The largest publicly disclosed medical malpractice settlement in U.S. history is the $190 million Johns Hopkins Hospital paid in 2014 to resolve claims by more than 7,000 women whose gynecologist had secretly filmed them during pelvic exams. That figure is the biggest confirmed settlement on record, though because most malpractice cases resolve under confidentiality agreements, larger private settlements may exist that have never been reported.
The Johns Hopkins Settlement
Dr. Nikita Levy, a gynecologist at Johns Hopkins, used a hidden camera to record pelvic exams of his patients over a span of years. The hospital fired him after learning of the recordings, and he died by suicide ten days later. No criminal charges were filed. The $190 million settlement, reached in 2014, covered more than 7,000 plaintiffs, which makes it an unusual mass-claim resolution rather than a single-patient dispute.
That structure matters when comparing it to other malpractice numbers. The Johns Hopkins payout is large in absolute terms but was divided among thousands of claimants. Individual malpractice settlements, where one patient or family receives the full amount, are routinely smaller than the headline jury verdicts you see in the news, even in catastrophic cases.
Why the “Largest” Settlement Is Hard to Pin Down
Settlements are negotiated agreements, and most come with confidentiality clauses. National Practitioner Data Bank records show that settlements account for roughly 96% of all malpractice payments, while jury verdicts make up less than 4%. The public sees only a small slice of what actually gets paid.
That means the Johns Hopkins figure is the largest known settlement, not necessarily the largest ever paid. A hospital system or insurer could have paid more in a sealed resolution without any public record of the amount.
How Settlements Compare to the Largest Verdicts
Jury verdicts and settlements are different animals. A verdict is what a jury decides after trial. A settlement is what the parties agree to, often before trial, sometimes after a verdict comes down. Verdicts generate headlines; settlements generate the actual money that changes hands in most cases.
Several jury awards dwarf the Johns Hopkins settlement on paper:
- In August 2025, Judge Patrick Corum entered a $951 million default judgment against Jordan Valley Medical Center in Utah after its operator, Steward Health Care, stopped participating in the litigation. The case involved Azaylee McMicheal, who suffered a severe hypoxic-ischemic brain injury during her October 2019 birth. Roughly half the award was punitive damages. Steward Health Care filed for bankruptcy in 2024, and the family’s attorneys have said they may recover only a fraction of the verdict.
- In 2024, a New Mexico jury awarded $412 million against NuMale Medical Center in a fraud and malpractice case brought by Michael Sanchez, who was misdiagnosed with erectile dysfunction and permanently injured by a botched penile injection. NuMale filed for Chapter 11 in January 2025. A federal bankruptcy court approved a global settlement in September 2025, with Sanchez receiving $96.5 million, less than a quarter of the verdict.
- A 2006 Florida verdict awarded $216.7 million to Allan Navarro, who was sent home from a Tampa hospital with a sinus-infection diagnosis when he was actually having a stroke.
- A 2014 New York verdict awarded $172 million to Tiffany Applewhite, who suffered permanent brain damage during a botched EMT response to anaphylaxis.
Each of these numbers is larger than $190 million. None of them represents what the plaintiff actually collected.
Why Big Verdicts Shrink Before Payment
Research on Florida’s largest malpractice payments between 1990 and 2004 found that of 34 awards exceeding $5 million, only two were paid at the full verdict amount after trial. The rest resolved earlier or shrank afterward, with some of the most publicized awards settling for just 5% to 10% of the original figure. A separate Texas study found that 75% of plaintiffs received less than what the jury awarded.
Several mechanisms account for the gap.
Remittitur
Trial judges can reduce awards they consider excessive. In the “Take Care of Maya” case, a Florida judge cut a $261 million verdict against Johns Hopkins All Children’s Hospital by $47.5 million. A Minnesota federal judge in 2023 reduced a $110 million malpractice award to $10 million, calling the original figure “shockingly excessive.”
Appellate Reversal
Higher courts can reduce verdicts or throw them out entirely. A Baltimore jury awarded $229 million to Erica Byrom after her baby suffered brain injuries at Johns Hopkins Bayview in 2014. A trial judge reduced it to about $205 million under Maryland’s damage cap. In 2021, the Maryland Court of Special Appeals reversed the verdict altogether, finding the evidence insufficient to support liability. The “Take Care of Maya” verdict met a similar fate in October 2025 when a Florida appeals court vacated the $208 million judgment and ordered a new trial on limited claims, with punitive damages barred.
Statutory Damage Caps
Roughly half of U.S. states cap non-economic damages (pain and suffering) in malpractice cases.
- Texas limits non-economic damages to $250,000 per defendant.
- California’s cap, reformed in recent years, will rise incrementally to $750,000 for injury cases and $1 million for wrongful death by 2034.
- Indiana caps total malpractice damages at $1.8 million for recent cases.
- Louisiana caps total damages at $500,000, excluding future medical care.
These caps can shrink a nine-figure verdict to a small fraction of its headline number.
Insurance Limits
Many outsized verdicts exceed the defendant’s malpractice insurance policy. When that happens, plaintiffs often settle for the policy limit rather than try to seize a physician’s personal assets, which is costly and uncertain.
Bankruptcy
When the defendant is insolvent, even an unchallenged verdict yields pennies on the dollar. The $412 million NuMale verdict became a $96.5 million bankruptcy settlement. The $951 million Utah award faces the same uncertainty because Steward Health Care is in Chapter 11.
What This Means for the “Largest Settlement” Question
The $190 million Johns Hopkins payment holds the record for the largest known medical malpractice settlement, but it reflects a mass claim across thousands of patients. Individual malpractice settlements, though frequently larger than most people realize, almost never approach that figure, and the ones that might come close are rarely disclosed. Headline verdicts in the hundreds of millions grab attention, but between damage caps, appeals, insurance ceilings, and bankrupt defendants, the money a patient actually receives tends to look much more like a settlement than like the number a jury wrote on the form.