National Health Statistics Reports

Number 96  July 28, 2016

National Survey of Prison Health Care:

Selected Findings 

Karishma A. Chari, M.P.H., Alan E. Simon, M.D., Carol J. DeFrances, Ph.D., National Center for Health Statistics; and 

Laura Maruschak, M.A., Bureau of Justice Statistics


Abstract

Introduction

Objectives—This report presents selected findings on the provision of health care
services in U.S. state prisons. Findings on admissions testing for infectious disease,
cardiovascular risk factors, and mental health conditions, as well as the location of the
provision of care and utilization of telemedicine are all included.
Methods—Data are from the National Survey of Prison Health Care (NSPHC).
The survey aimed to conduct semi-structured telephone interviews with respondents
from all 50 state Departments of Corrections and the Federal Bureau of Prisons.
Interviews were conducted in 2012 for calendar year 2011. The level of participation
varied by state and questionnaire item.
Results—Overall, 45 states participated in NSPHC. In 2011, the percentages
of prison admissions occurring in states that tested at least some prisoners for the
following conditions during the admissions process were: 76.9% for hepatitis A,
82.0% for hepatitis B, 87.3% for hepatitis C, 100.0% for tuberculosis, 100.0% for
mental health conditions and suicide risk, 40.3% for traumatic brain injury, 82.5% for
cardiovascular conditions and risk factors using electrocardiogram, 70.0% for elevated
lipids, and 99.8% for high blood pressure.
Of the 45 states that participated in the survey, most states delivered several
services on-site, including inpatient and outpatient mental health care (27 and 44
states, respectively), care for chronic diseases (31 states), long-term or nursing home
care (35 states), and hospice care (35 states). For inpatient and outpatient medical,
dental, and emergency care, most states delivered services using a combination of
on-site and off-site care locations. Most states delivered selected diagnostic procedures
and radiologic tests off-site. Telemedicine was most commonly used for psychiatry
(28 states).

At the end of 2013, there were more
than 1.5 million prisoners in the United
States (1). The number of prisoners aged
55 and over has increased in the last
three decades. In 1981, there were 8,853
prisoners aged 55 and over; this number
increased to 144,500 in 2013 (1,2). The
trend is expected to continue as the
number of prisoners in this age group is
expected to reach an estimated 400,000
by 2030 (2,3). Prison inmates have higher
rates of mental illness, chronic medical
conditions, and infectious diseases
compared with the general population
(4–6).
National- and state-level data
concerning the provision and delivery of
health care services in U.S. prisons are
lacking. In particular, data regarding the
provision of medical and mental health
services by type of services delivered
and the mechanisms used to deliver the
services to prisoners are generally not
available. To help remedy this research
gap, the National Center for Health
Statistics (NCHS) and the Bureau of
Justice Statistics (BJS) partnered to
develop and conduct the National Survey
of Prison Health Care (NSPHC). With
BJS’ expertise in correctional systems
and populations and NCHS’ expertise

Keywords: prison admissions testing • health care delivery • National Survey of
Prison Health Care (NSPHC)

u.S. depaRtmeNt of HealtH aNd HumaN SeRviceS

centers for disease control and prevention

National center for Health Statistics


Page 2

in health and health care, the agencies
brought together two perspectives
essential to the success of the project.
The BJS and NCHS project managers
provided input, guidance, and oversight
on all aspects of the data collection effort.
NCHS acted as the data collection agent,
conducted all semi-structured interviews,
processed the data, and created the data
files for analysis.
This report focuses on NSPHC’s
goal to gather data on the provision
and delivery of health care in U.S.
prison systems. Specifically, the
report highlights findings related to
admissions testing for selected infectious
diseases, mental health conditions, and
cardiovascular risk factors conducted
upon entry into the system; the location
of health care service delivery (including
general medical and mental health care,
as well as specialty services); and the
use of telemedicine for certain health
services.

Methods
To produce national-level findings,
NCHS staff sought interviews with one or
more respondents in each of the 50 state
Departments of Corrections (DOC) and
the Federal Bureau of Prisons (BOP). The
reference period for the semi-structured
telephone interview (Technical Notes)
is January 1, 2011, through December
31, 2011. NSPHC data collection began
in October 2012 and continued through
March 2013.
NSPHC respondents typically had
job titles related to medical or mental
health care fields. These often included
medical directors or deputy directors,
directors or deputy directors of nursing or
mental health, chief medical officers, and
health services administrators. In some
cases, respondents were from research
offices with positions such as health
records administrator.
In addition to survey questions, the
telephone interview guide also included
qualitative subquestions to facilitate
discussion and capture additional
information related to certain responses.
Each NSPHC telephone interview
involved one or more employees of a
state’s Department of Corrections as well
as two NCHS staff members. One NCHS
staff member led the interview and both

