BALTIMORE (AP) — A "rogue" gynecologist who used tiny cameras to secretly record videos and photos of his patients has forced one of the world's top medical centers to pay $190 million to 8,000 women and girls, lawyers said Monday.

Dr. Nikita Levy was fired after 25 years with the Johns Hopkins Health System in Baltimore in February 2013 after a female co-worker spotted the pen-like camera he wore around his neck and alerted authorities.

Levy committed suicide days later, as a federal investigation led to roughly 1,200 videos and 140 images stored on computers in his home.

"All of these women were brutalized by this," said their lead attorney, Jonathan Schochor. "Some of these women needed counseling, they were sleepless, they were dysfunctional in the workplace, they were dysfunctional at home, they were dysfunctional with their mates. This breach of trust, this betrayal — this is how they felt."

The preliminary settlement approved by a judge Monday is one of the largest on record in the U.S. involving sexual misconduct by a physician. It all but closes a case that never produced criminal charges but seriously threatened Hopkins' reputation.

Lawyers said thousands of women were traumatized, even though their faces were not visible in the images and it could not be established with certainty which patients were recorded or how many. Schochor said it would be impossible and only cause more distress to "sit around a table and try to identify sexual organs without pictures of faces."

Plaintiffs' attorney Howard Janet said 62 girls were among the victims, and that Levy violated hospital protocol by sending chaperones out of the exam room.

Hopkins said insurance will cover the settlement, which "properly balances the concerns of thousands of plaintiffs with obligations the Health System has to provide ongoing and superior care to the community."

"It is our hope that this settlement_and findings by law enforcement that images were not shared_helps those affected achieve a measure of closure," the hospital statement said, adding that "one individual does not define Johns Hopkins."

Myra James, 67, had been going to him for annual exams for 20 years. Since his misconduct became public, she hasn't been to a gynecologist once.

"I can't bring myself to go back," James said. "You're lying there, exposed. It's violating and it's horrible, and my trust is gone. Period."

The AP normally does not identify possible victims of sex crimes, but James agreed to the use of her name.

Levy, 54, graduated from the Weill Cornell Medical College in Manhattan, and completed his internship and residency at Kings County Hospital Center. He began working at Hopkins in 1988, and was working at Hopkins East Baltimore Medical Center at the end.

He saw roughly 12,600 patients during his years at Hopkins. About 8,000 joined the class-action, alleging the hospital should have known what he was up to.

"There was no inkling of it. Hopkins was unaware," said Hopkins' attorney, Donald DeVries, who said Levy went "rogue."

Once alerted, hospital authorities quickly notified Baltimore police and escorted Levy off campus. Police and federal investigators said they found no evidence he shared the material with others. Schochor said all the images will be destroyed by court order.

Some women told of being inappropriately touched and verbally abused by Levy, according to Schochor. Some said they were regularly summoned to Levy's office for unnecessary pelvic exams.

"Did he take pictures of me? There's no way of knowing," said another former patient whose two children were delivered by Levy. "I felt violated, because I don't know if for sure if he had pictures of me, or who has seen them."

His suicide — by wrapping his head in a plastic bag with a hose connected to a helium tank — frustrated everyone who wanted to know his motives and see him face justice.

The settlement involves eight law firms and is subject to final approval by Judge Sylvester B. Cox after a "fairness hearing" where the women can speak. Each 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.

Hopkins sent out letters to Levy's entire patient list last year, apologizing to the women and urging them to seek care with other Hopkins specialists.

But hundreds were so traumatized that they "dropped out of the medical system," and some even stopped sending their children to doctors, Schochor said.

James said her dealings with Levy were always unsettling. She said she found it strange that he conducted examinations without a nurse present.

"He was cold, and I was kind of scared of him. His bedside manner — he didn't have any," she said. "But all my doctors were at Hopkins. I've had two surgeries there, my primary doctor is there. I was used to going there for everything."