witness 31 Interview
937
Witness 90 Interview; Witness 65 Interview
938
Witness 12 Interview; USOC-Colorado Springs History, TEAM USA, http://www.teamusa.org/~/media/
bod%20manual/historical%20information/a%20historical%20overview.pdf; (last visited Dec. 6, 2018); Witness 90
Interview
939
Witness 68 Interview; Witness 90 Interview; Scott Blackmun, CEO, USOC, SPORTS BUSINESS DAILY
https://www.sportsbusinessdaily.com/Conferences-Events/2017/WCOS/Speakers/Scott-Blackmun.aspx (last visited
Dec. 6, 2018); Tom Roeder, U.S. Olympic Committee board reorganization places two women at top, THE GAZETTE
(Sept. 10, 2018), https://gazette.com/news/u-s-olympic-committee-board-reorganization-places-two-women-at/
article_ce34914e-b528-11e8-b584-774be0d60b37.html
940
United States of America, OLYMPICS, https://www.olympic.org/united-states-of-america (last visited Dec. 6, 2018);
Peopleas Republic of China, OLYMPICS, https://www.olympic.org/people-s-republic-of-china (last visited Dec. 6,
2018)
941
U.S. OLYMPIC COMMITTEE, CONSOLIDATED FINANCIAL STATEMENTS AND REPORT OF INDEPENDENT CERTIFIED
PUBLIC ACCOUNTANTS (2016), https://www.teamusa.org/-/media/TeamUSA/Documents/Financial/2016-USOCAudited-Financial-Statements.pdf
942
Blackmun Interview
943
Ashley Interview
944
USOC-R&G-00024027
945
Tripp Mickle, USOC funding strategy worries small NGBs, SPORTS BUSINESS DAILY (Oct. 3, 2011),
https://www.sportsbusinessdaily.com/Journal/Issues/2011/10/03/Olympics/NGB-funding.aspx; Ashley Interview;
Witness 4 Interview
946
Witness 72 Interview
947
USOC-R&G-00023308
948
Witness 12 Interview
949
Witness 18 Interview
950
Witness 18 Interview
951
Witness 109 Interview; Witness 84 Interview; Witness 49 Interview; Witness 7 Interview
952
Scott Reid, Former gymnasts claim USA Gymnastics broke negotiated promises, DAILY BREEZE (Apr. 5, 2018),
https://www.dailybreeze.com/2018/04/05/former-gymnasts-claim-usa-gymnastics-broke-negotiated-promises
953
USOC-R&G-00055989
954
36 U.S.C. ASS 220504 (2006)
955
Han Xiao,Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance and
Data Security (July 24, 2018)
956
Han Xiao,Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance and
Data Security (July 24, 2018)
957
Blackmun Interview
958
36 U.S.C. ASS 220509(b)(1)(C) (2006)
959
Witness 34 Interview
960
Witness 34 Interview; 36 U.S.C. ASS 220509(b)(1)(C) (2006)
961
Han Xiao,Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance and
Data Security (July 24, 2018)
962
Witness 12 Interview
931

223

963

REPORT OF THE SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION ON THE OLYMPIC AND
AMATEUR SPORTS ACT AMENDMENTS OF 1998 (1998); 36 U.S.C. ASSASS 220509 (2006)
964
Witness 12 Interview
965
Ruger Interview
966
Ruger Interview
967
Wallace Interview
968
Witness 34 Interview; Wallace Interview
969
Han Xiao,Testimony Before the Senate Subcommittee on Consumer Protection, Product Safety, Insurance and
Data Security (July 24, 2018); Wallace Interview
970
Wallace Interview
971
Witness 34 Interview
972
USOC Bylaws ASS 10.18, 10.19
973
USOC Bylaws ASS 10.1, 10.2
974
USOC Bylaws ASS 10.2(a)
975
USOC Bylaws ASS 10.2
976
Letter from Witness 7 to the Independent Investigators dated Feb. 15, 2018, on file with the Independent
Investigators; Sally Jenkins, Scott Blackmunas painful USOC legacy: Knowledge, inaction and misplaced priorities,
WASH POST (Feb. 28, 2018), https://www.washingtonpost.com/sports/scott-blackmuns-painful-usoc-legacyknowledge-inaction-and-misplaced-priorities/2018/02/28/7485b73c-1cc5-11e8-b2d9-08e748f892c0_story.html
977
Johansen Dep., Gatt v. USA Taekwondo, No. BC599321 (Cal. Sup. Ct. Sept. 27, 2016); John Ruger, From the
Trenches: The Landscape of Sports Dispute Resolution and Athlete Representation, 10 PEPP. DISP. RESOL. L.J. Iss. 1
(2010); Arbitration and Hearing Panel Cases, Index of Decisions, TEAM USA, https://www.teamusa.org/Footer/
Legal/Arbitration-and-Hearing-Panel-Cases/Section-10 (last visited Dec. 6, 2018)
978
Witness 34 Interview
979
Witness 34; Arbitration and Hearing Panel Cases, Index of Decisions, TEAM USA, https://www.teamusa.org/
Footer/Legal/Arbitration-and-Hearing-Panel-Cases/Section-9 (last visited Dec. 6, 2018)
980
USOC Bylaws ASS 9.3
981
USOC Bylaws ASSASS 9.3, 9.10
982
Witness 65 Interview; Katie Thomas, Wrenching Shake-Up of the U.S. Olympic Committee, N.Y. TIMES (June 27,
2009), https://www.nytimes.com/2009/06/28/sports/28usoc.html
983
Blackmun Interview
984
Blackmun Interview
985
Susanne Lyons, Testimony Before the Senate Subcommittee on Oversight and Investigations (May 25, 2018)
986
Adams Interview
987
36 U.S.C. ASS 220503
988
Witness 66 Interview
989
Blackmun Interview
990
Blackmun Interview
991
Letter from the USOC to House Energy and Commerce Committee (May 16, 2018)
992
Juliet Macur, Olympic Committee Moves to Revoke U.S.A. Gymnasticsa Governing Rights, N.Y. TIMES (NOV.5,
2018), https://www.nytimes.com/2018/11/05/sports/usa-gymnastics-usoc.html
993
36 U.S.C. ASS 220527(d)(2)(A)
994
Letter from the USOC to House Energy and Commerce Committee (May 16, 2018)
995
Blackmun Interview
996
Blackmun Interview
997
Arrington Interview
998
Johansen Dep., Gatt v. USA Taekwondo, No. BC599321 (Cal. Sup. Ct. Sept. 27, 2016)
999
U.S. OLYMPIC COMMITTEE, CONSOLIDATED FINANCIAL STATEMENTS AND REPORT OF INDEPENDENT CERTIFIED
PUBLIC
ACCOUNTANTS (2014), https://www.teamusa.org/-/media/TeamUSA/Documents/Financial/2014-USOCAudited-Financial-Statements.pdf; U.S. OLYMPIC COMMITTEE, CONSOLIDATED FINANCIAL STATEMENTS AND REPORT
INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS (2016), https://www.teamusa.org/-/media/TeamUSA/
OF
Documents/Financial/2016-USOC-Audited-Financial-Statements.pdf
1000
Blackmun Interview
1001
Tripp Mickle, USOC funding strategy worries small NGBs, SPORTS BUSINESS DAILY (Oct. 3, 2011),
https://www.sportsbusinessdaily.com/Journal/Issues/2011/10/03/Olympics/NGB-funding.aspx; Ashley Interview;
USOC-R&G-00023308

