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But the rules threaten to penalize potential whistleblowers. Although the new regulations offer some provisions for whistleblowers who take their concerns to government officials, there are none that allow for them to tell their stories to the press instead.

Even without the rules, the hospitals and the medical community have long enjoyed a culture of secrecy.

The Institute of Medicine illustrated such a tradition in its hotly debated report "To Err is Human: Building a Safer Health System," which speculated that between 44,000 and 98,000 people die in hospitals each year as a result of preventable medical errors. The 1999 report, in part, blamed the deaths on secrecy and reporting problems and suggested the creation of a federal clearinghouse to catalog the errors.

Michael Berens, a project reporter for the Chicago Tribune, said his experience covering hospitals in Illinois and across the country exposes him to such secrecy time and again.

"As a reporter, it's always disturbing when I'm learning information about patient cases and they never knew themselves," Berens said. "I found out that hospitals outright conceal information from patients."

And the new medical privacy rules, Berens and others say, promise to bolster such secrecy to the detriment of the very patients it proposes to protect. Berens said he fears hospital officials will use the rules to insulate themselves even more, using the guise of patient privacy protection.

They might justify these rules "as a catalyst for internal improvement they need without the glare of public debate or pressure of lawsuits," he said. "But time and time again, hospitals are failing in the mission they claim they are doing."

Berens understands the difficulties in securing records and information. For a just-published Tribune series on hospital infections, he spent months poring over databases to show how deaths linked to such infections represent the fourth leading cause of mortality among Americans, behind heart disease, cancer and strokes. Such reporting relied on mounds of medical records, some Berens feel would be even more difficult to secure in the future.

"There are already enough barriers," Berens said. "I don't know how we'll be able to penetrate these castle walls with the new rules. I fear that the medical community has already enjoyed decades of privacy and secrecy and that anything further should be viewed with suspicion."

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