For 25 years, Dr. Nikita Levy ran an obstetrics and gynecology practice out of the East Baltimore Medical Center, a community clinic run by the Johns Hopkins Hospital and Health System. Last February, Johns Hopkins authorities discovered that Levy had been secretly filming his patients in the examination room, using cameras embedded into pens that he wore around his neck and key fobs he carried in his pockets. At his home, police found hard drives and servers stocked with thousands of videos and photographs of his patient’s naked bodies, snapped under the auspices of performing routine pelvic examinations.
Levy treated 12,600 patients during his 25-year career. They will never know whether their trusted gynecologist filmed them at their most vulnerable: The evidence, collected by police, doesn’t reveal their faces, and Levy killed himself shortly after his abuse was discovered. Some patients now say they recall Levy bringing them in for unnecessary treatments and touching them inappropriately under the guise of medical care. In a lawsuit filed last fall, one former patient wrote that she and other victims must now live with the fact that their doctor viewed them “not through the clear eyes of a physician but through the filthy lens of a depraved pervert.” Some say they no longer feel safe seeking medical care at all. Others feel uncomfortable even bringing their children to doctors.
“They are in fear, dismayed, angry, and anxious over a breach of faith, a breach of trust, a betrayal on the part of the medical system,” Jonathan Schochor, an attorney who represented 8,000 plaintiffs in a class-action suit brought against Johns Hopkins’ medical network, said in a news conference Monday. “Many of our clients still feel betrayed, and still feel the breach of trust they have experienced, and they have fallen out of the medical system.”
On Monday, Johns Hopkins announced that it would pay $190 million in damages to the class-action plaintiffs for the sexual abuse they suffered at its medical center and the psychological distress that persists. Now, the court will go about the strange business of distributing those funds to each of Levy’s victims. According to the Associated Press, each individual plaintiff “was interviewed by a forensic psychologist and a post-traumatic stress specialist to determine how much trauma she suffered and how much money she will receive”; their relative harms and eventual payouts will be determined based on a “four-tier damage matrix.” In a letter to the JHU community, Johns Hopkins Hospital officials said, “It is our hope that this settlement—along with law enforcement’s findings that no images were shared—helps all who have been affected to achieve a measure of closure.”
This is the cold legal solution: Thousands of women will have their experience plotted on a “damage matrix” so that a court can calculate their distress and cut them checks. But Levy did not just victimize thousands of women—he victimized a community, and his abuse of his Johns Hopkins perch threatens to reverberate across the city and the country for generations. As one of Levy’s former patients put it in a lawsuit filed last fall, the doctor’s victims “were generally poor, black, undereducated, and of course, female.” Attorneys spearheading the class-action suit against the university notified former patients by publishing a full-page notice in the Baltimore AFRO-American and buying up ad space on local hip-hop station 92Q. Johns Hopkins is one of the most powerful landowners and employers in the state of Maryland, but many of the surrounding communities are among the country’s most vulnerable. Steps away from the university’s top-tier scientific research facilities, Baltimore’s black residents suffer from extreme health disparities and severe income inequality. Some local residents refer to JHU as “the Plantation.” Even $190 million will not provide “closure” for that reality.
“Monetary compensation is the easy part,” says Dr. Stephen B. Thomas, a professor of Health Services Administration at the University of Maryland’s School of Public Health and the director of the University of Maryland’s Center for Health Equity. “The harder part is making sure it never happens again, and recognizing that these communities are vulnerable at so many levels.”
Levy’s crimes won’t just affect the 8,000 women who sat on his examination table. The breach of trust that Levy’s actions represent will congeal into “a legacy that’s passed on to the next generation,” Thomas says. If women and their children stop seeing doctors, “the transference of distrust will be passed down by word of mouth, through family networks.” Thomas adds, “It’s very important to recognize that a community has been harmed, and that community, in my opinion, doesn’t just live in east Baltimore. The ripples extend across the black community.”
The Levy case is just the most recent incident that lays bare the long-standing “racial discord between black communities and white medical institutions,” as Thomas put it. A 2003 study by Johns Hopkins researchers found that black patients are more likely to distrust physicians than are white patients and more likely to be concerned about privacy violations and medical experiments. “There’s a broader context here that contributes to the hesitancy, leeriness, and distrust among these communities,” he says. “And that distrust has been earned; that distrust is legitimate.” In the 1950s, Johns Hopkins doctors treated a poor black woman named Henrietta Lacks for cervical cancer. In the course of her treatment, its scientists harvested her cells without her family’s permission; after her death,they used Lacks’ cells to fuel scientific experiments and build a multibillion-dollar biotechnical industry around her DNA.* Meanwhile, her family suffered in poverty, unable to afford their own health insurance. In the ‘90s, two JHU scientists ran experiments on local black residents, connecting with slumlords to lure families with small children into apartments coated with lead paint. When parents sued, a judge determined that researchers made those children “canaries in the mines” without their families’ consent.
These are headline-grabbing ethical breaches that inspire big lawsuits and celebrated books, but the day-to-day experience of urban health care speaks to a quieter tragedy. “The people living in the shadow of these institutions do not benefit from all the science and technology that’s being developed there,” Thomas says. “These communities should be the healthiest in the state.” Dr. Susan Reverby, a Wellesley historian who studies the ethics of public health and is an expert on the Tuskegee Institute’s infamous syphilis studies, says that high-profile incidents like the Levy case need to be understood in a greater context of health care disparities that reveal themselves in smaller, personal experiences. “Most of the research shows that it’s not usually the knowledge of incidents like Tuskegee that keep people from getting health care—it’s hearing about what happened to Grandma when she went to the doctor,” Reverby says. “The word Tuskegee gets used as a metaphor for attempting to give a voice to racist systems and bad experiences.”
In many ways, Johns Hopkins appears committed to improving its relationship with local residents. The university’s community physicians program—of which the East Baltimore Medical Center is a part—aims to extend the university’s medical services to surrounding neighborhoods. The university now sponsors an annual Henrietta Lacks memorial lecture, award, and scholarship dedicated to improving relationships between scientific researchers and their surrounding communities. Its researchers work with Building Trust, a Maryland organization dedicated to fostering positive and transparent collaborations between minority residents and scientific researchers. That’s why it seems so disingenuous for the university to suggest that a one-time monetary settlement will provide “a measure of closure” between its doctors and its patients. “No apology, no settlement, will solve these problems,” Thomas told me. “The ultimate response needs to be atonement—and atonement means making things better.”
* Correction, July 28, 2014: This post originally stated that doctors harvested Henrietta Lacks’ cells after her death; they were harvested before she died.