Mr. Ramirez is a 44-year-old male with multiple medical conditions, including cirrhosis of the liver and acute kidney failure. He has been receiving outpatient hemodialysis twice a week for the past eight months, which has managed his conditions effectively.

Recently, however, it has become increasingly difficult for Mr. Ramirez to access outpatient dialysis due to his immigration status as an undocumented resident living in the United States. As a result, his access to outpatient hemodialysis has been denied. He now often goes up to two weeks between treatments before presenting to the emergency department (ED) of his local hospital.

In the ED, Mr. Ramirez receives dialysis, is stabilized, and then discharged. The hospital does have a policy to provide dialysis to patients in need regardless of immigration or insurance status. However, the medical team has communicated to Mr. Ramirez that the emergency department is not the optimal method of receiving dialysis, as outpatient treatment would be more consistent and more cost-effective for both him and the hospital.

Mr. Ramirez has expressed that outpatient dialysis would indeed be his preference, but due to his undocumented status, accessing it is not an option.