The medical staff are still batttling with Maddox, the new Chief of Medecine. JD tells Elliot that their days of beating the system might be over, but Dr. Cox begs to differ. He got his 35-year-old head trauma patient into a clinical trial that has an age cutoff of 30 - despite the fact that the patient keeps shouting "35!" JD and Elliot are impressed, but Dr. Cox's victory is short-lived when Maddox gets wind of the scam and has the patient tossed.
A frustrated Cox forms an alliance with the unemployed Janitor to get rid of Maddox once and for all. Kelso offers to help, chiding Cox that he misses him as Chief. Dr. Cox denies this claim in that harsh, abrupt manner we’ve all come to love, leaving Kelso to console himself with a double chocolate buster muffin.
Carla catches Elliot's new intern, Katie, sucking up and getting other staff members to do her work. Carla leaves Katie with the point that without friends she can depend on, she’s never going to make it at Sacred Heart. JD and Elliot treat a middle-aged man with multiple sclerosis, but soon discover the patient is faking his symptoms. Elliot notices it's the guy's daughter who has MS symptoms. They agree to help the father and his uninsured daughter lie in order to get the meds. Unfortunately, Maddox catches on and the jig is up.
The alliance of Cox and the Janitor amounts to nothing. Desperate, Cox turns to Jordan for help, but she reminds him that she quit the Hospital Board in order to spend more time with their son. Gee, She suggests asking Kelso for help. Swallowing his pride, Cox admits to Kelso (in front of JD and Elliot) that he really does miss the old Chief and that maybe Bob wasn't a soulless monster. Satisfied, Kelso reminds the Board’s members about how much he knows about them, including some incriminating trips to Thailand.
The blackmail threat works and Maddox gets the boot. As she leaves, she reminds the staff of Sacred Heart that they haven't won anything. She'll soon be replaced by someone just as bad as her because nothing ever changes. With Maddox gone, JD and Elliot are able to get their 'patient' the meds he needs for his daughter. Cox and Kelso actually like each other now. And Katie fesses up to Elliot about having other doctors do her work, making Carla proud.
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