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After signing out against medical advice, Raohl Hursh listens to Dr. James Dunford as he pleads with him to go the the Veterans Administration hospital for follow up care, and asks that he not continue to drink if he gives him bus tokens to go to the VA. An ER physician should be able to assess and refer a patient to further care in 10 minutes. The extra time Dunford uses to make extra effort to coordinate further treatment for a frequent user like Hursh can interrupt the flow of the department and delay treatment of other patients in need of emergency care.