224

1002

USOC-R&G-00075553; Moreau Interview
Penny Interview
1004
Penny Interview
1005
Team Up with USA Gymnastics: Did You Notice Our New Logo?, USA GYMNASTICS, https://usagym.org/PDFs/
Member%20Services/newlogoflyer.pdf (last visited Dec. 6, 2018); Blackmun Interview
1006
USOC-R&G-00022780
1007
Blackmun Interview
1008
Witness 65 Interview; Witness 68 Interview; Witness 77 Interview
1009
Witness 66 Interview
1010
Witness 66 Interview
1011
Witness 66 Interview
1012
USOC-R&G-00071464
1013
Moreau Interview
1014
Moreau Interview
1015
USOC-R&G-00068158; USOC-R&G-00069341; USAG_00002153, USAG_00006978, USAG_00006422
1016
Moreau Interview
1017
Moreau Interview
1018
Letter from the USOC to House Energy and Commerce Committee (May 16, 2018); About the Lake Placid
Olympic Training Center, TEAM USA, https://www.teamusa.org/about-the-usoc/olympic-training-centers/lpotc/about
(last visited Dec. 6, 2018); About the Colorado Springs Olympic Training Center, TEAM USA,
https://www.teamusa.org/about-the-usoc/olympic-training-centers/csotc/about (last visited Dec. 6, 2018)
1019
USOC-R&G-0031253;; McGuire Interview; Working at the U.S. Olympic Training Center in Colorado Springs,
THE PLAYBOOK (Aug. 11, 2014), https://www.hss.edu/playbook/working-at-the-u-s-olympic-training-center-incolorado-springs; Stephen Hobbs, Officials: U.S. Olympic agreement with Colorado Springs has been good for both
sides, THE GAZETTE (Sept. 12, 2015), https://gazette.com/sports/officials-u-s-olympic-agreement-with-coloradosprings-has-been/article_dfcd4cb2-75f3-550c-84be-ccab0c795a1f.html
1020
USOC-R&G-00004640; USOC-R&G-00022780
1021
USAG_00004920; Witness 32 Interview
1022
Witness 32 Interview; USAG_00018690
1023
Witness 32 Interview; USAG_00018690; Blackmun Interview
1024
Susanne Lyons, Testimony Before the Senate Subcommittee on Oversight and Investigations (May 25, 2018);
Witness 32 Interview; Blackmun Interview
1025
Adams Interview
1026
USAG_00018690
1027
Witness 32 Interview
1028
Witness 32 Interview
1029
USAG_00018690
1030
USOC-R&G-00032724; USOC-R&G-00111175
1031
Blackmun Interview
1032
Blackmun Interview
1033
Lyons Interview
1034
Lyons Interview
1035
USOC designates USA Gymnastics National Team Training Center at Karolyi Ranch as newest U.S. Olympic
Training Site, USA GYMNASTICS (Jan. 26, 2011), https://usagym.org/pages/post.html?PostID=6979
1036
Natalie Musumeci, Parents of Nassar victims want others held accountable, N.Y. POST (Feb. 8, 2018),
https://nypost.com/2018/02/08/parents-of-nassar-victims-want-others-held-accountable
1037
Article on file with the Independent Investigators
1038
USOC-R&G-00032543; Nancy Armour and Rachel Axon, USOC did not heed sexual abuse warnings in 2004,
2005, USA Today (Mar. 31, 2017), https://www.usatoday.com/story/sports/olympics/2017/03/31/usoc-sexual-abuseusa-swimming-senate/99826600; Blackmun Interview
1039
Letter from Brian D. Smith, Counsel for USOC, to Brittany Havens et al. (May 16, 2018); Arrington Interview
1040
USOC Bylaws Section 8.7
1041
Arrington Interview; Blackmun Interview
1042
Arrington Interview
1043
William Nack, Every Parentas Nightmare The Child Molester Has Found A Home In The World Of Youth Sports,
Where As A Coach He Can Gain The Trust And Loyalty Of KidsaAnd Then Prey On Them, SPORTS ILLUSTRATED
1003

225

(Sept. 13, 1999), https://www.si.com/vault/1999/09/13/266260/every-parents-nightmare-the-child-molester-hasfound-a-home-in-the-world-of-youth-sports-where-as-a-coach-he-can-gain-the-trust-and-loyalty-of-kids--and-thenprey-on-them
1044
USOC-R&G-00032543
1045
USOC-R&G-00032543
1046
Nancy Armour and Rachel Axon, USOC did not heed sexual abuse warnings in 2004, 2005, USA TODAY (March
31, 2017), https://www.usatoday.com/story/sports/olympics/2017/03/31/usoc-sexual-abuse-usa-swimming-senate/
99826600
1047
https://harpers.org/archive/2017/11/pushing-the-limit
1048
Blackmun Interview
1049
Letter from Brian D. Smith, Counsel for USOC, to Brittany Havens et al. (May 16, 2018)
1050
RGID-3347161-0000006830; USFSA-000135; USAWP000186; RGID-3347161-0000000751
1051
Brian Epstein et al., aA deliberate cover-upa?: US Figure Skating reckoning with sexual abuse allegations against
Olympic coach, ABC News (May 12, 2018), https://abcnews.go.com/Sports/deliberate-cover-us-figure-skatingreckoning-sexual-abuse/story?id=53689618
1052
Will Hobson & Steven Rich, Every six weeks for more than 36 years: When will sex abuse in Olympic sports end?,
The Washington Post (Nov. 17, 2017), https://www.washingtonpost.com/sports/every-six-weeks-for-more-than-36years-when-will-sex-abuse-in-olympic-sports-end/2017/11/17/286ae804-c88d-11e7-8321-481fd63f174d_story.html;
Witness 10 Interview
1053
ABC News, Sexual Misconduct in U.S. Swimming (20/20 4-9-2010), YOUTUBE (July 25, 2012),
https://www.youtube.com/watch?v=GqmzMtp6iyw
1054
Sam Roberts, Chuck Wielgus, 67, Dies; Empowered U.S. Swimming and Apologized in a Scandal, N.Y. TIMES
(Apr. 25, 2017), https://www.nytimes.com/2017/04/25/sports/olympics/chuck-wielgus-dead-led-usa-swimming.html
1055
Compendium of Survivor Statements Maintained By Ropes & Gray
1056
Deb Lindsey, Abuse allegations against USA coaches rock the swim world, USA TODAY (Aug. 13, 2010),
https://usatoday30.usatoday.com/sports/olympics/2010-08-11-allegations-rock-swim-world_N.htm
1057
Blackmun Interview
1058
USOC-R&G-00022786
1059
USOC-R&G-00022780
1060
USOC-R&G-00004047
1061
USOC-R&G-00004721, USOC-R&G-00004465
1062
USAG_00131794
1063
Blackmun Interview
1064
Blackmun Interview
1065
Blackmun Interview; USOC-R&G-00004905; Will Hobson & Steven Rich, Every six weeks for more than 36
years: When will sex abuse in Olympic sports end?, WASH. POST (Nov. 17, 2017), https://www.washingtonpost.com/
sports/every-six-weeks-for-more-than-36-years-when-will-sex-abuse-in-olympic-sports-end/2017/11/17/286ae804c88d-11e7-8321-481fd63f174d_story.htm; Will Hobson & Steven Rich, 290 coaches, officials tied to U.S. Olympic
groups have been accused of sexual misconduct since 1982, CHI. TRIB. (Nov. 18, 2017),
https://www.chicagotribune.com/g00/sports/ct-olympic-sexual-abuse-20171118-story.html; USOC-R&G-00022928
1066
USOC-R&G-00032543; Nancy Armour & Rachel Axon, USOC did not heed sexual abuse warnings in 2004,
2005, USA TODAY (Mar. 31, 2017), https://www.usatoday.com/story/sports/olympics/2017/03/31/usoc-sexual-abuseusa-swimming-senate/99826600
1067
USAG_00226109; Penny Interview
1068
USOC-R&G-00098378
1069
Arrington Interview
1070
Arrington Interview
1071
Arrington Interview
1072
Arrington Interview
1073
Arrington Interview
1074
USOC-R&G-00098378
1075
Blackmun Interview; USOC-R&G-00003994
1076
USOC-R&G-00098378
1077
Blackmun Interview
1078
Blackmun Interview
1079
USOC-R&G-00004905

