Pia is a 50-year-old female. She has a history of substance misuse, who has been drug free for 2 years. She is currently living in a local shelter as her partner died suddenly from a massive stroke, without an updated will. All of his assets went to his wife, whom he had been estranged from for 15 years, forcing her return to her hometown. Pia presents to the emergency department of the local community hospital with severe abdominal pain. She has a history of GI issues including Irritated Bowel Syndrome (IBS). She has been managing her IBS successfully with diet and the support of her Nurse Practitioner. Since moving home, she has yet to find a primary health care provider. On admission to the emergency department her old records are accessed. The most recent visit was 5 years previous. After reviewing the old records, the first notation made at the top of the new chart is “known drug user.” She is seen by the ER nurse and physician who both ask about drug use. She explains her history to them, including her success with sobriety. She denies any recent drug misuse. She waits in the ER for 16 hours, very uncomfortable. No tests are done. No pain medications are offered. No referral is sent for a surgical consult. She is discharged at 4:00 am still with significant pain. The final entry on the ER record is “discharged home, pain of unknown origin.”  Pia was admitted 3 days later for a ruptured appendix, requiring surgical intervention.