Jack" has been in our emergency department at least 100 times in the 4 years I have worked at the Veterans Affairs Hospital. I first encountered him in the medical ICU, where he was hospitalized multiple times with chest pain and ECG changes after cocaine binges. He was often admitted to the inpatient psychiatric unit when we could not sort out his accidental overdoses from suicidal behavior or when he feigned self-harm to escape legal consequences or to have a warm, safe place to stay. Once in the psychiatry ward, Jack was sexually inappropriate and would exploit other, more vulnerable patients and was quickly discharged...