226

1080

USAG_HR_O00006456
USOC-R&G-00022951
1082
USOC-R&G-00022951
1083
USOC-R&G-00022951
1084
USOC-R&G-00098378
1085
USOC-R&G-00004374
1086
USOC-R&G-00004345
1087
USOC-R&G-00004349
1088
The US Center for SafeSport Opens, TEAM USA (Mar. 23, 2017), https://www.teamusa.org/USA-Weightlifting/
Features/2017/March/23/The-US-Center-for-SafeSport-Opens
1089
Arrington Interview; Penny Interview
1090
Blackmun Interview
1091
Penny Interview
1092
USOC-R&G-00042197
1093
Penny Interview
1094
Witness 8 Interview; Witness 48 Interview
1095
Witness 8 Interview; Witness 7 Interview
1096
Letter from Witness 7 to the Independent Investigators (Feb. 15, 2018), on file with the Independent Investigation
1097
Witness 70 Interview; Witness 49 Interview; Witness 8 Interview; Witness 7 Interview
1098
Womenas Sports Foundation, The Womenas Sports Foundation Congratulates Speedskaters And Calls Upon The
United States Olympic Committee To Provide Attorneys To Protect Athleteas Rights, on file with the Independent
Investigators; Wallace Interview
1099
Witness 6 Interview
1100
Witness 10 Interview; Witness 11 Interview
1101
Witness 11 Interview
1102
Email on file with the Independent Investigators
1103
Notice of Appearance, Court Filings on file with the Independent Investigators
1104
Arrington Interview
1105
Blackmun Interview
1106
Witness 4 Interview
1107
Witness 48 Interview
1108
USOC-R&G-00041327
1109
USOC-R&G-00043629
1110
Witness 62 Interview; Witness 70 Interview; Witness 49 Interview
1111
Witness 129 Interview
1112
Witness 7 Interview
1113
Witness 72 Interview
1114
Amanda Loudin, The Crusader Protecting Kid Athletes from Sex Abuse, Outsider Online (April 3, 2018),
https://www.outsideonline.com/2277976/fighting-sexual-abuse-behalf-young-athletes; Witness 8 Interview
1115
USAG_00214370; USAG_00222995
1116
USAG_00214370
1117
Rachel Axton, USA Gymnastics CEO said aweare pretty gooda as sex abuse crisis was nearing, USA TODAY (June
12, 2018), https://www.usatoday.com/story/sports/olympics/2018/06/12/usa-gymnastics-ceo-steve-penny-werepretty-good-sex-abuse-crisis-neared/691140002
1118
Rachel Axton, USA Gymnastics CEO said aweare pretty gooda as sex abuse crisis was nearing, USA TODAY (June
12, 2018), https://www.usatoday.com/story/sports/olympics/2018/06/12/usa-gymnastics-ceo-steve-penny-werepretty-good-sex-abuse-crisis-neared/691140002
1119
Marisa Kwiatowski et al., A blind eye to sex abuse: How USA Gymnastics failed to report cases, INDIANAPOLIS
STAR (Aug. 4, 2016), https://www.indystar.com/story/news/investigations/2016/08/04/usa-gymnastics-sex-abuseprotected-coaches/85829732; Team Up with USA Gymnastics: Did You Notice Our New Logo?, USA GYMNASTICS,
https://usagym.org/PDFs/Member%20Services/newlogoflyer.pdf. (last visited Dec. 7, 2018)
1120
USAG_HR_O00004339
1121
Witness 22 Interview; DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND
PROCEDURAL CHANGES FOR THE PROTECTION OF YOUNG ATHLETES (2017)
1122
About USA Gymnastics, USA GYMNASTICS, https://usagym.org/pages/aboutus/pages/about_usag.html (last
visited Dec. 6, 2018)
1081

227

1123

Professional Membership, USA GYMNASTICS, https://usagym.org/pages/aboutus/pages/about_usag.html;
https://usagym.org/pages/membership/pages/info_professional.html (last visited Dec. 6, 2018); USAG_04165034;
USAG_03914950
1124
About USA Gymnastics, USA GYMNASTICS, https://usagym.org/pages/aboutus/pages/about_usag.html (last
visited Dec. 6, 2018)
1125
USAG_01031772
1126
MSU-USOC-0001283
1127
USAG_01031772
1128
USAG_00090409
1129
USAG_00090409
1130
USAG_00028821; Jamison Interview
1131
MSU-USOC-0002577
1132
USAG_00579852
1133
USAG_00008894
1134
USAG_00008894
1135
MSU-USOC-0003948
1136
MSU-USOC-0004140
1137
USAG_00086659
1138
USAG_00086659
1139
Episode 63: Doctor Larry Nassar, GYMCASTIC, https://gymcastic.com/transcripts/transcripts-episodes-61-70
1140
Curriculum Vitae of Gary Warren, on file with the Independent Investigators; USAG_00291380
1141
MSU-USOC-0001700
1142
Witness 81 Interview
1143
USAG_00031719; Compendium of Survivor Statements Maintained By Ropes & Gray; Witness 81 Interview;
Witness 82 Interview; Witness 31 Interview
1144
MSU-USOC-0001700
1145
Witness 125 Interview
1146
USAG_00010335
1147
Penny Interview
1148
USAG_00010335; Penny Interview
1149
Penny Interview
1150
USAG_00314400
1151
USAG_00010335
1152
MSU-USOC-0002356; MSU-USOC-0002686; MSU-USOC-0007282
1153
USAG_00035885
1154
USAG_00011913
1155
USAG_00009627; MSU-USOC-0003936; USAG_01048588
1156
Member
Club
News:
Club
Close-Up,
USA
Gymnastics
(2002),
https://usagym.org/pages/memclub/news/winter02/page2.html;
Member Club News: Club Close-Up, USA
Gymnastics (2000), https://usagym.org/pages/memclub/closeups/2000_4.html
1157
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017)
1158
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017); Witness 22 Interview
1159
USOC-R&G-00039089; USAG_HR_O00004778; Permanently Ineligible Members, USA GYMNASTICS,
https://usagym.org/pages/aboutus/pages/permanently_ineligible_members.html (last visited Dec. 6, 2018)
1160
USAG_00804570
1161
Scott Reid, Banned after accusations of abuse, some gymnastics coaches continue to teach, ORANGE CTY.
REGISTER (Oct. 3, 2011), https://www.ocregister.com/2011/10/03/banned-after-accusations-of-abuse-somegymnastics-coaches-continue-to-teach; DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY
AND PROCEDURAL CHANGES FOR THE PROTECTION OF YOUNG ATHLETES (2017); USA Gymnastics adopts new policies
for sanctioning events, USA GYMNASTICS (Nov. 9, 2011), https://usagym.org/pages/post.html?PostID=9049
1162
USAG_01382734
1163
USAG_01382734
1164
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017); USAG_01744863; USAG_HR_O00002095

