Alex is at the hospital when Dr. Richardson goes home when he becomes very sick. This leaves the hospital without an on-call neurosurgeon and Alex realizes that this will threaten the hospital's status as a trauma center, forcing them to close down the emergency room and intensive care unit.
He immediately calls Cuddy's cell phone. However, she's spending her first morning in her new relationship with House. He is trying to keep her away from the hospital and when her phone rings, he answers it, pretending to be Cuddy's nanny. He tells Alex that Cuddy's too busy to speak to him and to use his head and find a new neurosurgeon. However, he doesn't know that Richardson is the only neurosurgeon on call at that point.
House soon finds out how critical it is to have a neurosurgeon. He calls Robert Chase to tell him to act as the hospital's neurosurgeon even though he's not board certified. However, when Chase claims to Alex that he can act as a neurosurgeon, he learns Alex knows all about House's team and that although Chase was a neurosurgical resident at one time, he never became board certified. Alex then feels he has to call the DPH.
When the DPH representative arrives, Chase has a new strategy - claim Richardson is scrubbing and can't break the sterile field. The representative is wary and ask Alex why he said Richardson wasn't at the hospital. Alex claims it was a mistake. However, at that point, Richardson burst out of the scrubbing area, complains about being hot, and strips to his underwear. The representative orders Alex to start closing departments.