Could technology be the answer to the crisis facing psychiatric patients in EDs?

Over a 2½-year period, Aaron Hernandez was taken to the emergency department at a California hospital eight times on a 72-hour involuntary psychiatric hold. Doctors told the teen's family that inpatient treatment had to be voluntary, and Aaron, legally an adult at 18, would refuse.

“They would pseudo-stabilize him and let him go,” said his father, Anthony Hernandez. “They always made it clear there is a waiting period to get a bed, which only intensified the dilemma.”

Anthony Hernandez spoke by cellphone as he drove from the California state psychiatric hospital that now houses his 20-year-old son. In September 2014, Aaron, in a delusional state, stabbed both his parents with a knife and used a baseball bat to beat the family dog to death. He was found not guilty of attempted murder by reason of insanity.

His family believes that the long waits for a bed prevented Aaron from getting the treatment he needed when he was in crisis. “They would make it difficult for us to get admission,” Anthony Hernandez said. “And we would be forced to take our sick, gravely disabled son back home with us for more chaos.”

Across the country, the number of psychiatric patients waiting in an emergency department for an inpatient bed has reached crisis levels. The wait typically lasts several hours or days, but can be as long as several weeks at some hospitals.

About a year ago, PatientValet, a small digital health startup, created a simple technology to track available psychiatric beds throughout a state. It allows hospitals to post and search for available beds, which are sortable based on a patient's needs. It would be a first for California.

“We started by going hospital by hospital to introduce the technology,” said Leila Entezam, the company's chief strategy officer. “We expected this to be simple and it's far from.”

Hospitals, it seemed, didn't want their competitors to see their bed availability. They also worried about staffing levels and low reimbursement from certain insurers, said Mike Bruner, PatientValet's CEO.

Facing roadblocks, the company decided to go in a new direction. PatientValet approached an organization founded by Darrell Steinberg, former president pro tem of the California State Senate.

The Steinberg Institute for Advancing Mental Health Policy is working with an undisclosed state assembly member to author a bill, said Anna Hasselblad, the group's director of public policy. The bill is modeled after Virginia's, the only state in the nation to have a mandated bed registry.

The group expects broad support, both in Sacramento and with those representing mentally ill patients, emergency medicine doctors and law enforcement. The deadline for introducing new legislation in the state was Feb. 19. Similar legislation is working its way through the New York Legislature and has been floated in Pennsylvania. In Maryland and Minnesota, hospitals have taken the lead on creating psychiatric bed registries.

Like other states, California has seen a reduction in the number of available psychiatric beds, which dropped to 6,500 in 2012 from 9,300 in 1995. Less than 30% of hospitals provide psychiatric care. Yet the number of ED patients with a behavioral-health diagnosis increased 47% between 2006 and 2011, compared with 14% for other diagnoses over the same period, according to data from the California Hospital Association.

But California is also different from other states, said Sheree Lowe, vice president of behavioral health at the hospital association. It's not a lack of transparency that creates the logjam, but a lack of bed availability as hospitals operate near capacity.

“Some states have huge state hospitals that provide that level of care,” Lowe said. “California is the exact opposite of that.” Private facilities provide most of the psychiatric care in the state, she said.

A bed registry would add costs and work for hospitals without providing more beds, Lowe said. Bed availability can change rapidly as new patients come into an ED and staff members, who need to meet state ratio requirements, clock in and out.

“To track that in real time is just not realistic,” Lowe said. “In a millisecond, it's going to change. Talk about giving false hope to patients.”

What the hospital association supports is a statewide inventory of all available crisis services. “We know that 70% of patients who present to an emergency department never make it to an inpatient bed,” Lowe said, and are better served by community-based resources.

Virginia's registry, meanwhile, has been “an abysmal failure,” she added. Although it is supposed to be a real-time resource, a report last month from the state inspector general found that the registry isn't being updated often enough to be useful, and hospital personnel still have to make phone calls to find beds. The Virginia Hospital & Healthcare Association says its members are still working to make sure patients get the services they need.

Dr. Richard Granese, a psychiatrist who practices at Southern California Psychiatric Associates and serves as PatientValet's chief medical officer, insisted there are often unfilled beds. “We should utilize what we have first before we invest millions of dollars in building new brick-and-mortar facilities,” he said.

PatientValet believes its solution is cost-effective. Boarding a psychiatric patient costs an ED as much as $2,500 a day, Granese said. Placing just one patient in an open bed would pay for its cost.

The exact number of psychiatric patients waiting for an inpatient bed is unclear and one issue the Steinberg bill would address.

The Hernandez family supports the Helping Families in Mental Health Crisis Act of 2015, sponsored by Rep. Tim Murphy (R-Pa.), which, among other goals, aims to track and reduce the number of patients boarded in EDs.

“There's no way you can keep an individual in that environment,” Anthony Hernandez said. “This is an ancient problem that we have not touched for 50 years. It's not only dangerous to the individuals themselves, but to society.”