“(The pelvic region) is referred to as the ‘no-fly zone’ because of the many cultural stigmas in touching this area,” Nassar wrote. “However, it is only with thorough examination of the pelvic structures of the gymnast that dysfunction is found and proper treatment can be applied to resolve the symptoms.”

The chapter warns clinicians to take precautions when treating patients’ pelvic regions.

“Take special measures to explain any examinations and techniques applied in this region, including appropriate draping, presence of a chaperone or another clinician, and warning in advance of what you are planning to do.”

Nassar has been accused of failing to follow these procedures, allegedly digitally penetrating patients without warning or explanation and without the presence of a chaperone.

A March 16 motion filed in Denhollander et al v. Michigan State University et al reports that Nassar described the alleged abuse as a “myofascial release” to one plaintiff, and as a “pelvic adjustment” to another. Nassar’s chapter describes myofascial release as an “appropriate (treatment) for the gymnast,” though the techniques described do not appear to include vaginal or anal penetration.

A motion filed on March 8 in the same lawsuit says Nassar’s alleged sexual abuse was repeatedly described to patients as an appropriate medical procedure. A 2014 Office for Inclusion and Intercultural Initiatives investigation found the treatment was “not of a sexual nature,” and the complainant did not “understand the ‘nuanced difference’ between sexual assault and an appropriate medical procedure.”

Former MSU gymnastics coach Kathie Klages is one of four university officials recently named as defendants in the lawsuit. Klages allegedly “dissuaded an athlete from completing a formal report” after the athlete told Klages about Nassar’s conduct, and said “she had known Nassar for years and could not imagine him doing anything questionable.”

Director of Sports Medicine Jeffrey Kovan and Dean of the College of Osteopathic Medicine William Strampel have been named as defendants for failing “to report sexual abuse about which they knew or should have known.”

Former professor of clinical psychology Gary Stollak has also been named as a defendant. Stollak was recently called as a witness for the defense in Nassar’s Feb. 17 preliminary examination in the 55th District Court in Mason, Mich.

A plaintiff in the case testified that she saw Stollak about eight times because her father believed she was lying about her encounters with Nassar.

Judge Donald Allen, Jr. did not accept Stollak as a witness, because Stollak suffered a stroke after his retirement in 2010 and had no memory of his involvement in the case, and all of his medical files were “gotten rid of” upon his retirement.

Stollak is accused of having knowledge of, and failing to report, sexual abuse perpetrated by Nassar.

MSU president Lou Anna K. Simon reminded faculty in 2012 of their obligation to report sexual assault after sexual abuse at Penn State University became public knowledge.

MSU policy would have mandated faculty members to report suspected sexual assault at least as early as 1997.