July 22, 2014; CBS

Johns Hopkins Hospital agreed to pay $190 million in damages to more than 8,500 women who were secretly videotaped and photographed during examinations by Dr. Nikita Levy, a gynecologist who worked for the nonprofit hospital from 1988 to early 2013. Dr. Levy took his own life as an investigation into his actions was nearing completion. Over 1,200 videos and images of patient examinations were found on Dr. Levy’s computer, apparently taken by him using miniature cameras in items such as pens and key fobs.

The $190 million settlement, which works out to about $22,000 (before legal fees and costs are deducted) per member of the class action lawsuit, is approximately equal to 10 percent of the annual revenue of the Johns Hopkins Hospital. CBS reports that the settlement will be paid by insurance companies that provide coverage to the hospital.

How did this happen? Why did it happen for so long before it was discovered? Dr. Levy’s secretive methods are part of the answer. We can only speculate that a doctor’s presumed credibility and authority as a medical specialist persuaded staff and patients alike that his methods and practices were allowable even when seen as unusual. Dr. Levy scheduled some patients for pelvic examinations far more frequently than medical protocols would indicate. In addition, it has been reported that Dr. Levy often did not have a female third party in the examination room when he was working with a patient.

The class action was filed on behalf of about two-thirds of the 12,500 patients Dr. Levy is estimated to have seen at Johns Hopkins in his practice there. The hospital has contacted all of Dr. Levy’s patients to apologize and encourage them to seek help from other Hopkins doctors. Some patients are reluctant to see another doctor, with a few also reluctant to have their children visit a physician.

Johns Hopkins Hospital was fortunate to have generous insurance resources to cover what otherwise might be a crippling financial settlement. The damage to its reputation as one of the great hospitals of the world is still unknown. The apology and settlement are only the beginning. Surely, stricter attention to policy and procedure, including medical treatment protocols and patient protections for women, should be high on John Hopkins’s priorities (not to mention those of their insurance carriers). The teaching moment for all nonprofits, especially nonprofit hospitals, is to identify and prepare for potential serious risks to operation and reputation by acting to protect those we serve. Vigilance by executives and boards is especially important when service providers have great influence over clients in vulnerable, intimate situations.—Michael Wyland