228

1165

USAG_00131097; USOC-E&C-006392
Susan Tuz, Former local gymnastics coach gets 8-10 years in prison in child rape case, NEWSTIMES (May 27,
2010),
https://www.newstimes.com/local/article/Former-local-gymnastics-coach-gets-8-10-years-in-500999.php;
Keith OaBrien, Ex-coaches accused of abuse: Gymnastsa 1997 allegations emerge in rape case, BOSTON.COM (Dec.
10, 2007), http://archive.boston.com/news/local/articles/2007/12/10/ex_coaches_accused_of_abuse/?page=2
1167
Penny Interview
1168
USAG_00016561
1169
USAG_HR_O00008651
1170
USAG_HR_O00008651
1171
USAG_HR_O00008651; USAG_00584481; USAG_HR_O00005008
1172
USAG_HR_O00005008
1173
USAG_HR_O00005008
1174
USAG_00584990; USAG_HR_O00008651; USAG_00584989
1175
USAG_HR_O00006679; USAG_01475504; DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED
POLICY AND PROCEDURAL CHANGES FOR THE PROTECTION OF YOUNG ATHLETES (2017)
1176
USAG_HR_O00004986; USAG_HR_O00000523
1177
USOC-R&G-00015509
1178
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017); USAG_HR_O00007783
1179
USAG_HR_O00007783
1180
USAG_00728059; USAG_00728060; DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY
AND PROCEDURAL CHANGES FOR THE PROTECTION OF YOUNG ATHLETES (2017)
1181
DEBORAH J. DANIELS, REPORT TO USA GYMNASTICS ON PROPOSED POLICY AND PROCEDURAL CHANGES FOR THE
PROTECTION OF YOUNG ATHLETES (2017); USAG_HR_O00004339
1182
USAG_00538603; USAG_00222886
1183
USAG_01750761
1184
USOC-R&G-00016686
1185
Steve Penny, USA Gymnastics Message, TECHNIQUE (May 2008), http://www.usagymlegacy.org/library/decade/
2000s
1186
USAG_HR_O00006668
1187
USAG_00121878
1188
USAG_00872478
1189
USOC-R&G-00022719; Blackmun Interview
1190
USAG_00226274
1191
USAG_00204145
1192
USAG_00229131
1193
USAG_00814949
1194
Article on file with the Independent Investigators
1195
Natelie Musumeci, Parents of Nassar victims want others held accountable, N.Y. POST (Feb. 8 2018),
https://nypost.com/2018/02/08/parents-of-nassar-victims-want-others-held-accountable
1196
USAG_00702172
1197
USAG_01434274
1198
USAG_01095342
1199
USAG_00212799
1200
USAG_00752786
1201
USAG_01433884
1202
USAG_00170712
1203
36 U.S.C. ASS 220522(a)(8) (1998)
1204
36 U.S.C. ASS 220522(a)(13) (1998)
1205
Blackmun Interview
1206
Blackmun Interview
1207
USAG_00130915
1208
Blackmun Interview
1209
USAG_HR_O00006963
1210
USAG_00228241; USAG_00224009; USAG_HR_O00003439
1211
USAG_00012892
1166

229

1212

USAG_00012892
USAG_00012892
1214
USAG_04217493
1215
USAG_04217918
1216
Marisa Kwiatowski, et al., A blind eye to sex abuse: How USA Gymnastics failed to report cases, INDIANAPOLIS
STAR (Aug. 4, 2016), https://www.indystar.com/story/news/investigations/2016/08/04/usa-gymnastics-sex-abuseprotected-coaches/85829732
1217
Matt Bonesteel, Top U.S. gymnastics coach Marvin Sharp arrested on suspicion of child molestation, WASH. POST
(Aug. 25, 2015), https://www.washingtonpost.com/news/early-lead/wp/2015/08/25/top-u-s-gymnastics-coachmarvin-sharp-arrested-on-suspicion-of-child-molestation; Justin L. Mack, Indy gymnastics coach accused of child
molesting found dead in jail, INDIANAPOLIS STAR (Sep. 20, 2015), https://www.indystar.com/story/news/crime/2015/
09/20/indy-gymnastics-coach-accused-child-molesting-found-dead-jail/72516232; Tyler Conway, Marvin Sharp,
Gymnastics Coach, Arrested on Accusation of Child Molestation, BLEACHER REPORT, https://bleacherreport.com/
articles/2554209-marvin-sharp-gymnastics-coach-arrested-on-accusation-of-child-molestation (last visited Dec. 6,
2018)
1218
USAG_00014625; Marisa Kwiatkowski et al., As evidence mounted, IMPD child abuse investigator defended
USA Gymnastics, INDIANAPOLIS STAR (Nov. 11, 2018), https://www.indystar.com/story/news/2018/11/11/usagymnastics-larry-nassar-sexual-abuse-scandal-impd-detective-bruce-smith-conduct-under-review/1693853002
1219
USAG_02212128
1220
Marisa Kwiatkowski et al., As evidence mounted, IMPD child abuse investigator defended USA Gymnastics,
INDIANAPOLIS STAR (Nov. 11, 2018), https://www.indystar.com/story/news/2018/11/11/usa-gymnastics-larry-nassarsexual-abuse-scandal-impd-detective-bruce-smith-conduct-under-review/1693853002
1221
USAG_02212128; USAG_00228277; Marisa Kwiatowski, et al.,A blind eye to sex abuse: How USA Gymnastics
failed to report cases, INDIANAPOLIS STAR (Aug. 4, 2016), https://www.indystar.com/story/news/investigations/2016/
08/04/usa-gymnastics-sex-abuse-protected-coaches/85829732
1222
USAG_02212128
1223
Marisa Kwiatkowski et al., As evidence mounted, IMPD child abuse investigator defended USA Gymnastics,
INDIANAPOLIS STAR (Nov. 11, 2018), https://www.indystar.com/story/news/2018/11/11/usa-gymnastics-larry-nassarsexual-abuse-scandal-impd-detective-bruce-smith-conduct-under-review/1693853002
1224
USAG_02342345; USAG_01595564; USAG_01435033; USAG_01434796; USAG_02212128
1225
Marisa Kwiatkowski et al., As evidence mounted, IMPD child abuse investigator defended USA Gymnastics,
INDIANAPOLIS STAR (Nov. 11, 2018), https://www.indystar.com/story/news/2018/11/11/usa-gymnastics-larry-nassarsexual-abuse-scandal-impd-detective-bruce-smith-conduct-under-review/1693853002
1226
USAG_02212128; USAG_01435033
1227
USAG_02212128
1228
USAG_02212128
1229
USAG_01435033
1230
Marisa Kwiatkowski et al., As evidence mounted, IMPD child abuse investigator defended USA Gymnastics,
INDIANAPOLIS STAR (Nov. 11, 2018), https://www.indystar.com/story/news/2018/11/11/usa-gymnastics-larry-nassarsexual-abuse-scandal-impd-detective-bruce-smith-conduct-under-review/1693853002
1231
USAG_02212128
1232
USAG_00228277
1233
USOC-R&G-00031251
1234
USAG_00206050
1235
USAG_00212799
1236
Rachel Axton, USA Gymnastics CEO said aweare pretty gooda as sex abuse was nearing, USA TODAY (June 12,
2018), https://www.usatoday.com/story/sports/olympics/2018/06/12/usa-gymnastics-ceo-steve-penny-were-prettygood-sex-abuse-crisis-neared/691140002
1237
USAG_00191339
1238
USAG_00212799
1239
Posan Dep., Court Filings on file with the Independent Investigators; Kelly Dep., Court Filings on file with the
Independent Investigators
1240
USAG_00130404
1241
USAG_0001289
1242
USAG_00144305
1243
RGID-3347161-0000002003; USAG_04148338
1213

