After listening to tearful, devastating accounts told by over 150 survivors on Jan. 24, Michigan judge Rosemarie Aquilina sentenced former team doctor for USA Gymnastics and Michigan State University, Larry Nassar, to 40 to 175 years in prison. At the federal level Nassar has been charged 60 more years on top of those given by Aquilina.

Now, it is imperative that the focus shifts to what was wrong with the systems in place that allowed Nassar free reign to abuse over 200 young women and girls. More importantly, it is time to make changes — monumental ones.

According to USA Gymnastics (USAG) policies, another adult was required to be in the same room as athletes as they received physician examinations, but this rarely happened in practice. The coach of MyKayla Skinner, an alternate for the 2016 Olympic team, said that she personally was always in the examination room with Skinner. Without a doubt, this should have been the case across the board for every athlete and every coach.

The United States Olympic Committee (USOC) has launched an investigation to examine how Nassar was able to take advantage of athletes of this magnitude without discovery or, more to the point, who was hiding what and how they were able to do so. The USOC has demanded that every member of USAG’s Board of Directors resign immediately from their position, which is crucial to ensuring a thorough reconstruction of the organization. An interim board will be appointed within the month.

Additionally, in order to support all survivors, both USAG and the USOC must allocate sufficient funds to provide treatment and counseling to the young women affected.

From the powerful testimonies from the young women, it is clear that an atmosphere of fear was established in order to keep many of the girls from focusing on anything but their gymnastics and winning medals. It was also evident that there were no formal channels for reporting this type of conduct and abuse.

In 1997, sixteen year old Larissa Boyce reported to coach Kathie Klages that she and another gymnast had felt uncomfortable with the way that Nassar had touched her while she was participating in a youth program at Michigan State. Klages, a close friend of Nassar’s, told the girls that they had misinterpreted Nassar’s actions and dismissed their claims. By the time gymnast Maggie Nichols reported Nassar to USAG in 2015, it is likely that most gymnasts in similar positions did not know telling someone was even an option.

In a recent statement, the president of the International Federation of Gymnastics (FIG), the governing body for international gymnastics, said that “[the organization is] committed more than ever to ensuring a safe environment for the welfare of [their] athletes in every part of the world.” The statement also claims that the FIG has been working over the past several months to establish an independent board to which cases of abuse can be reported and investigated through close consultation with legal experts.

Perhaps one of the largest challenges, but certainly one of the most necessary changes, has to do with the culture of the sport. In the last decade, American women’s gymnastics has seen an insurgence of dominance on the world stage. As we rooted for these gymnasts, we were unaware of the incredible amount of pressure and mistreatment that these young women had to endure.

Not only are many of these young women convinced by national and club coaches that their self-worth is attached to how many titles they win, they also train and compete with the fear of being ignored by national team coaches and chastised for mistakes. The gold medals and global recognition come at a cost, and it is becoming more and more apparent that the most detrimental costs are the risks associated with mistreatment and abuse.

Former national team member Mattie Larson spoke at the Nassar hearing and claimed Marta Karolyi, who retired as national team coordinator in 2016, ignored signs because Nassar would allow girls to compete with severe injuries.

“One time, I was so desperate not to go I thought faking an injury bad enough was the only way out,” Larson said, fighting back tears. “I was taking a bath, when I decided to push the bath mat aside, splash water on the tiles, get on the floor, and bang my head against the tub hard enough so I would get a bump, so it seemed like I slipped… I was willing to physically hurt myself to get out of the abuse that I received at the ranch.”

The “ranch” she refers to is the USA Gymnastics National Team Training Center, also colloquially called the “Karolyi Ranch.” The training center is located on an isolated farm in Huntsville, Texas, miles away from the nearest mark of civilization. In a form of tragic irony, the closest place to the Karolyi Ranch is a maximum security prison.