We all know what it's like to have an overbearing boss, right? Well, new Chief of Medicine, Dr. Taylor Maddox (guest star Courteney Cox, before she moved to Cougar Town), isn't as much overbearing as she is "pure evil." Okay, maybe that's a bit harsh. But how would you describe a person who cheerfully bounces desperate people out of a hospital because they can't afford treatment? On second thought, "pure evil" kinda works. Hey, she fired the Janitor, people!
J.D. 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!" J.D. 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. Someone needs an attitude adjustment, and who better to set her straight than Carla. It doesn't go well at first and even an interjection from the Janitor (his rules for getting along at Sacred Heart are the same as his rules for getting along in Mexico) doesn't help much. Carla finally leaves Katie with the point that without friends she can depend on, she's never going to make it at Sacred Heart. Didn't Carla go through something similar with Elliot way back when?
J.D. and Elliot treat a middle-aged man with multiple sclerosis, but soon discover the patient is faking his symptoms. At first they think it's a scam for drugs, but as J.D. is threatening the man with getting "Chiklis'd," 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. What is it with this lady?
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, Perry, maybe you should have gone to her retirement party after all. She suggests asking Kelso for help.
Swallowing his pride, Cox admits to Kelso (in front of J.D. 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, J.D. and Elliot are able to get their "patient" the meds he needs for his daughter. Cox and Kelso actually like each other now. Well, maybe "like" is too strong a word. And Katie fesses up to Elliot about having other doctors do her work, making Carla proud. Sorry, Dr. Maddox, it looks like things do change.