NEW YORK (AP) — A gynecologist who sexually abused dozens of 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 shocking and unprecedented.

The sentence for Robert Hadden, 64, came nearly a month after he heard nine victims describe how the doctor abused them during gynecology treatments from the late 1980s until 2012 at prominent hospitals, including Columbia University Irving Medical Center and NewYork-Presbyterian Hospital.

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.

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“I’m very sorry for all the pain that I have caused,” a sobbing Hadden said through his tears 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 last 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 the government has reported that at least 245 women among thousands he treated have claimed they were abused by Hadden.

Testimony at a January trial by four women who said they crossed state lines to be treated by Hadden, and an additional five women who described abuse by him, was “shocking in the extreme,” the judge said. Hadden was convicted of four counts of enticing victims to cross state lines so he could sexually abuse them.

Berman also accused Hadden of deceiving psychologists to hide the voyeuristic tendencies and sexual deviant characteristics that led him to abuse his patients. The judge said he still considers Hadden a “clear danger to others, especially women.”

Nine victims spoke at the first stage of the sentencing hearing late last month. Numerous victims attended the proceeding on Monday and Tuesday but were not invited to speak again.

“Robert Hadden is a sexual predator disguised in a white coat,” one woman, who spoke under the pseudonym Emily Anderson, told Berman last month.

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 for medical reasons.

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 quadrupled the roughly five-year term suggested by federal sentencing guidelines.

“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.

Prosecutors had requested a prison sentence of at least 25 years while defense lawyers urged a sentence of three years.

Prosecutors say Hadden’s abuse of women began soon after he started working in 1987 at Columbia-Presbyterian in New York, which later became NewYork-Presbyterian. The institutions have agreed to pay more than $236 million to settle civil claims by more than 200 former patients.

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.”

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

Hadden received no jail time after pleading guilty in state court in 2016 to allegations involving a smaller number of women. He was required then to surrender his medical license.