Johns Hopkins Hospital has agreed to pay $190 million to settle claims from thousands of women who may have been surreptitiously recorded during pelvic exams by gynecologist Dr. Nikita A. Levy.

The amount of the settlement is one of the largest on record involving sexual misconduct by a physician. Levy, a doctor in the Johns Hopkins Community Medicine system for 25 years, took his life in February 2013 during an investigation that revealed he was using tiny cameras concealed in pens and key fobs to record patients.

Investigators found more than 1,300 videos and images during searches of Levy's home and office. Plaintiffs' attorneys estimate more than 8,000 patients could have a claim.

Because the women could not be identified from the images, all former patients could be considered victims. Anyone treated by Levy has been affected by a feeling of "betrayal" and an invasion of doctor-patient confidentiality, said Jonathan Schochor, the lead attorney for the patients.

"Many of our clients still feel a betrayal and lack of trust and have fallen out of the medical system," Schochor said. "They stopped seeing their doctors, they stopped taking their children to doctors. They refused to see male OB-GYNs, or any OB-GYN.

"Their lives, needless to say, have been severely and negatively impacted," he said.

In a statement, Hopkins said the settlement would be paid through its insurance policy and "will not in any way compromise the ability of the health system to serve its patients, staff and community."

"It is our hope that this settlement, and the findings by law enforcement that the images were not shared, helps those affected achieve a measure of closure," the hospital statement read.

Donald L. Devries Jr., an attorney for Hopkins, acknowledged that Levy had committed a "colossal breach of trust" but emphasized that the doctor was a "rogue employee" whose actions could not have been flagged by the institution.

"There was no inkling of it," Devries said. "It's one of those situations where no matter what rules or regulations or whatever you put in place, if somebody wants to violate it secretly as this physician did, there's not a thing that institution is going to be able to do to know that."

Howard Janet, another plaintiffs' attorney, disputed that, saying Levy's actions occurred within the scope of his employment as a physician working for Hopkins.

"Our position is that if it's something they didn't know, it's something they should have known," Janet said.

While industry experts said Hopkins, a multibillion-dollar operation, would be able to absorb any financial hit, hospital system officials might be more cautious in hiring decisions, especially in affiliated settings that carry the Hopkins banner — and benefit from its credibility and resources.

"That's what the hospital brand name means to the consumer," said Mark Pauly, a professor of health care management, business economics and public policy at the Wharton School of the University of Pennsylvania.

Hopkins might have settled to avoid more liability, said Tom Baker, a professor of law and health sciences at the University of Pennsylvania Law School. "You don't pay $200 million unless you thought you had a risk of losing quite a bit more than that," he said.

Levy, who was 54 at the time of his death, practiced in East Baltimore under the arm of the Johns Hopkins Community Physicians, where he served largely low-income residents of the area. A Jamaican-born New Yorker, he was married and had three children, and had a reputation among some patients as willing to go above and beyond to provide care, such as driving through a snowstorm to deliver a patient's child.

In court, plaintiffs' attorneys alleged that Levy "engaged in doctor-patient boundary violations during the course of his patients' treatment," including "an excessive number of unnecessary pelvic exams and engaging in inappropriate physical contact." Some patients said Levy practiced without medical professionals on hand as observers. Observers are used routinely in hospitals for the safety of patients and doctors.

Kim Hoppe, a spokeswoman for Hopkins Medicine, said hospital officials had "redoubled our efforts to uphold the highest standards of patient privacy."

"We have implemented numerous steps to educate, inform and empower our staff to identify and alert us if they have any concerns," she said in an email. "We also conducted a comprehensive initial inspection of our facilities and continue to conduct random inspections."

Schochor said settlement negotiations had been continuing for months until Friday, and attorneys received word Monday that Circuit Judge Sylvester B. Cox had granted preliminary approval of the agreement.