National Health Statistics Reports  Number 96  July 28, 2016
used a copy of the NSPHC interview
guide to record answers and take notes.
During an interview, if a respondent was
unsure of an answer, the interviewer
gave him or her the opportunity to refer
to another, more appropriate respondent.
In addition, if a respondent did not know
the answer to a question at the time of the
interview, but believed that the answer
could be obtained, he or she was given
the opportunity to follow up by email.
To ease the burden on study
respondents who also participated in
an earlier pilot study, NCHS provided
them with an NSPHC interview guide
that was prefilled with the information
already obtained, and newly requested
information was highlighted. The
reference dates for the pilot study (July
1, 2010, through June 30, 2011) differed
from those for the national study (January
1, 2011, through December 31, 2011).
To help respondents prepare for
the interview, NCHS staff developed a
“topics document” that described the
content areas that would be discussed
during the interview and sent it to many
of the respondents before the scheduled
interview. The initial plan was to
provide this document to respondents
only upon request. However, during
the study, NCHS staff decided to offer
the document ahead of each interview
to decrease the burden on respondents
and increase item validity. The topics
document was sent to respondents before
the interview in 19 states.
NCHS staff collected data from 45
states. In addition to the data collected
via telephone interviews from 43 states,
2 states (Texas and Wyoming) supplied
written submissions. For the majority of
the states, only 1 respondent participated
in the interview; however, for 15 states,
2 or more respondents took part.
Respondents from 12 states
failed to provide some or any of the
follow-up information by email when
information was unavailable at the time
of the interview. Five states (Alaska,
Massachusetts, Mississippi, Tennessee,
and West Virginia) and the BOP did not
participate in NSPHC. Reasons for not
participating included: NCHS was unable
to reach the appropriate respondent,
NCHS was unable to schedule a
telephone interview within the data
collection time period, or respondents

stated that they were too busy to
participate in a telephone interview.
To efficiently organize interview
data, NCHS staff used Q-Notes, a
computer software system developed by
NCHS’ Questionnaire Design Research
Laboratory for cognitive interviews. The
NSPHC data were analyzed using SAS
9.3 and Excel.
For questions related to the
admissions process, respondents were
asked whether they test prisoners for
certain infectious diseases (hepatitis
A, B, and C, and tuberculosis) and
cardiovascular risk factors [e.g., testing
for elevated lipids, electrocardiogram
(ECG), and high blood pressure] during
the admissions process. For mental health
conditions, including general mental
health, suicide risk, and traumatic brain
injury (TBI), respondents were asked
if they screened prisoners during the
admissions process. Answer categories
included: “yes,” “no,” and “don’t know.”
Respondents were also given
an opportunity to provide qualifying
information on the criteria used to
determine if a prisoner would be
tested (e.g., all prisoners, upon clinical
indication, or upon request). In providing
information about these criteria, many
states used the terms “opt-in” and
“opt-out” to describe their testing
practices. Although definitions were
not provided to the states during the
interview process, opt-in testing generally
means that the tests are offered, but the
prisoner must actively give permission
before the test or procedure is performed.
In contrast, opt-out testing generally
means that the test is performed after
informing the prisoner that the test is
normally performed, but the prisoner can
refuse the test.
The question related to blood
pressure testing asked whether blood
pressure was taken during the admissions
process to the prison system, not whether
prisoners were tested for hypertension,
which can require multiple blood
pressure measurements to diagnose.
For mental health and TBI screening,
respondents were asked to provide
additional information on the minimum
qualifications of the staff member
conducting the screening (e.g., social
worker, nurse, or physician). No precise
definitions were provided for TBI;

National Health Statistics Reports  Number 96  July 28, 2016	
methodology was used. Similarly,
denominators of prison admissions
were not calculated using a sampling
methodology and are considered to be
without sampling error.

Results
Admissions testing and
screening
Infectious disease testing
●	 Respondents in all 45 participating
states were able to provide
information regarding infectious
disease testing during the admissions
process for the reference period of
January 1, 2011, through December
31, 2011.
●	 Hepatitis A: Two-thirds or 30 of
the 45 participating states tested at
least some incoming prisoners for
hepatitis A. About three-quarters
(76.9%) of the prison admissions
in participating states occurred in
these 30 states. Of the 30 states
that tested, only 1 state universally
tested all incoming prisoners for
hepatitis A, while 24 tested upon clinical
indication. Three states offered the
tests to incoming prisoners on an
opt-out basis. Two states indicated
that hepatitis A testing was done

