Newly suspicious of the pen hanging on a lanyard Johns Hopkins gynecologist Dr. Nikita A. Levy wore around his neck, a clinical technician who had worked with him for two years took it one day early last year.
What she saw when she got home and plugged the device into her computer set off an investigation that shook thousands of women across the region and led the world-renowned hospital to pay $190 million to settle a class-action lawsuit.
After she notified Hopkins officials, who viewed the files and confronted Levy, they did not contact city police for a few days.
These new details of how Levy was discovered are contained in investigative documents related to the case, obtained Friday by The Baltimore Sun under a Maryland Public Information Act request. The documents from lead detective Amy Strand's file also show that police believe 310 to 360 patients — including 60 prepubescent girls — were filmed, though lawyers say thousands of patients were victimized by the revelations.
The Hopkins technician, whose name was withheld, suspected that the pen contained a tiny camera and was being used to take inappropriate images of female patients. When he stood up while performing pelvic exams on patients, he often pulled the pen attached to the lanyard down, as if directing it.
Her hunch proved correct, but Levy was also recording his co-workers in the bathroom, the documents show.
After plugging the camera into her computer on Feb. 1, 2013, a Friday, she opened up a 48-minute video that showed Levy, then footage of two women using the toilet.
She notified the legal department of Johns Hopkins Hospital the next Monday. Hopkins investigators confronted Levy that day, Feb. 4, and eventually took several hidden camera devices from his East Baltimore office.
Police records show that the city's sex offense unit was not notified of the allegations until Feb. 7, three days later. The hospital has said it "promptly" notified police.
Johns Hopkins officials said they notified police Feb. 6, a day earlier than the investigative report shows.
"Dr. Levy breached a trust not only to his patients, but to Hopkins as well," wrote Kim Hoppe, a Hopkins spokeswoman, in an email. "We acted quickly and decisively to investigate concerns about his actions and reported events faithfully and completely to the Baltimore City Police. All actions were conducted in a manner to ensure patient safety and facilitate a thorough investigation."
The lead attorney for the plaintiffs, Jonathan Schochor, said he could not comment on the delay, citing the pending settlement of the litigation. But he had raised the idea previously that police might not have recovered all of the evidence in the case.
Documents show that Levy's Towson home, vehicle and office were not searched by Baltimore police until after midnight Feb. 8, four days after the initial confrontation. He was fired later that day and offered counseling.
The documents show that Levy remained in contact with investigators. On Feb. 9, he called police and asked whether his daughter's laptop could be returned, and said he would speak to detectives Feb. 13. The day before, Levy canceled the appointment, saying there had been a death in the family and offering a meeting Feb. 20 instead.
Levy committed suicide Feb. 18, suffocating himself with helium. He left his wife a note, which is included in the file.
"I am sorry but I could not bear to see you suffer with the truth," the handwritten note reads. "Please, please forgive me for letting you down so horribly. Please continue to love me. I am proud to be your husband and am so sad to have it end this way."
He signed his first name in all capital letters, then wrote another line: "I am sorry that I hurt almost every one around me."
According to the police report, when Hopkins investigators went to Levy's office they saw a pen camera device hanging from Levy's neck identical to the one the technician took. He denied that the pen had the ability to record anything, and said it was a flash drive "used to store patient files and procedures," police wrote in a report.
The investigators told police they then asked Levy to show them those files, on the spot.
As they opened the files, the Hopkins investigators saw two women — who appeared to be employees — using the toilet. Levy acknowledged that the recording had been made in the bathroom at his clinic, according to the police report. The investigators gathered the pen camera and a second device plugged into Levy's computer, which contained images showing a patient lying on an examination table, under anesthesia.
Levy at first told the Hopkins investigators that he was unaware that a recording was being made.
"When Johns Hopkins Hospital Investigators asked Dr. Levy if any of these women knew or consented to being video/audio recorded, Dr. Levy advised that none of the women knew or consented to being recorded," detectives wrote in a report.
According to detectives' handwritten notes, Levy told the investigators he had no explanation for his behavior — "No rationale behind it" and "Stupid idea."
The Hopkins investigators checked Levy's briefcase and took three more pen cameras as well as two cameras concealed in key fobs, which he ordered from China.
Some victims have complained about Hopkins' handling of the situation, saying that they were not notified about Levy's conduct until after his death. Police said at the time that they had asked the hospital to hold back as detectives investigated.
"Because an employee was willing to step forward, we were able to put a stop to Dr. Levy's behavior as soon as we learned of it," Hopkins' Hoppe wrote.
Staff members who worked with Levy told police that they believed he scheduled unnecessary pelvic exams and said they had observed that he frequently went to the bathroom — four or five times over a period of four hours, yet they never saw him eating or drinking anything at work.
Detectives' handwritten notes show that Levy was observed on the video entering the bathroom to turn the camera off after someone left. The camera was concealed in a toilet paper cover.
Levy treated patients ages 13 to 70. In August, the FBI informed police that it had reviewed about 9 terabytes of images contained on hard drives, flash drives and servers seized from Levy's property.
Prosecutors have said that more than 1,300 videos and images were found, and the documents show investigators determined that there were 250 to 300 different adults and 60 prepubescent individuals depicted in the seized recordings.
Police said "many of the images were labeled with the patient's name or within their [patient's] medical file," according to documents. A notation says "most" videos have a patient name attached.
Schochor, the patients' lead attorney, contends that the number of patients that police believe Levy recorded does not fully address the scope of the case.
"The number of photographs or videos is irrelevant," Schochor said. "It's the knowledge of what he did — the fear of where those images may have gone. That breach of faith. And breach of faith is what this case is about."
Hopkins has redoubled its efforts to ensure that employees understand their responsibility for patient privacy and has implemented steps to educate them to identify potential problems, Hoppe said.
In July, Hopkins agreed to pay $190 million to settle claims from thousands of women who might have been surreptitiously recorded during pelvic exams in one of the largest settlements on record involving sexual misconduct by a physician. The patients' attorneys estimate that as many as 8,000 women might have a claim.
The images remain under seal and are likely to be destroyed once the litigation is complete, Schochor said. Even during the investigation, the FBI refused to transfer the evidence to Baltimore police or Johns Hopkins because some of the images were deemed to be child pornography.
After Levy's death, authorities continued to investigate in an attempt to learn the scope of the criminal activity and determine whether images were shared with others. A spokesman for the Baltimore state's attorney's office said this year that authorities had concluded that Levy was acting on his own.
In the investigative notes, police wrote that a patient called a hot line set up by police and said she had seen images of herself on a doctor-patient fetish website. But police wrote that the Web address given did not exist.
Police wrote that though Levy appeared "very tech savvy," they found no evidence of uploading or sharing, and no Web pages, emails or chats that indicated trading. They found additional pornography in his files, but "not illegal porn."