230

1244

RGID-3347161-0000002003
RGID-3347161-0000002003
1246
USAG_02209803
1247
USAG_00124299
1248
USAG_01704101
1249
USAG_01704101
1250
USAG_04143889
1251
USAG_04143889
1252
MF_HC00001796
1253
MF_HC00001792
1254
USAG_00262246
1255
USAG_04148830
1256
USAG_04148830
1257
USAG_04148756
1258
USAG_04148749
1259
USAG_04148745
1260
USAG_HR_O00005008
1261
Jamison Interview
1262
USAG_04147258
1263
USAG_04147258; USAG_04147260, USAG_04148562
1264
USAG_00250263; USAG_00230406
1265
USOC-R&G-00026096
1266
USAG_04145397
1267
RGID-3347161-0000002808
1268
RGID-3347161-0000002808
1269
USAG_SEN_SCP_00006763
1270
MF_HC00005987
1271
USAG_04143889
1272
MF_HC00001649
1273
MF_HC00007531; MF_HC00007541; MF_HC00007543
1274
USAG_00261132; USAG_00261137
1275
MF_HC00006902
1276
USAG_01245625; MF_HC00006905; MF_HC00006906
1277
Tweet on file with the Independent Investigators
1278
USAG_00368370
1279
USAG_00368370
1280
USAG_00368370
1281
USAG_00368370
1282
USAG_00368370
1283
USAG_00368370
1284
USAG_00368370
1285
USAG_00368370
1286
USAG_00368370
1287
USAG_00368370
1288
USAG_00368370
1289
USAG_00368370
1290
USAG_00368370
1291
USOC-R&G-00030690; USA Gymnastics Webpage, How USA Gymnastics Combats Sexual Misconduct,
https://www.usagym.org/pages/aboutus/pages/misconduct.html
1292
Jamison Interview
1293
Witness 30 Interview
1294
Witness 30 Interview
1295
Witness 30 Interview
1296
Witness 30 Interview
1297
Witness 30 Interview
1298
Witness 30 Interview
1245

231

1299

Witness 30 Interview
Witness 30 Interview
1301
USAG_05378653; Witness 30 Interview
1302
Witness 30 Interview
1303
USAG_05378653
1304
USAG_05378653; USAG_04534828
1305
USAG_05378653; USAG_04534828
1306
USAG_05378653
1307
Witness 30 Interview
1308
Witness 30 Interview
1309
Witness 30 Interview
1310
USAG_05378653; USAG_05378687
1311
Marisa Kwiatkowski et al., Trail of Warnings, INDIANAPOLIS STAR, https://interactives.indystar.com/news/
standing/OutofBalance/McCabeTimeline (last visited Dec. 6, 2018); Marisa Kwiatkowski et al., Trail of Warnings,
INDIANAPOLIS STAR, https://interactives.indystar.com/news/standing/OutofBalance/McCabeTimeline (last visited
Dec. 6, 2018)
1312
Marisa Kwiatkowski et al., Trail of Warnings, INDIANAPOLIS STAR, https://interactives.indystar.com/news/
standing/OutofBalance/McCabeTimeline (last visited Dec. 6, 2018); Marisa Kwiatkowski et al., Trail of Warnings,
INDIANAPOLIS STAR, https://interactives.indystar.com/news/standing/OutofBalance/McCabeTimeline (last visited
Dec. 6, 2018)
1313
Marisa Kwiatkowski et al., Trail of Warnings, INDIANAPOLIS STAR, https://interactives.indystar.com/news/
standing/OutofBalance/McCabeTimeline (last visited Dec. 6, 2018); Marisa Kwiatkowski et al., Trail of Warnings,
INDIANAPOLIS STAR, https://interactives.indystar.com/news/standing/OutofBalance/McCabeTimeline (last visited
Dec. 6, 2018)
1314
Marisa Kwiatkowski et al., Trail of Warnings, INDIANAPOLIS STAR, https://interactives.indystar.com/news/
standing/OutofBalance/McCabeTimeline (last visited Dec. 6, 2018); Marisa Kwiatkowski et al., Trail of Warnings,
INDIANAPOLIS STAR, https://interactives.indystar.com/news/standing/OutofBalance/McCabeTimeline (last visited
Dec. 6, 2018)
1315
Marisa Kwiatkowski et al., Trail of Warnings, INDIANAPOLIS STAR, https://interactives.indystar.com/news/
standing/OutofBalance/McCabeTimeline (last visited Dec. 6, 2018)
1316
Scott Reid, USA Gymnastics Tightens Rules on Banned Coaches, ORANGE CTY. REGISTER (Nov. 9, 2011),
https://www.ocregister.com/2011/11/09/usa-gymnastics-tightens-rules-on-banned-coaches
1317
Witness 70 Interview
1318
Witness 70 Interview
1319
Articles on file with the Independent Investigators
1320
Casey Wian, Former gymnasts claim systemic physical, sexual abuse by ex-coach, CNN (Mar. 31, 2012),
https://www.cnn.com/2012/03/29/us/california-alleged-coach-abuse/index.html
1321
USAG_02210859
1322
Witness 70 Interview
1323
Witness 70 Interview
1324
USAG_02210800
1325
USAG_02210863
1326
USAG_02210859
1327
Tim Evans et al., A 20-year toll: 368 gymnasts allege sexual exploitation, INDIANAPOLIS STAR (Dec. 15, 2016),
https://www.indystar.com/story/news/2016/12/15/20-year-toll-368-gymnasts-allege-sexual-exploitation/95198724;
Boger 2009 Coach of the Year, on file with the Independent Investigators; 2009 Award Winners, TECHNIQUE (Sept./
Oct. 2009), https://usagym.org/pages/home/publications/technique/2009/09/06_awards.pdf
1328
USAG_04146749; Witness 70 Interview
1329
Witness 70 Interview
1330
USAG_04146749; USAG_02210863
1331
USAG_00260350;
USAG_00260058;
USAG_00260102;
USAG_00260152;
USAG_00260152;
USAG_00260191; USAG_00260223; USAG_00260280; USAG_00260328; USAG_00260378; USAG_00260408;
USAG_00260444; USAG_00260477; USAG_00260540; USAG_00260578; USAG_00260610; USAG_00260662;
USAG_00260678
1332
USAG_04146692
1333
USAG_04146693
1300

