NEW YORK (AP) — A gynecologist who sexually abused vulnerable and trusting patients for over two decades at prestigious New York hospitals cried before he was sentenced Tuesday to 20 years in prison by a federal judge who called his crimes unprecedented.

The sentence for Robert Hadden, 64, was a measure of vindication for hundreds of former patients who accused the doctor of molesting them during examinations but saw an earlier prosecution end with a plea bargain that spared him from jail.

Given his chance to speak Tuesday, Hadden stood with his hands folded before him to say that there was “much I’d like to say” but that he had been advised by his lawyers to keep his statement brief.

“I’m very sorry for all the pain that I have caused,” a sobbing Hadden said before dropping his head down as he sat again. He then took off his glasses and wiped tears from his eyes.

In statements over the past two days, U.S. District Judge Richard M. Berman said the case was like none he’d seen before and involved “outrageous, horrific, beyond extraordinary, depraved sexual abuse.” He noted that at least 245 women Hadden treated said they were abused.

The federal trial involved a smaller number of victims. Hadden was convicted of four counts of enticing women to cross state lines so he could sexually abuse them.

Nine victims testified at the trial, describing how Hadden molested them during gynecology treatments, starting in the late 1980s, at prominent hospitals, including Columbia University Irving Medical Center and NewYork-Presbyterian Hospital.

Allegations of misconduct during examinations first surfaced in 2012. Hadden was indicted on state charges in 2014 as women — 19 and counting — kept coming forward. But in 2016, the office of the Manhattan district attorney at the time, Cyrus Vance Jr., allowed Hadden to plead guilty to two low-level felonies and a misdemeanor in a deal that required him to give up his medical license but didn't require jail time and kept him out of the state's sex offender registry.

Some of the women who had gone to state prosecutors were outraged, but their stories didn't start receiving public attention until the #MeToo movement began gaining steam in 2017.

Federal prosecutors in Manhattan got a grand jury indictment against Hadden in 2020, charges based on the fact that some patients at his New York offices had come into the city from suburbs in other states. He was convicted in January.

Several dozen of Hadden's accusers were in the courtroom for his sentencing. Among them was Liz Hall, who said she found Hadden's expression of regret hollow.

“That was not an apology. He has shown zero remorse or empathy. I think he’s incapable," she said.

Hall said she hoped the sentence would give other victims of sexual abuse courage to speak out.

“It’s the first time ever that the justice system did what it was supposed to do: take it seriously,” she said.

The Associated Press does not typically name victims of sexual assault unless they come forward publicly.

According to trial testimony, Hadden benefited from the prestige of the hospitals where he worked as he groomed his patients in a private office decorated with pictures of his children as he conversed with them about their personal lives.

But once he had isolated them after a chaperone or nurse left the treatment room, he fondled and probed them with gloveless fingers and sometimes orally.

The judge noted that many patients were particularly vulnerable because they were pregnant, had physical problems, or had never been to another gynecologist and trusted that Hadden was behaving properly.

One of his accusers was Evelyn Yang, whose husband, Andrew Yang, ran unsuccessfully as a Democrat for president in 2020 and for New York City mayor in 2022. She said Hadden sexually assaulted her years ago when she was seven months pregnant.

Some women abused by Hadden later pushed for a change to state law that made it easier for survivors of sexual abuse to sue over allegations normally barred by the statute of limitations. Hospitals where Hadden worked have agreed to pay more than $236 million to settle civil claims by more than 200 former patients.

Hadden's lawyer, Deirdre von Dornum, asked the judge Tuesday to credit her client for his efforts to reform himself and his devotion to his family.

A day earlier, when the judge announced that he planned to impose a 20-year sentence, she had complained that Berman was being too harsh.

“Here you have somebody who has already lost everything, and you’re giving him effectively a life sentence,” she said.

The lawyer said her client was enduring harsh jail conditions at a federal lockup in Brooklyn, where inmates make threats and extort him to turn over his commissary money.

Assistant U.S. Attorney Jane Kim said Tuesday that Hadden still had not accepted responsibility for his crimes.

She said he “still has the same sexual disorders he had as he carried out his career of sexual abuse.”