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Malkin shows up after Cuddy's assistant Alex finds out Dr. Richardson, the hospital's only on-call neurosurgeon, is ill. and calls the DPH. Cuddy can't be reached because House is isolating her from the hospital so they can nurture their new relationship. He has told his team to find a new neurosurgeon, and tells Chase to fake being one. Chase's ruse fails because Alex has already checked his file.
When Malkin arrives, Chase tries to tell him that Richardson is scrubbing for surgery and can't be disturbed. Alex explains the call was a misunderstanding. However, as Malkin goes to leave, Richardson bursts out of the scrub-up area and starts stripping to his underwear. Malkin orders the emergency room and intensive care unit closed.
However, Thirteen finally realizes that Richardson is suffering from toad egg poisoning. After they give him the antidote, he's back to normal and when Malkin quizzes him, easily comes up with the right response. Malkin agrees to re-open the closed parts of the hospital.