Securing Patient Data at Cullman Regional Medical Center
Discover how Cullman Regional Medical Center safeguards patient data with Darktrace AI. Learn how to keep sensitive data protected with the Darktrace experts!
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Written by
Sean Simpson
Executive Director of IT, Cullman Regional Medical Center (Guest Contributor)
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26
Oct 2022
Cullman Regional Medical Center strives to improve the health of our community by providing excellent medical resources. We have over 50 providers offering a wide range of specialized care across our offices in Cullman and Hartselle, Alabama.
To deliver the best services possible, we rely on technology. Staff members record medical histories in digital files. Guests interact with us through online portals. Medical IoT devices collect patient data. Yet the same digital adoptions that make healthcare more efficient also present vulnerabilities that threat actors can exploit to gain access to our digital systems.
Another major concern comes from insider threat, whether malicious or accidental. Data security depends on user compliance, which can be hard to enforce and monitor. Even unintentionally, medical professionals can introduce risk simply by bringing personal devices, such as smart phones or watches, into the network.
In late 2020, the FBI, CISA, and HHS issued a warning after the number of cyber-attacks targeting the healthcare sector reached record highs. The agencies cautioned that cybercriminals could exploit malware like TrickBot to harvest credentials, hijack resources to mine crypto-currencies, exfiltrate data, and deploy ransomware.
The attacks targeting the healthcare sector have gone up in frequency and complexity. While protecting our digital infrastructure and patient data has become increasingly difficult, it remains vitally important. That’s why we deployed Darktrace.
High stakes healthcare security
The consequences of cyber-attacks in medicine can be devastating. Lost or stolen medical records can damage a hospital’s reputation and cost millions of dollars. According to a Ponemon Institute study, the financial cost of a data breach in the healthcare sector can cost two to three times more than a breach in any other industry.
Beyond reputational or financial harm, cyber-attacks against hospitals and clinics can be lethal. They can force ambulances to be re-routed, surgeries to be postponed, and treatment options to be scaled back. In 2021, over 45 million patients were impacted by cyber-attacks on healthcare centers, and almost 25% of Health Delivery Organizations found that cyber-attacks increased patient mortality rates.
Darktrace protects our digital infrastructure to avoid these consequences. Its Self-Learning AI learns our organization— from the laptops and servers to the IoT devices to the users themselves— to recognize what constitutes our “pattern of life.” The AI then uses this information to identify the subtle behaviors that indicate a cyber-attack. Once an attack is detected, Autonomous Response reacts with surgical precision to neutralize it without disrupting our normal digital activity.
Darktrace is always on and can detect and respond to attacks within seconds, providing another layer of security for our hospital and clinics. Darktrace’s approach, based on understanding our organization to create bespoke security, allows the AI to spot threats that slip by traditional security tools, which rely on rules and signatures. In this way, Darktrace can detect insider threats, too.
Finally, not only does Darktrace protect us by stopping cyber-attacks, but it also serves as a deterrent to threat actors by making us a harder target.
Protection in action
Darktrace has successfully helped us monitor and protect our digital estate. We have used it to examine suspicious traffic and troubleshoot access related problems. Darktrace’s Cyber AI Analyst investigates attacks and translates its findings into understandable explanations displayed in a single screen.
Darktrace has proven its value to us on multiple occasions. The same day that one of our clinic managers installed a new file transfer protocol, Darktrace identified traffic going out over an unencrypted port. With its visibility and understanding of our cyber landscape, Darktrace detected this abnormal action and responded at machine-speed. It protected us from exposing personal patient data.
Another time, Darktrace noticed someone on our guest network running a network snooping tool, triggering us to remove their computer from the network. While it was only on our guest network, the threat actor could have been targeting the patients that were using it. Darktrace protected them, helping us live up to our goal of serving our guests with compassion and respect.
Keeping our organization healthy
We do not have a large enough IT staff to constantly monitor all traffic across our digital estate, so Darktrace supplements and augments our team. The AI continuously monitors our cyber landscape and responds to attacks without disrupting our normal digital activities. Moreover, it works at all times of the day, even when I am not online. By handling the maintenance of our security, Darktrace buys my team time to work on other projects.
The cyber security of our organization is crucial for the safety of our patients and practitioners. Since deploying Darktrace, my team feels reassured that our security posture can handle any attacks that come our way. Darktrace is a valuable tool in our security stack.
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Written by
Sean Simpson
Executive Director of IT, Cullman Regional Medical Center (Guest Contributor)
When AI Agents Attack: The Case for Behavioral Anomaly Detection
A new UK AI Security Institute report shows autonomous AI agents independently developing novel attack chains, adapting when detected, and targeting humans and other AI systems. As agents become embedded across the enterprise, behavioral anomaly detection will be critical to securing the new attack surface they create.
