Emergency room physician James Dunford evaluates Raohl Hursh at UCSD Medical Center-Hillcrest for the 19th time in nearly 30 days and one of three visits in 24 hours. Hursh, who is homeless and suffers from alcoholism and cirrhosis of the liver, complained of an altered state of consciousness and abdominal pain. He was intoxicated and presented the night before in the same way. The emergency room can do little for such a patient except to provide food and a sober period before release. Dunford also tries to contact social services in an attempt to find better follow up care, in the case of Hursh, to the Veteran's Administration. Without follow up care, patients like Hursh often stay in the cycle of frequent use of the ER without achieving any permanent solution to their medical problems.