NEW YORK (AP) — A federal judge said Monday he plans to sentence a former gynecologist to 20 years in prison for the sexual abuse of dozens of patients for over two decades at prestigious New York hospitals.

Judge Richard M. Berman announced his intention at a sentencing hearing for Robert Hadden that will continue on Tuesday, when Hadden is expected to speak after some legal issues are resolved. The judge was expected to impose the sentence after the hearing resumes, unless he changes his mind.

Hadden, 64, has been in custody since his January conviction on four counts of enticing victims to cross state lines so he could sexually abuse them.

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A 20-year senctence would be four times the roughly four-to-five-year term that the judge concluded federal sentencing guidelines recommend.

The guidelines are calculated for each case to ensure that people convicted of specific crimes generally are treated equally, and judges can go below or above guidelines but must explain why.

The judge said the crimes Hadden committed while working at hospitals including Columbia University Irving Medical Center and New York-Presbyterian Hospital merited a longer sentence.

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.

The judge’s announcement of his sentencing plans drew a complaint from defense attorney Deirdre von Dornum. She said it was overly harsh.

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

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

At trial, women testified in graphic detail that Hadden repeatedly forced them to submit to sexualized breast exams and touched their vaginas in ways that seemed sexual rather than for a medical purpose. They urged the judge to give him the maximum prison sentence possible.

In 1987, Hadden started working at Columbia-Presbyterian Medical Center in New York, which later became New York-Presbyterian Hospital. The institutions have agreed to pay more than $236 million to settle civil claims by more than 200 former patients.