but did not provide any qualifying
information. Of the 15 states that
did not conduct routine hepatitis A
testing, 3 states reported that they
offered vaccinations to incoming
prisoners (Table 1, Figure 1).
●	 Hepatitis B: Nearly three-quarters
of the 45 participating states (32
states) tested at least some incoming
prisoners for hepatitis B. Eighty-two
percent of the prison admissions in
participating states occurred in these
32 states. Of the 32 states testing, 21
conducted testing for hepatitis B upon
clinical indication, and 5 offered tests
to incoming prisoners on an opt-out
basis.
●	 Hepatitis C: Thirty-six of the
45 participating states tested at
least some incoming prisoners for
hepatitis C. Nearly 9 out of 10
(87.3%) of the prison admissions in
participating states occurred in these
36 states. Of the 36 states testing,
3 universally tested all incoming
prisoners, and 23 tested incoming
prisoners upon clinical indication.
Five states offered hepatitis C tests
to incoming prisoners on an opt-out
basis, while two other states provided
testing only for prisoners who opted
in.
●	 Tuberculosis (TB): All 45
participating states reported that they
conducted TB tests on at least some

100
23.1

12.7

18.0

Not tested

80

Percent

therefore, states could vary in the type
of screening tools they used to qualify a
“yes” for this question.
For questions related to the location
of general health care services (e.g.,
inpatient mental health or hospice care),
states were asked if a given service was
provided to prisoners on-site (within the
DOC facility), off-site, or both on-site
and off-site. For specialty health services
(e.g., cardiology or colonoscopy),
answers included: “on-site,” “off-site,”
“both on-site and off-site,” “don’t know,”
and “not available.” Additionally, for
specialty health services, states were
asked whether telemedicine services were
available. For all questions related to the
location of health services, respondents
were given an opportunity to provide
reasons why a prisoner would be sent
off-site versus being treated on-site.
For admissions testing and screening,
statistics are expressed as the percentage
of prison admissions occurring in states
where a particular test or screening was
performed on at least some prisoners
during the admissions process. This
method represents the coverage of prison
admissions in participating states that
screen or test at least some prisoners
upon entry into the system. For these
percentages, the numerator equals the
number of prison admissions in
NSPHC-participating states indicating
that they tested or screened at least
some prisoners during the admissions
process, and the denominator equals
the total number of prison admissions
in 2011 (578,175) in the 45 states
participating in NSPHC. Admissions
data for these calculations came from
the BJS report, "Prisoners in 2011" (7).
The total prison admissions in the 45
participating states made up 86.4% of 

total admissions in state and federal
prisons in the United States in 2011. This
method of calculating coverage is less 

appropriate for measuring the availability
and location of health care services and
diagnostic testing, as these services may
or may not be accessed by any given
prisoner during the data collection year.
Therefore, all other statistics in this
report are presented as the number of
participating states by response category.
No standard errors were calculated
for statistics, as the survey aimed to
collect data for all states, and no sampling

Page 3

Tested

60
100.0
40

76.9

87.3

82.0

20

0

Hepatitis A

Hepatitis B

Hepatitis C

Tuberculosis


Type of test

NOTE: Percentages are based on the number of admissions occurring in the 45 participating states. 

SOURCE: NCHS, National Survey of Prison Health Care, 2011.


Figure 1. Percentage of prison admissions occurring in states testing for selected
infectious diseases: United States, 2011

National Health Statistics Reports  Number 96  July 28, 2016

Page 4	

prisoners during the admissions
process. In 43 participating states,
TB testing was universally required
of incoming prisoners. In two states,
prisoners could decline TB tests.
Cardiovascular risk testing
●	 Respondents from all 45
participating states were able
to provide information on
cardiovascular risk testing during the
admissions process.
●	 Elevated lipids: Respondents
from two-thirds or 30 of the 45
participating states indicated that
they tested at least some prisoners
for elevated lipids during the
admissions process. Seventy
percent of the prison admissions
in participating states occurred in
these 30 states. Among the 30 states
testing for elevated lipids, 12 states
provided testing for prisoners upon
clinical indication (e.g., history of
cardiovascular disease), 15 states
tested all prisoners, and 3 states
did not provide any additional
information (Table 1, Figure 2).
●	 High blood pressure: Respondents
from 44 of the 45 participating states
reported that their prison system
tested at least some prisoners for
high blood pressure during the
admissions process. Almost all

(99.8%) of the prison admissions in
participating states occurred in these
44 states.
●	 Electrocardiogram (ECG):
Twenty-nine of the 45 participating
states reported that their system
conducted an ECG on at least some
prisoners during the admissions
process. More than 8 out of 10
(82.5%) prison admissions in
participating states occurred in these
29 states. Of the states testing, 20
provided an ECG for prisoners with
a history of heart disease or upon
other clinical indication, 3 states
offered the test to all prisoners over a
certain age (e.g., aged 50 and over),
and 6 states provided an ECG to
prisoners who either had a clinical
indication or were over a certain age.
None of the states tested universally
during the admissions process.
Mental health screenings
●	 Respondents from all 45
participating states were able to
provide information on mental health
and suicide risk screening during the
admissions process.
●	 Mental health: Respondents from
all 45 participating states reported
that they provided mental health
screening to at least some prisoners
during the admissions process.