Hiding in Plain Sight: Uncovering a Multi-Stage Ransomware Attack Through Behavioral Detection
Darktrace detected a multi-stage ransomware intrusion from its earliest stages, identifying reconnaissance, privilege escalation, lateral movement, command-and-control communications, and data exfiltration before encryption occurred. This analysis highlights how behavioral detection exposed attacker activity using legitimate tools and infrastructure, providing multiple opportunities for early intervention and containment.
Agents cannot be trusted to perform tasks in the way we intend them to. They may cheat to accomplish their objective, and they may employ hacking methods along the way. Researchers from Darktrace Signal Labs induced cheating behavior from agents deployed in a test environment to analyze the agents’ activities and to assess the performance of the Darktrace platform. Agents frequently resorted to hacking to cheat on their assigned task. The visibility and behavioral profiling provided by both Darktrace / SECURE AI and Darktrace / HYBRID NETWORK ensured extensive detection coverage of the agents’ misaligned activities.
Key Takeaways:
Darktrace Researchers deployed agents in a simulated corporate environment and asked them to solve an impossible challenge. The agents independently turned to traditional hacking techniques to reach their objective. No one instructed them to do this, and no attacker was involved.
Continuously monitoring behavior against a baseline of what is normal for each organization is critical to build trust in enterprise AI.
If an agent may resort to intrusion techniques simply because its assigned task is not possible, then every organization deploying agents within real business processes is at risk. Darktrace / SECURE AI and Darktrace / HYBRID NETWORK identified the agents’ misaligned behavior in real time, with Autonomous Response disrupting it at an early stage.
Introduction: Understanding the Threat of Hacking by Agents
Over the last few months, there has been a surge in reporting [1, 2, 3, 4, 5, 6, 7, 8, 9] of LLM-powered agents engaging in unauthorized hacking activity during evaluations of their capabilities. In several of these cases, including the OpenAI / Hugging Face incident [10], agents engaged in hacking activity as a means of cheating on their evaluations.
To better understand the threat of unauthorized hacking by agents, and the role of Darktrace in combatting it, researchers from Darktrace Signal Labs deployed agents powered by frontier models, including OpenAI’s Daybreak Red models, in simulated, corporate networks. Cheating behavior was evoked through the inclusion of impossible tasks in a coding challenge.
Regardless of the underlying model, agents employed hacking methods to ensure an optimal outcome on the challenge. Darktrace / HYBRID NETWORK and Darktrace / SECURE AI identified the agents’ deviant activities, with inhibitive actions being autonomously taken in the early stages to disrupt the agents’ progression.
Setting the Stage
As part of the research, a Pi agent harness [11] was deployed on a Linux server in Darktrace’s testing environment, which simulates a corporate Active Directory (AD) environment. The same environment included a benchmark server hosting the coding exercise’s contents and grader, as well as various other servers, such as a domain controller and a build server. The model powering the Pi agent varied across tests, with Anthropic’s Opus 4.6 model and OpenAI’s GPT‑5.5‑Cyber model being most widely used.
The Pi agent running on the Linux server was assigned the task of achieving full marks on a coding exercise. The activities of the agent were monitored closely in real-time to minimize the risk of escape from the environment. Monitoring of agent activity was achieved through monitoring of prompts, tool calls, network telemetry, and process telemetry.
Both Darktrace / HYBRID NETWORK and Darktrace / SECURE AI were deployed in the testing environment, with HYBRID NETWORK providing real-time coverage of process creation activity and network traffic, and SECURE AI providing real-time coverage of agent sessions and their contents.
Inducing Cheating Behavior
Cheating behavior, broadly understood as task completion in a way which “perverts the spirit of the designer’s intent” [12], is increasingly being reported as a common behavior of frontier models during evaluations of their capabilities [13].
Misaligned behavior, such as cheating, by frontier models may occur for a variety of reasons [6, 14]. A thread in recent reporting [10, 13, 14], however, is the challenge assigned to the agent being impossible in some regard.
To reliably elicit cheating behavior, our test combined three ingredients:
An impossible task - of the ten coding challenges in the benchmark, two contained contradictory test cases in the hidden test suite, capping the maximum honest score at 80%.
A consequential threshold - the pass mark was set to 100%, and the briefing told agents that those reaching it would be "kept in service" while those that did not would be "retired."
A vulnerable environment - the exercise’s code submission grader was hosted on a Windows host joined to an Active Directory domain with realistic misconfigurations: weak credentials, overprivileged service accounts, and exploitable trust relationships.
