A female colleague of Johns Hopkins gynecologist Dr. Nikita Levy became suspicious about a pen the doctor wore around his neck and alerted officials at the medical institution, touching off an investigation into whether he secretly recorded patients.
When confronted with the woman's concerns, the doctor handed over several recording devices, including a similar pen camera, to investigators, according to a letter to victim advocates from the institution's top medical official that provided new details about how the allegations came to light.
Hopkins has tapped former Baltimore Police Commissioner Frederick H. Bealefeld III to aid in an internal inquiry, he confirmed Wednesday. Parallel investigative efforts have been undertaken by city police, civil attorneys and state regulators.
Bealefeld declined to comment further, and a Hopkins spokeswoman would not comment either. Levy was found dead of an apparent suicide Feb. 18 at his Towson-area home.
Police say more than 2,000 of Levy's patients have contacted a hotline established last week, but have not identified any potential victims. Investigators have been reluctant to reveal further details, citing an ongoing criminal inquiry.
Victim advocates had pushed for more information about what Hopkins knows about Levy's alleged activities, arguing that women need to know whether they might have been secretly recorded. In response to those requests, the letter sent Tuesday provides new details into how the case came to Hopkins' attention.
When security staff visited Levy to question him about the pen, they found similar recording devices in his office and on his person, Hopkins Dean of Medicine Dr. Paul B. Rothman wrote. The interview ended after Levy agreed to give up the devices and was escorted from the property, Rothman wrote.
Hopkins officials have said they received the tip on Feb. 4. Security interviewed Levy and seized the devices Feb. 5, after which Levy was barred from contact with patients, Rothman wrote in the letter to the Maryland Crime Victims' Resource Center and law firm Silverman Thompson Slutkin & White.
Lawyer Andrew Slutkin praised Hopkins for a "prompt and thorough" response but also said the information in the letter raises new, troubling questions.
"Here you had a doctor in an open way, in a non-concealed way, using a pen camera," Slutkin said. "Why wasn't this discovered earlier? Why is it only discovered after he has hard drives and hard drives, and computer servers?"
He said "about a third" of the people who have contacted his law office have said that Levy conducted some exams without a staff member present. "Some patients even stopped seeing him because of that. That's the kind of thing we think allowed this practice to go on for so long."
Police have not said how far-reaching they believe the recording was or how long it had occurred.
Dori Henry, a spokeswoman for the Department of Health and Mental Hygiene, said there is no state requirement for another medical professional to be present as a "chaperone" during a gynecological exam, but it is recommended for the protection of both the patient and the physician. Some institutions and facilities establish their own policies requiring chaperones, she said.
Kim Hoppe, a Hopkins spokeswoman, said it is the institution's practice to have a chaperone present for all pelvic exams.
David Chelmow, chairman of the department of obstetrics and gynecology at Virginia Commonwealth University Medical Center in Richmond, Va., said chaperones can help make patients more comfortable and speed along pelvic exams.
"There's certainly more of a consideration for male doctors, but I think in practice that many, if not most, [female doctors] would have chaperones present," Chelmow said.
A. Dwight Pettit, another attorney who said he has been fielding calls from Levy's patients, said his firm has heard many allegations — "about no staff being present, people being sent out of the [examination] rooms, people who have already been in for examination and supposed to be coming back for results of tests and being asked to disrobe a second time."
Pettit said the patients he's spoken to are "really, really psychologically stressed out."
Russell Butler, executive director of the Maryland Crime Victims' Resource Center, said Wednesday that he's pleased with Hopkins efforts to reach out to Levy's patients.
"It's positive that Johns Hopkins is cooperative," Butler said. "We're hopeful that they will be pressing law enforcement to promptly respond to the victims, to make sure that they understand whether they have been photographed or not been photographed."
While he said he understands police are continuing to investigate, "there's a lot of anxiety, it's very personal. We clearly want to hear from and want to work with law enforcement to make sure that there are prompt responses to these victims of these horrible offenses."
In the Hopkins letter, Rothman wrote that aside from a small number of patients who have already been notified, it has not been determined which or how many women are identifiable in evidence police have gathered.
Rothman offered sympathy to Levy's patients and pledged to help police notify those who are identified in any images or video. He said Hopkins officials don't know what Levy did with the images or videos.
"We are terribly sorry this has happened and for how the patients of Dr. Levy must be feeling," Rothman wrote. "The last few days have been difficult and trying ones for all of us."