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A Baltimore judge on Friday approved a $190 million settlement between Johns Hopkins Medicine and patients of a gynecologist who secretly photographed and filmed women during exams — a ruling that victims' attorneys praised as a step in their clients' healing from a traumatic betrayal.

Circuit Court Judge Sylvester Cox called the settlement fair and reasonable.

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Dr. Nikita Levy, an obstetrician and gynecologist with Johns Hopkins Community Health Systems who practiced in an East Baltimore clinic for 25 years, was accused last year of secret filming of female clients.

More than 1,300 videos and photographs were found during searches of Levy's office and his Towson home. Levy killed himself while authorities were investigating.

The secret filming, first discovered by a suspicious coworker, shocked patients who had trusted the doctor. Several sat in the courtroom Friday.

It will never be known exactly which of Levy's thousands of patients were actually recorded. The images are of genitals during pelvic examinations, and attorneys for both Hopkins and the patients agreed to forego the difficult and potentially invasive process of identifying the victims.

Attorneys Jonathan Schochor and Howard Janet said more than 4,000 women have been interviewed. As many as 9,500 former patients might be eligible for an award under the settlement.

Maria Lennon, 47, said she was a patient of Levy from 1982 until the late 1990s. Looking back, the Baltimore woman said after the hearing, she realizes some of his behavior was rude and inappropriate.

She said she was too young at the time to understand.

"To know his touch was not a friendly touch — it was a nasty, perverted touch — is creepy," she said.

Lennon said the settlement is a victory, but does little to calm the fear she now experiences about seeing a doctor. With Levy dead, she said, she'll never have answers to many questions.

"He chose his out," she said. "We'll never know why he did this to us."

Schochor said interviews with patients have revealed patterns of behavior that included Levy asking women to undress when it was not necessary, asking assistants to leave the room during exams, not wearing gloves and conducting exams that were "sexual in nature, not clinical."

He said patients have told him Levy had a folksy demeanor but was possessive, and discouraged them from seeking a second opinion or visiting an emergency room.

Schochor praised clients who fought for the settlement, and who shared their stories.

"We proved that these damages will not be trivialized," he said. The patients "were exploited and they were betrayed."

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Now, he said, "our clients can begin to get closure."

Donald L. DeVries, an attorney who represents Hopkins, urged Cox to approve the settlement, which he described as the result of "protracted negotiations" with patients' attorneys.

DeVries said it was his "sincere hope" that the settlement, combined with the belief that Levy did not distribute the pictures, would help former patients achieve closure.

Cox noted Hopkins could have fought lawsuits in court in an attempt to whittle down the number of women seeking damages. He said Hopkins could have argued it wasn't responsible for Levy's actions, or could have forced women to prove that they were the ones photographed or videotaped.

"If they had vigorously filed motions to dismiss the claims for various reasons ... by the time all that litigation concluded there would be no money left," Cox said.

Cox didn't settle the objections of the more than two dozen patients who say attorneys in the case shouldn't get a third of the settlement in legal fees. A separate hearing on that matter will be held Oct. 2.

Hopkins has 30 days to appeal Cox's ruling. Fourteen days after that date, it must deposit $190 million in an account.

Then the process of dividing the money can begin. Eligible patients are to be placed into four categories related to the level of harm they incurred, and award amounts will then be proposed.

Cox must approve an allocation plan before any money is awarded. Schochor wouldn't estimate what the payments might be, and said it could be a year before women receive any money.

Levy's former patients have until Nov. 14 to apply to be part of the settlement.

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