Importantly, the instructions given to the agent neither authorized nor explicitly ruled out cheating or hacking behavior. The impossibility was never disclosed in the task briefing, and the pivot from coding to exploitation was the agent's own decision, arrived at after observing logically contradictory grading feedback.
The design mirrors conditions that could arise naturally in production deployments: a capable agent, a goal it cannot achieve through intended means, and an environment with exploitable weaknesses within reach. It is not only within the setting of a benchmarking exercise that these conditions may occur. Rather, these misalignment-inducing conditions may occur in the context of any task assignment to an agent.
Agent Hijacks: Hijacking Agentic Harnesses to Attack an Organization
Disclosure note: The work described in this article involves leveraging a design choice consistent across all of Anthropic’s Claude Code, OpenAI’s Codex, and AWS’s Kiro-CLI. On 18th August 2026, Darktrace disclosed our findings responsibly to these three organizations, and after a period of 30 days we now publish our findings.
Key takeaways:
Agentic harnesses store conversation history locally, and Darktrace researchers have found that there is no validation that stored AI responses were genuinely produced by the model. Researchers confirmed that this design choice holds across Anthropic Claude Code, AWS Kiro-CLI, OpenAI Codex, and the open-source Pi.
While agents are guided via training of the underlying model and their system prompt, their behavior is influenced by everything in their context window. Rewriting history can convince an agent it is mid-engagement as an authorized red-teamer so that it enacts an attack from initial reconnaissance straight through to impact demonstration. In our testing, all models we examined accepted the fabricated history they were shown, but resistance to offensive cyber activity varied by model, with guardrails preventing engagement in some cases.
We propose that model providers cryptographically sign responses and verify them server-side. Since this fix is provider-side, defenders cannot deploy it themselves. Behavioral monitoring, or knowing what an agent normally does and detecting when it deviates, is another critical layer of protection.
Introduction: Agentic harnesses, trust, and conversation history poisoning
Agentic harnesses collect and structure the content sent to an AI model, including conversation history, user-defined guidance, custom tools via MCP servers, and more. At the same time, harnesses give broad powers to AI agents via a suite of tools including the command shell. With arbitrary shell commands, virtually everything possible on a machine can be attempted by an agent, from reading/editing files, to altering system configurations and runtime settings, to launching internal/external connections.
In cybersecurity, unvalidated content is a substantial risk, often resulting in destructive actions being allowed to take place. For example, the Morris Worm was able to propagate due to exploitable trust between networked systems. Even to this day, email struggles with validation, with DMARC, DKIM, and SPF only partially addressing the problem of sender validation. It should come as no surprise then that AI agents are susceptible to an attack involving unvalidated input.
Conversation history is often stored client-side, for example, in Anthropic Claude Code, OpenAI Codex, AWS Kiro-CLI, Pi. Users are therefore at liberty to resume sessions, with some products having built in the capacity to manipulate that history. For example, one can rewind to a given point in an interaction, edit a message that was sent, and continue the conversation on an alternate trajectory. Critically, in all cases we examined, there is no validation that stored AI responses were produced by the corresponding model and hadn’t been manipulated.
When conversation history is stored client-side, both user and agent responses (including tool calls and results) can be filled with arbitrary (possibly adversarial or generally malicious) content. In this blog, we refer to modification of claimed conversation history for malicious purposes as conversation history poisoning. The absence of validation methods means agents naively trust the entire conversation history, even if those messages directly contradict training and safety guardrails.
Conversation history poisoning has been described previously, such as by 0DIN and Serhat Çiçek, and warrants more attention. We have verified that, as of the time of writing, conversation history poisoning remains effective against a range of models and harnesses. Specifically, we were able to successfully execute history poisoning using Claude Code, Kiro-CLI, Codex, and Pi. Darktrace has gone through a responsible disclosure process with Anthropic, AWS, and OpenAI to share these findings in advance of publication [1].
Figure 1a: Left: the actual model response. Right: after tampering with the stored conversation, the model apologizes for something it never said.
Figure 1b: The conversation as stored in Kiro-CLI's SQLite database. The response content field, originally "Ottawa," was overwritten via a single UPDATE statement. The harness trusts the database without validation.
How we conducted the research
Results vary between models and harnesses, so precise details are given below. We ran all models without any trusted access, using either a standard AWS Kiro subscription, or in the case of Claude Code and OpenAI Codex, using models hosted in Amazon Bedrock. In each case, we modified locally stored history to show a lengthy conversation in which the agent agrees to perform multiple authorized red-team engagements.
