This patient obviously needed dialysis or he could die. Every Monday, Wednesday, and Friday Mr. X (we will refer to him as this) would show up in the ER for dialysis. As weeks went on, he would check in and get pushed back further and further down in the patient list, especially on the high volume days. Nurses and physicians naturally became frustrated with his situation knowing that he was not unstable or in need of emergent dialysis. Even though missing one dialysis session may not be fatal, it can for some individuals. This presents a legal and ethical/moral dilemma. What does the ER do when an undocumented immigrant who needs dialysis presents with hyperkalemia, but no EKG changes? Is this life threatening and covered by EMTALA? If not, how is his visit reimbursed? Should an ER have policies that address these issues? The patient is the one who is benefiting from the situation because he eventually gets dialysis. However, it also could be harming him because frequent hospital visits are potentially exposing him to other illness and possible further admissions. This negatively impacts other patients in the ER as well. Patient occupancy and physician