Legislation would require participation in psychiatric bed registry

A Baltimore lawmaker plans to introduce legislation that would require all Maryland hospitals to participate in an online psychiatric bed registry meant to expedite care for the mentally ill.

Del. Samuel I. "Sandy" Rosenberg said the registry can help hospitals more speedily transfer mentally ill patients who arrive at emergency rooms.


"I'm doing this to make better care available to people," Rosenberg said, "not to harm the hospitals."

The Baltimore Sun reported Tuesday that some hospitals have been reluctant to take part in a new registry launched by state health officials. The registry, which currently is voluntary, allows hospitals with psychiatric units to routinely post notice of available beds. This lets emergency rooms more easily determine where patients can be transferred.

Launched in November, the registry is being used by about a dozen hospitals with psychiatric units, or a third of the total number statewide.

Participating hospitals include Johns Hopkins, Sinai, Sheppard Pratt, St. Joseph Medical Center and Baltimore Washington Medical Center.

Some hospitals have steered clear of the registry, concerned that its upkeep would present an additional burden on staff and that it could be used by federal regulators looking for care violations. State officials have said that the registry would be most valuable if it is used by all hospitals.

Rosenberg, a Northwest Baltimore Democrat, has been a champion of reforms within Maryland's mental health care system. He said his legislation would require every hospital in the state to join the registry by Jan. 1, 2014, and to regularly update the availability of beds in their psychiatric units.

Rosenberg said he expects the legislation will go before the Health and Government Operations Committee in March.

"It'll get a shorter hearing than if I had learned about this sooner," he said. "But it should still get adequate and full consideration by the legislature."

The registry was created to help address the widespread problem of patients arriving at emergency rooms and occupying beds there for long periods of time while nurses and other staff members try to find an available bed in a designated psychiatric unit at other hospitals in the state.

The time-consuming task is most common in hospitals without their own psychiatric units and in hospitals with psychiatric units that are already at capacity when a new patient arrives. Officials have said it saps resources meant for triage and trauma care and often results in patients in the midst of psychotic episodes remaining in hectic emergency rooms longer than is appropriate.

Officials hope the registry will improve care for psychiatric patients, ease emergency room overcrowding, help psychiatric units fill their beds and allow state health officials to study whether the current number of psychiatric beds in the state meets patient demand.

Rosenberg said the potential for the state to learn whether current capacity meets demand is largely dependent on universal participation, and a key reason he is drafting the legislation.

Most medical providers agree that psychiatric patients don't belong in emergency rooms. But some have expressed concerns that the registry would be a constant burden on staff, and that it could be used by federal regulators to identify violations of federal law, which requires hospitals to find beds for patients who arrive at their doors while experiencing severe psychosis.

A spokeswoman for the state's Department of Health and Mental Hygiene, which helped create and is helping to administer the registry, said the agency could not comment on Rosenberg's proposed legislation until officials review it.


According to Dr. Steve Daviss, head of the psychiatry department at Baltimore Washington Medical Center, state health officials broached the subject of mandating registry participation last year while discussing its development with hospital administrators, only to receive adamant disapproval from some.

"That kind of freaked everybody out," said Daviss, whose hospital is participating.

Del. Shawn Z. Tarrant, a member of the Health and Government Operations Committee who has been active on mental health issues, said he likes the concept of Rosenberg's bill.

"It's a great way to reduce time that a person has to wait in a setting that is inappropriate for them," he said. "A person having mental health challenges needs to be treated immediately."

Tarrant, also a Baltimore Democrat, said he hadn't heard concerns about such a registry being used to detect violations of federal law, but he said administrators' worries about oversight should not be a barrier to improvements in the system.

"If it improves health care, we all have to adjust to the growing pains," he said.

Rosenberg said he is aware that there are some concerns, including that the registry would be used to identify perceived violations of the Emergency Medical Treatment and Active Labor Act.

But he believes that the legislative process will provide opportunities for critics of the registry to voice their concerns, and said that provisions could be added to address those concerns.

"It just struck me that the bill is an opportunity to have a fuller discussion," Rosenberg said. "Just by getting the various parties to the witness table to testify on the bill ... would hopefully have a positive effect."

Participating hospitals

Hospitals with inpatient psychiatric facilities that are taking part in the registry:

St. Joseph Medical Center

Howard County General

Western Maryland Health System

Prince George's Hospital Center

Brook Lane

Sheppard Pratt at Ellicott City

Sheppard Pratt Hospital

Northwest Hospital Center

Dorchester General

Johns Hopkins Hospital

Sinai Hospital

Baltimore Washington Medical Center

Emergency departments taking part in the registry:

St. Agnes

Holy Cross

Baltimore Washington Medical Center

Frederick Memorial

Northwest Hospital Center

Prince George's Hospital Center

Sinai Hospital

St. Joseph Medical Center

Upper Chesapeake Medical Center

Source: Maryland Department of Health and Mental Hygiene