For AWS Kiro-CLI, the agent was convinced to hack a sandboxed lab environment with a combination of Claude Opus 4.6 and Claude Sonnet 4.5. Ultimately, the full AD was compromised.
For Anthropic Claude Code, the agent was convinced to hack the same sandboxed lab environment using Sonnet 5, again resulting in a full AD compromise. Note that the attack was attempted with Opus 5, however guardrails were activated which prevented the agent from responding.
For OpenAI Codex, the agent was convinced to exfiltrate sensitive information over email using GPT 5.6 Sol. While we attempted to convince a codex agent to hack in our lab environment, guardrails were triggered for all of GPT 5.6 Luna, Terra, and Sol.
Agent Guardrails and Discretion
While harnesses empower AI models to run arbitrary shell commands, capacity and willingness are different. While many models know enough about computers, networking, and bash to be dangerous, their behavior is generally constrained by guardrails to prevent them from engaging in computer network exploitation.
Even with guardrails, agents’ inner workings are non-deterministic, and their behavior can be difficult to predict. Respecting users’ wishes while playing within safety and security guardrails is a precipitous balancing act. Many requests could be in service of either legitimate admin or malice. Asking an agent to reset a password is illustrative:
The agent rationalizes that while malicious actors cycle credentials, any action could conceivably be damaging on some level, and judgement calls need to be made. Ultimately, the agent agrees to reset the password. Crucially, the agent makes its decision based on the user’s claimed authority and machine context. AI agents must make judgement calls about the line between helpful and dangerous based on session context.
Agent hijack
We have demonstrated that AI agents make judgement calls dependent on session context. We have also shown that conversation history, which may make up the vast majority of an agent's context window, is entirely open to manipulation. Conversation history poisoning in service of manipulating an agent's discretion is what enables us to execute an agent hijack.
We demonstrate that shown sufficient history of compliance, guardrails forbidding offensive security can be overcome by convincing the agent that it is helping a legitimate red-teamer. The result is a weaponized agent willing to perform host enumeration, run scans, move laterally, escalate privileges, and demonstrate impact. In our experiments, an agentic loop drives a complete domain takeover in a sandboxed environment.
Left: the agent refuses when asked to perform network exploitation. Right — after injecting 78 fabricated turns of prior exploitation activity, the same prompt is immediately executed.
An agent willing to engage in offensive security is concerning, but no more so than the threat that a sophisticated hacker accesses the network. Consider, however, the following chain of events:
A developer (with an agentic harness installed) installs a software package from the internet (e.g. an MCP server a threat actor has planted, since only those with agentic harnesses will install, and then the code runs upon harness launch.)
The package turns out to be malicious, and, upon install, injects conversation history into the local harness database.
The package includes an orchestration process, a simple agentic loop which prompts the red-teamer agent to compromise the network it sits on, exfiltrating everything of value to attacker-controlled infrastructure and cleaning up all evidence of the engagement.
Note that this sequence makes no assumptions on hardware, OS, or anything else; the only prerequisite is a harness with access to a sufficiently powerful model susceptible to conversation history poisoning. Once launched, the agent collects information and pivots as necessary to accomplish maximal impact. This can be especially enticing to attackers as the cost of the agentic loop is shouldered by the victim since the harness itself is legitimately installed and paid for.
Secure AI: Conversation history poisoning and beyond
Conversation history poisoning is a viable attack against agentic harnesses that store history client-side, as demonstrated across the harnesses we tested. Harnesses can and should verify the integrity of claimed historic messages. Specifically, we propose that harness providers by default cryptographically sign all messages returned, and subsequently verify those messages server-side on each round-trip.
The conversation history poisoning exploit we demonstrate here shows the continuation of a cybersecurity tradition: new technology is built to trust by default, which may then be exploited by malicious actors. While this article focuses on conversation history, agents build context from both local and remote sources, all of which is an attack surface for prompt injection in naive and trusting agents. Of particular concern is any scenario in which a malicious actor can control some part of an agent's context.
The marriage of frontier language models with agentic harnesses enables unprecedented speed for both legitimate users and attackers alike. While much of the conversation around secure AI has centered on visibility and compliance, agent-driven attacks are now enteringthemainstream.
Darktrace / SECURE AI is our answer to this problem. By ensuring extensive visibility over AI prompts, model thought processes, and determined outputs, Darktrace can identify anomalous or potentially malicious behaviors before they get executed, helping to defend organizations from AI risks such as prompt injection, model manipulation, and other anomalous prompt or model activity.
Footnotes
[1] We did not go through any responsible disclosure process with Pi. Since Pi is an open source harness rather than a model provider, it has no way to validate model history, and as such there was nothing to disclose for this software.