232

1334

USAG_00166762
USAG_00166762
1336
USAG_00689199
1337
Scott Reid, Banned after accusations of abuse, some gymnastics coaches continue to teach, ORANGE CTY.
REGISTER (Oct. 3, 2011), https://www.ocregister.com/2011/10/03/banned-after-accusations-of-abuse-somegymnastics-coaches-continue-to-teach
1338
Scott Reid, Coach accused of abuse is fired by Colorado gym, ORANGE CTY. REGISTER (Oct. 6, 2011),
https://www.ocregister.com/2011/10/06/coach-accused-of-abuse-is-fired-by-colorado-gym
1339
Scott Reid, USA Gymnastics tightens rules on banned coaches, ORANGE CTY. REGISTER (Nov. 9, 2011),
https://www.ocregister.com/2011/11/09/usa-gymnastics-tightens-rules-on-banned-coaches
1340
Compendium of Survivor Statements Maintained By Ropes & Gray
1335

233

APPENDIX

Report of the
Independent Investigation

The Constellation of Factors
Underlying Larry Nassaras
Abuse of Athletes

Joan McPhee James P. Dowden

Exhibit A

An Open Letter
To Survivors of
Larry Nassaras Abuse
We are leading an independent investigation into the abuse of hundreds of gymnasts by Larry Nassar.
We are applying our investigative skills as former federal prosecutors and tapping the resources of our
global law firm to conduct an exhaustive and independent investigation. Our mission is to produce and
publicly issue an unvarnished, definitive report that addresses individual and institutional accountability a
and helps ensure that such an outrage can never happen again.

We are writing this Open Letter because you play a critical role in
our independent investigation and we feel it is essential that we
make every effort to hear from those affected by Nassaras abuse.
We want to underscore the breadth of our mandate and encourage
you to participate in our fact-finding process.
THE INVESTIGATION IS COMPLETELY INDEPENDENT
Before accepting this assignment, we made sure our work would be completely independent from the
United States Olympic Committee (USOC), USA Gymnastics (USAG) and any other organization or
individual. Specifically:
AA

We alone direct the investigation and the writing of our report a no one else will have input
or influence into the questions we ask, the findings we make, or our ultimate conclusions.

AA

We have broad access to documents, witnesses and other information from USOC and
USAG, and we determine what is relevant to our investigation.

AA

We will directly issue our report to the public in its entirety upon completion of our work.

THE INVESTIGATION IS BROAD IN SCOPE
The scope of our investigation extends far beyond awho knew what whena at USOC and USAG about
Nassaras abuse and what was and was not done in response. We also are examining contributing factors
and circumstances, including systemic deficiencies, failures of oversight and cultural conditions in elite
athletics and Olympic sports.
Over the last seven months, we have made substantial progress. We have interviewed gymnasts and
elite athletes in other sports who are survivors of abuse. We have had access to more than one million
documents, including reports, files, emails, notes and text messages. We also have interviewed more
than 60 individuals at USOC and USAG, from the most senior leadership to junior employees.

WE WANT TO HEAR FROM YOU
We have sought from the beginning of our investigation to speak with the survivor community, but we
have not attempted to contact you directly out of respect for your privacy and because some athletes have
retained counsel. We believe strongly in doing everything we can to make sure we have heard from every
survivor who is interested in speaking with us before we complete our investigation, including those who
wish to remain anonymous.
If you would like to learn more, please visit our website, NASSARINVESTIGATION.COM, or call us
confidentially at (833) 458-8316. Our team would also be happy to speak with you or your attorney to
answer any questions you may have.
We respect how difficult it is to talk about such painful events. If you need to talk with a trained support
specialist, RAINN (The Rape, Abuse & Incest National Network) is available to provide information
and crisis intervention services to any survivor 24 hours a day, 7 days a week. RAINN can be reached
confidentially at (800) 656-4673 or online.rainn.org.
We admire your courage and sincerely hope to hear from you.

Joan McPhee
Partner

James P. Dowden
Partner

Exhibit

USOC Email Investigation
Summary Report

Prepared for:

Covington & Burling LLP

Prepared by:

December 4, 2018

Risk Resilience

Cyber

Stroz Friedberg, an Aon Company

Diligence + Compliance

Intellectual Property

Discovery

Prepared for: Covington & Burling LLP

TABLE OF CONTENTS
I.

Executive Summary ............................................................................................................................ 1

II. Background and Scope ....................................................................................................................... 1
A. Company Background...................................................................................................................... 1
B. Project Scope ................................................................................................................................... 2
III. Information and Data Examined .......................................................................................................... 2
IV. Analysis and Findings ......................................................................................................................... 3
A. Email Systems Information .............................................................................................................. 3
B. Analysis of Emails Previously Collected .......................................................................................... 3
C. Analysis of Devices and Network Share .......................................................................................... 4
D. Possible Explanations ...................................................................................................................... 5
1.

Loss Due to Corruption .............................................................................................................. 5

2.

Custodians Never Received the Email ...................................................................................... 5

3.

Custodians Received the Email and Deleted it Recently ........................................................... 5

4.

Custodians Received the Email and Deleted Shortly Thereafter .............................................. 6

A(c) 2018 Stroz Friedberg. All rights reserved.

