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When the railroad work he undertook proved too strenuous, his life deteriorated, and he became an indigent in Los Angeles. Having lost the power of speech, Ramirez was picked up by authorities in 1930, placed in a local mental institution, and transferred seven months later to DeWitt State Mental Hospital in Auburn, where he spent the remaining thirty years of his life.

After twenty years of hospitalization, Ramirez commenced making remarkable drawings and collages on sheets of paper formed of scavenged scraps glued together with mashed potatoes. Having hidden his drawings from the hospital staff, whose policy it was to confiscate and burn such works in order to keep the wards clean, Ramirez in 1954, presented a bundle of them to Dr. Tarmo Pasto, a psychology professor at Sacramento State College, who was conducting research at the hospital. Recognizing the mastery of artistic craft, Pasto asked the staff's permission to keep the drawings. Pasto regularly visited Ramirez thereafter, bringing art supplies and saving the drawings, some of which he used in his classes. In 1968, while teaching at the college, Chicago artist Jim Nutt discovered Ramirez's work in the storage bins of the audiovisual department and with the assistance of Pasto organized the first exhibition of Ramirez's work.