BALTIMORE - A Baltimore judge on Friday approved a $190 million settlement to compensate thousands of women who were secretly photographed by a now-deceased Johns Hopkins Hospital gynecologist during exams.

The hospital and former patients of Dr. Nikita Levy, who had worked there for 25 years, reached a preliminary settlement in July to resolve accusations the doctor secretly filmed and took photos of up to 9,500 women, often using a spy pen.

"The court finds that the settlement as proposed is fair and reasonable," Baltimore City Circuit Court Judge Sylvester Cox told a courtroom packed with lawyers and Levy's former patients.

"To all the patients of Dr. Levy, I hope you're able to heal and move forward," he said.

The accord comes after nearly a year of talks.

An employee of the renowned hospital told officials there in February 2013 he suspected Levy was wearing a tiny camera around his neck as he examined patients. Levy committed suicide shortly afterward as authorities weighed whether to bring criminal charges.

Attorneys believe no faces were recorded and all of Levy's patients are eligible to be part of the class action without having to prove their pictures were taken. Johns Hopkins officials contacted patients to alert them to the police investigation and the allegations against Levy.

"I just felt embarrassed and ashamed," said Monica Jones, 40, who had been a regular patient of Levy since she was a teenager.

"The examinations were really, really intense," said Jones, who recalled feeling that things were not right. "He would want to do a whole examination just to pick up birth control."

Baltimore lawyer Jonathan Schochor, the lead counsel for the women, told a news conference the settlement was "truly historic."

"We are told that this is the largest, single perpetrator, sexual abuse case in this country in history," he said. "I think we have been extraordinarily successful for our clients."

The number of patients involved in the suit ranged from 8,000 to 9,500 and lawyers were working to eliminate duplicate registrations, Schochor said.

If no appeals are filed, the $190 million would go into a settlement fund overseen by a court-appointed administrator in 44 days.

A panel of psychologists and lawyers will evaluate the women who were photographed to determine the level of trauma they experienced, with payments being made in four tiers depending on each woman's experience.

Schochor did not say how long it could take for money to be disbursed.

A second hearing is scheduled for Oct. 2 to address legal fees and expenses. Some patients objected the proposed payment to lawyers of 35 percent of the total settlement as too high.