Prepared for: Covington & Burling LLP

I. EXECUTIVE SUMMARY
On or about October 24, 2018, Covington & Burling LLP (aCovingtona), on behalf of its client the United
States Olympic Committee (aUSOCa), engaged Stroz Friedberg LLC (aStroz Friedberga) for digital forensic
and analysis services in relation to potential issues with its production of electronic data for an
investigation. Specifically, Covington instructed Stroz Friedberg to utilize available data sources and
information to investigate a specific email (the aEmaila) believed to have been received by two USOC
employees from an employee of USA Gymnastics (aUSAGa). Covington advised Stroz Friedberg that the
Email (which would have been responsive to search criteria used by Covington) had not been found
within the possession of the USOC by Covington in the course of the investigation. The Email was
produced to Ropes by USAG.
Stroz Friedberg analyzed various data sources as part of its work, specifically: the email data sets initially
collected for processing; the devices and network shares used by the USOC employees; and information
about the email system in use at the USOC. Based on its analysis, Stroz Friedberg has determined:
i*

The Email or fragments of it were not present on any of the data sources reviewed by Stroz
Friedberg.

i*

The Email was not part of the initial collection of data from the two USOC employees that
Covington reviewed and processed for production. As such, the Email was not excluded during
the processing, searching or review stages of electronic discovery.

i*

After considering a number of possible scenarios to explain the fact that the Email was not
included in the collection of data, the most likely explanation is that the Email was deleted shortly
after it was received in 2015.

II. BACKGROUND AND SCOPE
A. COMPANY BACKGROUND
Stroz Friedberg is a specialized risk management firm built to help clients solve the complex challenges
prevalent in todayas digital, connected, and regulated business world. A global leader in the fields of
cybersecurity, with leading experts in digital forensics, incident response, and security science;
investigations; and eDiscovery, Stroz Friedberg works to maximize the health of an organization, ensuring
its longevity, protection, and resilience. Founded in 2000 and acquired by Aon in 2016, Stroz Friedberg
has thirteen offices, including offices in nine cities across the United States and international locations in
London, Zurich, Dubai, and Hong Kong. Stroz Friedberg serves Fortune 100 companies, 80% of the
AmLaw 100, and the Top 20 UK law firms.

A(c) 2018 Stroz Friedberg. All rights reserved.

1

Prepared for: Covington & Burling LLP

B. PROJECT SCOPE
In 2018, Covington coordinated the collection, processing, and review of electronic documents from its
client the USOC, and the production of documents to respond to requests to the USOC from Ropes &
Gray LLP (aRopesa), the law firm conducting the independent investigation into the abuse of gymnasts
and other athletes by Larry Nassar. Stroz Friedberg learned from Covington that Ropes had informed
Covington about a document produced by a third party. The document appeared (in form) to be an email
dated September 8, 2015, with the aFroma field listing Steve Penny of USAG, the aToa field listing Alan
Ashley and Scott Blackmun, executives at the USOC, and the aSubjecta field listing aFYI a Larry Nassara
(the aEmaila). Ropes asked Covington to investigate why this email was not included in USOCas
productions in the independent investigation, although the Email should have been responsive to the
search criteria used. Covington engaged Stroz Friedberg to analyze available data sources and
information about USOCas email system to determine the possible reasons the Email was not included in
available USOC email data sources or the USOC productions to Ropes.

III. INFORMATION AND DATA EXAMINED
Stroz Friedberg obtained and reviewed the following items:
i*

Copies of the email files (in PST file format) of the two USOC employees that were collected as
part of the initial collection in early 2018. These were provided by Innovative Discovery, LLC, the
electronic discovery provider that assisted Covington with the processing of these emails.

i*

Forensic images created by Stroz Friedberg of:
o

An HP Desktop with serial number MXL7191PZ4, reported to be used by Scott Blackmun
(aBlackmun Desktopa);

o

A Lenovo Thinkpad laptop with serial number R9-XNCC413/03, reported to be used by
Scott Blackmun (aBlackmun Laptopa);

o

An Apple MacBook Pro laptop with serial number C02QVENCFVH5, reported to be used
by Alan Ashley (aAshley Laptopa);

i*

Contents of the (personal) network share drive used by Scott Blackmun1.

Stroz Friedberg also conducted an interview of David Zodikoff, Chief Technology Officer (aCTOa) of
USOC to understand the email systems in use and availability of associated logs.

1

Alan Ashleyas personal network share was reviewed by Stroz Friedberg and found to not contain any data.

A(c) 2018 Stroz Friedberg. All rights reserved.

2

Prepared for: Covington & Burling LLP

IV. ANALYSIS AND FINDINGS
Stroz Friedberg analyzed the available data sources to determine if the Email was present or if there were
artifacts that provided some information about the Email even if it was not currently present. This section
summarizes this review and Stroz Friedbergas observations.

A. EMAIL SYSTEMS INFORMATION
Stroz Friedberg understands from the interview of Mr. Zodikoff and subsequent information provided by
him that the USOC has been using Microsoftas cloud-based email system known as Office 365 since
2015. Prior to this, USOC maintained their own Exchange servers within their environment where usersa
mailboxes resided. The migration of mailboxes from the Exchange servers to the Office 365 environment
started in the spring of 2015 and was completed by September 2015 (prior to the date of the Email).
While the servers that previously hosted the Exchange servers are still available, the space used by the
mailboxes was re-purposed in the spring of 2017 to be used for other data needs2.
Stroz Friedberg also learned from the interview of Mr. Zodikoff that the USOC uses Proofpoint with their
email system to scan for potential spam messages. While the Proofpoint system does not retain an
archive of every message, all incoming messages pass through Proofpoint and are quarantined there if
Proofpoint determines the messages to potentially be spam. Stroz Friedberg understands from USOC
that Proofpoint retains at most 30 days of email. As such, this system does not have the historical record
going back to the September 2015 timeframe.
Through its discussions with Mr. Zodikoff, Stroz Friedberg learned that the Exchange email system
suffered certain corruption issues in 2015, potentially leading to some email loss. This outage occurred in
early 2015 (before the Email) and prompted the migration to Office 365 to avoid such issues.

B. ANALYSIS OF EMAILS PREVIOUSLY COLLECTED
Stroz Friedberg understands from Covington that in early 2018, USOC personnel collected electronic
documents, including email, in response to requests from Ropes and other third parties. The collected
data was processed, searched, reviewed and the responsive content was produced.
Stroz Friedberg received a copy of all the email files collected for Scott Blackmun and Alan Ashley from
Innovative Discovery, LLC, the electronic discovery provider that assisted Covington with the processing

2

The hardware that previously hosted the Exchange Servers was not forensically imaged or reviewed as the
transition to the Office 365 environment was completed prior to the date of the Email. As such, the Email would have
never been in the mailboxes on the Exchange Servers.

A(c) 2018 Stroz Friedberg. All rights reserved.

3

Prepared for: Covington & Burling LLP

of these emails. In all, Stroz Friedberg received eleven email files for Scott Blackmun totaling 72.7
gigabytes (aGBa) in size and five email files for Alan Ashley totaling 39GB in size.
Stroz Friedberg parsed the email files using forensic tools (including parsing for deleted emails within the
container files) and did not find the Email to be present. Stroz Friedberg noted that the email messages
present in the containers did span the timeframe before and after the time of the Email.
Based on this analysis, Stroz Friedberg determined that the Email was not present in the initial collection
in early 2018. As such, the fact that the Email was not present in the production cannot be attributed to an
omission or error when the email data was processed, reviewed or produced to Ropes.

C. ANALYSIS OF DEVICES AND NETWORK SHARE
Stroz Friedberg extracted and enumerated the contents of all email containers found on the imaged
devices. Table 1 below lists the noted timeframe of usage of each device, as well as the date range of
emails found to be present on each device.

