Heal Thyself

Anthony Black is not happy. As the husband of one of the 8,000 or so plaintiffs in a class action suit against Johns Hopkins Hospital, Black says the proposed $190 million settlement is “not fair” to the women whom the late Dr. Nikita Levy surreptitiously photographed for years in his clinic office.

The proposed settlement, which if divided evenly after attorney’s fees would amount to more than $15,000 per plaintiff, won’t substitute for knowing for sure what Levy did with the one hundred plus still photos and more than a thousand videos he took during gynecological examinations, he says. The money won’t restore the women’s trust in their doctors or in Hopkins, which cooperated with the investigation into Levy’s actions but even now will not say what changes it has made to its own policies and procedures to prevent something like this from happening in the future.

“She complained about him more than once,” Black says. “At a regular checkup he would make her take off all her clothes.”

Black’s complaints echoes others’, including Jonathan Schochor, chairman of the plaintiffs’ steering committee, who says that for years before the hidden cameras were discovered, many women complained to the Hopkins administration about Levy’s language in the examination room and seemingly inappropriate touching, including possible unnecessary pelvic exams.

“There were people who complained to the administration . . . and got no response,” he says, though he is not sure how many did so.

In its public statements regarding the scandal, Hopkins stops just short of denying this claim. The hospital says it took action as soon as it became aware of Levy’s transgressions.

“One thing we have been reminded of throughout this difficult situation is how important it is that we foster an environment that encourages us all to speak up,” the administration said in a “dear colleague” letter made public last October. “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. We have redoubled our efforts to ensure that all of us in the Johns Hopkins community understand our responsibility, and we want to encourage you to speak up if you have any concerns about patient care or privacy.”

According to Hopkins public relations office, Levy was caught on Feb. 4, 2013, when a colleague spotted a tiny lens embedded in a pen he wore around his neck. Levy had by then examined more than 12,000 patients during his 25-year career at Hopkins.

The hospital’s security staff interviewed him “within a day” and seized both the pen around his neck and several other cameras, including two secreted inside key fobs he carried.

Levy was escorted off the premises by Hopkins security and Hopkins formally fired him on Feb. 8, 2013.

Police searched Levy’s house and seized computers that contained more than 1,300 video clips and images. The department reportedly tried to determine if Levy had shared his trove of images and concluded that he most likely had not, but could not be 100 percent sure.

On Feb. 18, Levy committed suicide by placing a bag over his head attached to a helium hose. According to published reports, he wrote a letter of apology to his wife.

Hopkins did not share all the details immediately, constrained by police requests during the initial investigation. But the institution sent emails and letters to thousands of patients the day of Levy’s firing, adding details after his death.

The class-action lawsuit was preordained. The question was only how much it would cost Hopkins’ insurance carrier, and how the money would be divided among the victims. Those questions are still open: The agreed settlement of $190 million is in escrow but the exact payouts are months (at least) from being known, subject to a fairness hearing scheduled for Sept. 19. The plaintiffs will be placed in a damage matrix with four tiers of compensation, with those judged to be the most traumatized awarded the most money, Schochor says. Members of the class may opt out of the settlement, litigating on their own for more money.

Those who elect to stay in the class will be examined by what Schochor calls a “sophisticated allocation team” led by Dr. Annie G. Steinberg, a forensic psychiatrist who will place victim in one of four categories indicating the emotional damage they suffered. “The dollar amount for each category will be assigned by the forensic team,” Schochor says. “Category four might be ‘severe, unremitting emotional distress.’ Category one might be ‘mild or no damage.’”

 Told of the plan, Black says, “That sounds almost like a lie detector test.”

The other big question involves hospital policy. Levy reportedly routinely broke rules that required a nurse or other chaperone to be present during gynecological exams, Schochor says. He is alleged to have done this for years without sanction, even as more than a few patients questioned his manner and methods.

Hopkins says it does not tolerate such behavior. “We have strong policies to protect patient privacy, but all hospitals must rely to some extent on the integrity of their caregivers,” Kim Hoppe, Hopkins’ director of public relations and corporate communications, says in an email. “Employees are our best partners in safeguarding patient privacy. 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.  We acted quickly and decisively.

“We have redoubled our efforts to ensure that everyone in the Hopkins community understands his or her responsibility to speak up if they have any concerns about patient care or privacy,” Hoppe continues. “We have implemented numerous steps to educate, inform and empower our staff to identify and alert us if they have any concerns. We have a variety of methods for reporting issues—employees can go directly to their managers or call an anonymous compliance line that is available 24/7. We also conducted a comprehensive initial inspection of our facilities and continue to conduct random inspections.”

But asked to detail the steps the hospital has taken since the Levy matter became public, Hoppe falls silent. She answered a series of emails and phone messages with emails pointing to previously released material and a link to an online complaint form. She did not respond to City Paper’s last requests to clarify whether it denies that patients complained long before Levy’s actions came to light and to detail the specific steps it has taken to encourage staff to come forward.

Hopkins may have taken very specific steps to make its staff more comfortable reporting bad or just unusual behavior by doctors, but it apparently has not reached out to an expert in its own ranks. Dr. Martin Makary, a surgeon who wrote a book about how hospitals can improve their communication to avoid malpractice, says he can’t comment on the changes Hopkins instituted in the wake of the Levy scandal. “It’s not my department,” he says in a short phone conversation between surgeries.

Much of Makary’s 2012 book, “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care,” recounts how the culture of many hospitals keeps medical staff from intervening in, correcting, or even reporting doctors’ errors and bad acts. The book suggests a number of concrete steps hospital administrators can take to improve “teamwork” and accountability among staff. Although Makary focuses more on surgical errors and infection rates, the techniques—including checklists, formal reporting procedures, and even things as simple as making sure everyone on a “team” knows everyone else’s name—would appear to apply broadly. Makary’s book also suggests that hospitals make these performance measures and surveys public. It has not happened yet.

“My wife is a Hopkins employee,” Black says. “An up-close and tight employee.” He says he learned of Levy’s acts before she did.

“When I told her his name, she froze,” Black says of his wife. “She said you are joking me. She said, ‘He always, even for a regular checkup, made me take off all my clothes.’ She complained to the receptionist—she said, ‘Why do I have to take my clothes off?’”

Black says he doesn’t know what, if anything, the receptionist said or did about that.

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