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Department officials say the absence of a national standard concerning the confidentiality of health information has caused both patients and the health care industry great anxiety concerning the handling of such records.

Public comment on the proposed rules attest to concern. In the wake of releasing the draft rules in 1999, the department received more than 52,000 comments. A Wall Street Journal-ABC poll released that year found that 29 percent of respondents considered "loss of personal privacy" as the first or second most pressing issue for them in the 21st century.

"Many plans, providers, and clearinghouses have taken steps to safeguard the privacy of individually-identifiable health information," federal health officials wrote in justifying the new rules. "Yet they must currently rely on a patchwork of State laws and regulations that are incomplete and, at times, inconsistent."

The final regulations provide privacy protection for all personal medical information, whether collected in oral, paper or electronic form. They also require patients to consent for release of any of their medical records, even for routine purposes. The regulations offer some provisions, however, for disclosure but only in emergency situations and only to groups such as law enforcement officials.

Penalties for the unauthorized release of such information by health-care workers can reach as high as $250,000 and 10 years in jail for each violation. The regulations offer some waivers for law enforcement officials conducting investigations.

But journalists and press advocates fear the loss of crucial sources of newsworthy and, until now, public information. These concerns come despite the fact that the rules themselves make no reference to journalists nor do they specifically prohibit the release of information for newsgathering purposes.

Indeed, press groups such as the Society of Professional Journalists, the Newspaper Association of America, the National Newspaper Association and American Society of Newspaper Editors say they are not offended by the bulk of the rules. They simply fear that the lack of recognition of the journalist's role in covering medical issues, coupled with the rules' enforcement guidelines, means the end of valuable sources of information.

"Our concern is that these very stiff penalties under the privacy rule will have a chilling effect for hospitals, especially when there is an accident or some sort of community emergency or when someone in a very important standing is in the hospital," said Ian Marquand, chairman of SPJ's Freedom of Information committee. "Even though a release of information might be harmless, people are just not going to tell us because of the penalties.

"It's such a part of hard news reporting to follow up and know how someone's doing," he said. "This is going to change what people see on television newscasts and what they read in their newspapers. I think that's a loss."

The loss? Literally thousands of stories.

Joel Campbell, formerly of the Deseret News and now a professor at Brigham Young University, researched such stories for SPJ several years ago and found that in 1999 no fewer than 28,400 newspaper articles reported either serious or critical medical conditions of public officials, public figures or victims of accidents or crimes.

And this is critical information for the public, journalists say. Regardless of the scale of the incident, the general public wants to know two things: How the accident occurred and what happened to the people involved.

"Certainly, an individual has a right to guard his or her own medical records from abusive releases," the newspaper groups wrote in comments on the rules. "But when matters of public concern demand the telling of the individual's story to expose a wrongdoing, to inform a community of a disaster or to hold the medical system accountable, some use of individual information is necessary and justified -- and protected by the Constitution."

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