Custodian
Scott
Blackmun
Scott
Blackmun
Alan Ashley

Type

OS Version
Windows 10
Desktop Enterprise
Windows 7
Laptop Enterprise
Mac OS X
Laptop 10.13.6

OS Install Date

OS Last Shutdown

Email_Earliest

Email_Recent3

02/07/2017

03/01/2018

03/15/2017

05/09/2018

05/14/2013

06/30/2017

01/10/2010

10/19/2017

10/23/2015

10/23/2018

06/14/20154

10/30/2018

Table 1 - Timeframes of Device Usage

Stroz Friedberg noted that only the Blackmun Laptop appears to have been in use during the timeframe
of the Email. This device was found to contain other emails dated September 8, 2015, but not the Email.
Stroz Friedberg searched and parsed the forensic images of these devices to look for fragments of the
Email. From its analysis, Stroz Friedberg did not find any artifacts indicating the presence of the Email on
these devices. Stroz Friedberg did find other emails in a deleted state, but not the Email.

3

The most recent email present on a computer does not necessarily indicate the last date or time the computer was
used to send or receive email. Rather, this date reflects the most recent email that was found to be present on the
computer. A user can use a computer to interact with his/her mailbox (e.g., to send or receive email) without a copy
being downloaded locally to the computer.
4

This device had 45 items in email containers that pre-dated the install date of the system. Review of these items
indicated all of them to be calendar-related items and not email messages

A(c) 2018 Stroz Friedberg. All rights reserved.

4

Prepared for: Covington & Burling LLP

Stroz Friedberg did not find any email files in Scott Blackmunas network share.

D. POSSIBLE EXPLANATIONS
From its review of the available data sources and information, Stroz Friedberg noted four possible
scenarios to explain why the Email was not present in the data that was collected and processed. This
section summarizes these possibilities with Stroz Friedbergas estimation on the likelihood of each based
on the facts known, observations from its analysis and its experience.

1. LOSS DUE TO CORRUPTION
The USOC reported to Stroz Friedberg that a known corruption event caused the loss of some email in
2015. Based on the recollections of the personnel involved, this event appears to have occurred in early
2015, before the date of the Email. USOC personnel interviewed by Stroz Friedberg were confident that
the corruption event occurred in early 2015, and cited this event as one that accelerated the migration to
Office 365, which began shortly thereafter. Given the timeframe of the known corruption issue relative to
the date of the Email, Stroz Friedberg believes it is unlikely that this was the reason the Email was absent
from the production and could not be located in those USOC email data sources reviewed by Stroz
Friedberg.

2. CUSTODIANS NEVER RECEIVED THE EMAIL
With the use of spam filters and quarantine (such as Proofpoint), it is possible that the USOC employees
never received the Email if it was caught in the spam filter. Stroz Friedberg understands from the
interview of Mr. Zodikoff that Proofpoint only retains email for 30 days. Consequently, reviewing emails
potentially caught in the spam filter from the relevant timeframe is not possible.
From its review of the Email, Stroz Friedberg noted that the Email itself does not have any characteristics
that would be likely to cause it to be marked as spam (such as embedded links, large attachments or
attachments with unusual extensions, different sender and reply addresses etc.). The Email only contains
text characters. Further, from a review of all other email for these users, Stroz Friedberg noted that the
sender of the Email was a known contact and the users received emails from this contact prior to and
after September 8, 2015. Based on these observations, Stroz Friedberg believes this explanation is
unlikely to be the reason for the Email to be missing.

3. CUSTODIANS RECEIVED THE EMAIL AND DELETED IT RECENTLY
This scenario involves the possibility that the users received the Email, had it in their mailboxes for a
period and deleted it sometime before the initial collection that occurred in early 2018. If this had
happened, Stroz Friedberg would have expected to see some remnants of the Email at least on the older
system (Blackmun Laptop) which was in use on September 8, 2015. Stroz Friedberg would expect to find
this email in a deleted state (as was seen for a handful of other emails from this timeframe), if the deletion

A(c) 2018 Stroz Friedberg. All rights reserved.

5

Prepared for: Covington & Burling LLP

occurred shortly before the system was finally shut down. Stroz Friedberg understands that both USOC
usersa mailboxes were put on hold related to the Ropes investigation in early 2018, and materials related
to allegations of misconduct or Nassar were under holds in 2017. Any email deleted after that time would
have been still retained within the Office 365 environment and included in the collection effort. While it is
possible that this situation occurred (i.e. the users deleted the Email subsequent to the fall of 2015 but
prior to collection efforts), Stroz Friedberg believes it is less likely than the next scenario.

4. CUSTODIANS RECEIVED THE EMAIL AND DELETED SHORTLY THEREAFTER
In this scenario, the users received the Email and deleted it shortly thereafter. The Email would have
never synchronized down to the newer systems (as it would not have been present in the mailbox when
the new systems came online5) and the constant use of the older system for almost two more years would
likely cause the deleted email to be overwritten, resulting in an absence of fragments. While still a
hypothesis, from its review of system usage and for the reasons noted above for the other scenarios,
Stroz Friedberg believes this scenario is the most likely explanation for why the Email was not available to
be collected from the USOC data systems and then produced.

The newer systems had operating system install dates of October 23, 2015 for Alan Ashleyas MacBook Pro and
February 7, 2017 for Scott Blackmunas HP Desktop
5

A(c) 2018 Stroz Friedberg. All rights reserved.

6

About Stroz Friedberg
Stroz Friedberg, an Aon company, is a specialized risk management firm built to help clients solve the complex challenges prevalent in todayas digital,
connected, and regulated business world. A global leader in the fields of cybersecurity, with leading experts in digital forensics, incident response, and
security science; investigation; eDiscovery; and due diligence, Stroz Friedberg works to maximize the health of an organization, ensuring its longevity,
protection, and resilience. Founded in 2000 and acquired by Aon in 2016, Stroz Friedberg has thirteen offices across nine U.S. cities, London, Zurich,
Dubai, and Hong Kong. Stroz Friedberg serves Fortune 100 companies, 80% of the AmLaw 100, and the Top 20 UK law firms. Learn more at
https://www.strozfriedberg.com/.
This document and/or its attachments may contain information that is confidential and/or protected by privilege from disclosure. If you have reason to
believe you are not the intended recipient, please immediately notify the sender by reply e-mail or by telephone, then destroy this document, as well
as all copies, including any printed copies. Thank you.

A(c) 2017 Stroz Friedberg. All rights reserved.

Saturday, March 11, 2017 at 11:44:39 AM Eastern Standard Time

Subiect: FYI - Larry Nasser
Date: Tuesday, September 8, 2015 at 9:22:26 AM Eastern Dayiight Time

From: Steve Penny
To: Alan Ashiey, Scott Blackmun

Greetings:

Just a quick foiiow-up note. Larry Nasser announced his retirement from USA Gymnastics this past weekend. i am
not too sure what prompted this, however, it couid have been a number of things. Wili keep you posted as I iearn

more.

Steve

i

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