A 74-year-old former surgeon was given a maximum 20-year prison sentence Wednesday by a French court for the rape and sexual assault of hundreds of patients, mostly children, over more than two decades.

Joel Le Scouarnec was sentenced after admitting molesting nearly 300 victims in one of the country’s largest-ever child sex abuse cases, which has raised questions about how he was able to abuse so many, for so long.

Judges followed the public prosecutor’s recommendations regarding the length of the sentence, and the criminal court of Morbihan, in western France, ordered that Le Scouarnec should serve at least two-thirds of the punishment before he can be eligible for release, because he remains dangerous.

But the court did not impose a post-sentence preventive detention, prompting the anger of many victims.

Solene Podevin Favre, president of an advocacy group for child victims of incest and other sexual crimes, expressed shock at a verdict “we might have expected to be less lenient,” lamenting that post-sentence preventive detention was not imposed.

“It’s the maximum sentence, certainly,” she said. “But it’s the least we could have hoped for. Yet in six years, he could potentially be released. It’s staggering.”

Le Scouarnec, who has been jailed since 2017, is already serving a 15-year prison sentence, for a conviction in 2020 for the rape and sexual assault of four children, including two nieces. In French law, sentences run concurrently and Le Scouarnec should only serve the additional years after the first sentence is completed.

Post-sentence preventive detention is a measure rarely used in France that applies to the country’s most dangerous offenders. Had it been approved, Le Scouarnec could have been held indefinitely in a secure socio-medical facility, even after serving his time.

"The Court fully understood the requests from the civil parties that Mr. Le Scouarnec should never be released from prison. It would be demagogic and illusory to make them believe that this is possible," the court said. “As things stand, the law does not allow it. And preventive detention, an exceptional measure, could in no way allow the Court to circumvent this reality.”

Le Scouarnec's lawyer said his client won't appeal the ruling.

Accusations of inaction

The new trial began in February and laid bare a pattern of abuse between 1989 and 2014. Most of the victims were unconscious or sedated hospital patients at the time of the assaults. The average age was 11.

Le Scouarnec has confessed to all the sexual abuse alleged by the civil parties, as well as to other assaults that are now beyond the statute of limitations. In a shocking admission during the trial, he also acknowledged sexually abusing his granddaughter — a statement made in front of her visibly distraught parents.

During the trial, advocacy groups have accused health authorities of inaction after they were notified as soon as 2005 of Le Scouarnec’s conviction for possessing child pornography pictures. At the time, no measures were taken to suspend his medical license or limit his contact with children and Le Scouarnec continued his abuse in hospitals until his arrest in 2017.

Child protection groups hope that the case will help strengthen the legal framework to prevent such abuse.

Dismantling taboos

Le Scouarnec’s trial came as activists continue to push to dismantle taboos that have long surrounded sexual abuse in France. The most prominent case was that of Gisele Pelicot, who was drugged and raped by her now ex-husband and dozens of other men who were convicted and sentenced in December to three to 20 years in prison.

In a separate case focusing on alleged abuse at a Catholic school, an inquiry commission of the National Assembly, France’s lower house of parliament, is investigating allegations of physical and sexual abuse over five decades.

Victims of Le Scouarnec have, however, complained of a perceived lack of attention.

"This trial, which could have served as an open-air laboratory to expose the serious failings of our institutions, seems to leave no mark on the government, the medical community, or society at large,” a group of victims said.

Horrific notebooks

Not all victims were initially aware they had been abused. Some were contacted by investigators after their names appeared in journals kept by Le Scouarnec, in which he meticulously documented his crimes. Others only realized they had been hospitalized at the time after checking medical records. Two of his victims took their own lives some years before the trial.

Using the cover of medical procedures, the former abdominal and digestive surgeon took advantage of moments when children were alone in their hospital rooms. His method was to disguise sexual abuse as clinical care, targeting young patients who were unlikely to remember the encounters.

The notebooks, which detail the abuse in graphic language, have become central to the prosecution’s case.

Despite the scope of the allegations, Le Scouarnec remained calm and composed throughout the trial.

“I didn’t see them as people,” he told the court. “They were the destination of my fantasies. As the trial went on, I began to see them as individuals, with emotions, anger, suffering and distress.”

He said his first act of abuse occurred in 1985, when he raped his 5-year-old niece.

Detached and emotionless

While he offered apologies to some victims, his demeanor struck many as detached and emotionless.

The court, however, noted that Le Scouarnec “made a point of taking responsibility for his actions,” demonstrating “his intention to make amends for the consequences of his actions.”

The case first came to light in April 2017, when a 6-year-old neighbor told her mother that the man next door had exposed himself and touched her through the fence separating their properties. A search of his home uncovered more than 300,000 photos, 650 video files, as well as notebooks where he described himself as a pedophile and detailed his actions.

A third trial is expected in the coming years, following the emergence of new allegations during this trial, including further abuse involving his granddaughter.

French surgeon sentenced to 20 years in prison for raping and abusing hundreds of patients