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In Indiana, reporters got a preview of the possible effects of closed medical records almost a half decade ago. In the mid-1990s, the Indiana Health and Hospital Association determined that ambulance records, including ride logs, should be closed to public inspection because of privacy concerns.

Journalists immediately began negotiating with medical officials to reopen the records, but the medical privacy regulations appeared and ended the discussion.

"That basically knocked us out of the box in getting information back to where it had been," said Steve Key, counsel for government affairs for the Hoosier Press Association. "No one wanted to run afoul of HIPAA."

During the 2001 session of the Indiana General Assembly, open government advocates succeeded in getting legislation that restored some access to information. But because of medical privacy, they still could not get patients' names or locations.

"And it wasn't because the health and hospital officials weren't willing," Key said. "It was because of their fear with HIPAA regulations that, if they gave that type of information, it would expose them to litigation, penalties or fines."

Even outside the immediacy of hospital buildings and ambulances, reporters have run into trouble securing medical information.

The St. Louis Post-Dispatch, in covering the death of St. Louis Cardinals pitcher Darryl Kile before an away game against the Chicago Cubs, ran into an uncooperative medical examiner even though Illinois law allows for the release of autopsy and coroner reports. The Cardinals, too, stopped offering information about Kile's health condition, saying they did not wish to violate his family's privacy.

Susan Kelleher of the Seattle Times said she discovered recently that even city police, who are not affected by these rules, have begun using medical privacy reasons to redact criminal records.

For a story about violence in hospital waiting rooms, Kelleher hoped to cull through police reports. But police redacted any names from the reports that could identify patients, including the names of other family members who weren't hospitalized. Police told Kelleher that she could secure names by going to the hospitals and getting approval.

"To me that's an abuse of their privilege," she said. "They have these records, and it could be months before we could look at them under this cumbersome setup."

The full extent of the rules' effects on newsgathering remains to be seen. But press advocates fear that if such rules had existed in the past, much of the top journalism about tragedies and disasters and medical crises might have gone underreported.

Most notably, perhaps, are the events of September 11.

Marianne McCune of WNYC said she is not sure if she will ever forget the people she saw that day as she covered the tragedy and the despair of people as they searched hospital after hospital.

And she wonders what it would have been like if the rules were that they could not get answers.

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