The spy-camera gyno is every woman's worst nightmare – and a wake-up call

Don't let creeps like the voyeur doctor from Baltimore keep you from medical care. It's already difficult enough for so many of us

Privacy is priceless – but thousands of girls and women will benefit from a $190m settlement from Johns Hopkins Health System announced on Monday after a (now-deceased) doctor was alleged to have secretly photographed and filmed some of his more than 12,000 patients during pelvic exams between 1988 and 2013.

But while Dr Nikita Levy is said to have violated his patients with an assist from modern technology, this case is, in many ways, a very familiar story about the reproductive injustice and health-care inequality faced by black women in America.

In February 2013, a colleague reported that Levy – a long-time gynecologist at the East Baltimore Medical Community Center owned by Hopkins – was recording images of patients with a tiny pen-camera combo he wore around his neck. Hopkins reported Levy to the police and authorities found multiple cameras in his office and more than 1,200 videos or photographs at his home. In the midst of the ongoing investigation – and after more than 300 current or former patients contacted the police – Levy was fired by Hopkins and he committed suicide.

There's virtually no way to match the names to the faceless shots of women disrobing or to their body parts on the table found on Levy's computer, and, after his suicide, no other means to identify them. While some patients expressed surprise at his reported violations after the case, others spoke up with stories that Levy dismissed chaperones from exam rooms, requested multiple unnecessary procedures, was verbally abusive, touched them inappropriately or seemed inordinately interested in younger patients.

As a result, Johns Hopkins, one of the most storied hospitals in the United States, will make payments to all the possibly affected women. It is, in the end, the right thing to do.

So why did Levy get away with this behavior? Though we can't say in this case that Hopkins turned a blind eye to rumor or complaints, race and place often matter when it comes to whose complaints get traction. The community clinic is in East Baltimore – made infamous as the setting of The Wire – where minority communities and women are drastically underserved by healthcare providers. Exposed to chronic illness and violence, impoverished women are easily targeted by the occasional predatory doctor – some like Levy and others like Philadelphia's Kermit Gosnell, who ran a dangerous, poorly-regulated abortion clinic that targeted poor and immigrant women unable to afford better care. Predators like these know that their patients often fall between the cracks, and they sees those "cracks" as an opportunity for exploitation.

And, by their nature, gynecological and obstetric care are rife with opportunities for sexual misconduct. Splayed partly dressed on a table, their feet in stirrups, their lower halves concealed to them but accessible to the medical staff and perhaps under sedation, women are at the intimate mercy of a physician – and you just have to trust that your Pap smear or other procedure will be done quickly, gently and respectfully.

But respect hasn't been the norm in black women's encounters with the medical community. Today's gynecological science was, in fact, built on the medical experimentation on black bodies.

As "women's medicine" became a more popular specialty, medical students often polished their skills, such as they were, on black women because it was distinctly improper to lift the skirts and peer at the genitalia of white women. J Marion Sims, called the father of gynecology, honed his craft and developed his namesake Sim's speculum – one of the essential medical instruments for OB-GYNS to this day – through public and private examinations and operations on enslaved women (and later on impoverished Irish immigrants) suffering from gynecological conditions like fistulas. He performed these procedures mostly without anesthesia because, like many of his colleagues, he opined that black women were almost impervious to pain. Today, he's memorialized by statues in New York's Central Park and at the South Carolina State Capitol.

The Hopkins settlement is thus the latest chapter in an all-too American story: black women's bodies have rarely been seen as private, are rarely accorded the same feelings or rights to consent as white women's bodies and were more often subjected to individual doctors' prurient interests or medical research.

To this day, women who are poor, urban, black and brown have fewer choices of physician or facility. Specialists are often few and far between in America's urban corridors and rural spaces, and the numbers dwindle when you consider those who accept Medicaid. It's particularly difficult for patients – and particularly low-income ones – receiving subsidized care to question men in white doctors' coats. And in a system where a few doctors or clinics hold the key to services, it's understandable that you wouldn't want to jeopardize your care with even a valid complaint – or that lingering feeling that those brushes against your breast weren’t accidental.

Despite the settlement money, for the many women who received services at the clinic, which serves mostly low-income residents and communities of color in blighted Baltimore, the ordeal isn't over. As the hospital system's lead attorney told the press, many of the former patients have ongoing fear, anxiety and worse:

Many of our clients still feel a betrayal and lack of trust and have fallen out of the medical system. … They stopped seeing their doctors, they stopped taking their children to doctors. They refused to see male OB-GYNs, or any OB-GYN.

But while you couldn't blame those women for seeking care elsewhere or avoiding the dreaded annual exam, that's a dangerous choice when black women tend to die at far higher rates than white women from endometrial and gynecologic cancers and are far more likely to die of breast cancer. Black women would benefit more than almost any community from regular preventative medical (and specifically gynecological) care, but when we can't afford it or feel we can't trust the medical establishment to respect our bodily autonomy, we have to hope that nothing is seriously wrong.

Money may help Levy's former patients find doctors they can trust. But it’s little consolation for the black girls and women who walked into that Baltimore clinic, determined to make health-care decisions, and walked out the victims of a video criminal.

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