0.2

100

17.5

Percent

80


30.0


Not tested
Tested

60
99.8
40

82.5
70.0

20

0


Elevated lipids

High blood pressure

Electrocardiogram


Type of test
NOTE: Percentages are based on the number of admissions occurring in the 45 participating states. 

SOURCE: NCHS, National Survey of Prison Health Care, 2011.


Figure 2. Percentage of prison admissions occurring in states testing for cardiovascular
risk: United States, 2011

One state provided mental health
screening only as needed and
based on whether a prisoner had
a history of mental health issues.
Respondents from about two-thirds
of participating states (31 states)
provided additional information
on the minimum qualifications of
health care workers administering
the mental health screenings.
Among these 31 states, nurses
administered the screening in 9
states; psychologists or psychiatrists
administered the screening in 7
states; some other form of licensed
mental health care provider
(including master’s-level social
workers) administered the screening
in 14 states; and correctional officers
who had been specially trained
for this purpose administered the
screening in 1 state (Table 1, Figure 3).
●	 Suicide risk: Respondents from all
45 participating states indicated that
their systems screened at least some
prisoners for suicide risk during the
admissions process.
● Traumatic brain injury (TBI):
Twenty-three of the 45 participating
states screened at least some
prisoners for TBI during the
admissions process. A respondent
from one state did not know whether
the system provided such screening,
and respondents from two states did
not answer the question. Four out
of 10 (40.3%) prison admissions in
participating states occurred in the
23 states that screened at least some
prisoners for TBI. More than
one-half (53.3%) of prison
admissions in participating states
occurred in the 19 states that did not
screen prisoners for TBI; 5.3% of
prison admissions occurred in the
2 participating states that did not
respond to the question; and 1.1%
of prison admissions in participating
states occurred in the 1 state that
responded “don’t know.”
Among the 23 states that
provided TBI screening, respondents
from 3 states specified that nurses
or licensed mental health care
providers of some type administered
the screening. Respondents from
seven states indicated that their states
screened for TBI as part of the initial

National Health Statistics Reports  Number 96  July 28, 2016	

Page 5

1.1
5.3

100

Don't know
80

Missing

Percent

53.3

Not screened
Screened

60
100.0

100.0

40

●	
40.3

20

0

Mental health

Suicide risk
Type of screen

Traumatic brain injury

NOTE: Percentages are based on the number of admissions occurring in the 45 participating states.
SOURCE: NCHS, National Survey of Prison Health Care, 2011.

●	

Figure 3. Percentage of prison admissions occurring in states screening for selected
mental health conditions: United States, 2011

admissions process or mental health
screening.
Among the 19 states that did
not screen for TBI, respondents
from 2 states provided additional
information. A respondent from one
state mentioned that their prison
system had been trying for several
years to implement TBI screening
and that the system planned to add
extensive procedures for detecting
TBI during the admissions process,
contingent on funding. One state did
not screen for TBI during 2011 but
implemented a program for prisoners
admitted beginning in 2012.

Location of services
●	 Inpatient and outpatient mental
health care: Of the 45 participating
states, 44 delivered outpatient mental
health care exclusively on-site. In 27
states, inpatient mental health care
was delivered exclusively on-site.
Three states delivered inpatient
mental health care exclusively
off-site. Respondents from about
one-third of participating states
(14 states) reported that inpatient
mental health care was provided both
on-site and off-site. Respondents
from 3 of the 27 states that answered
“on-site only” for inpatient mental
health care clarified that a prisoner

with a serious mental health issue
might be sent to an off-site facility,
but these were extremely rare
cases. And in three states, off-site
inpatient mental health facilities
had reserved beds or secured units
specifically for prisoners. In the 14
states where inpatient mental health
care was delivered both on-site and
off-site, the severity of the issue
(e.g., violent episodes or crises) and
the resources available in the local
community surrounding the facility
consistently determined whether
off-site treatment was provided
(Table 2, Figure 4).
●	 Inpatient and outpatient medical
care: For inpatient medical
services, about four out of five of
the participating states (38 states)
delivered care both on-site and
off-site, depending on the severity of
the issue or the expertise required.
Two states delivered inpatient care
exclusively on-site, while four states
delivered all inpatient care off-site.
Nineteen states delivered outpatient
care exclusively on-site, and 25
states delivered outpatient medical
care both on-site and off-site.
Respondents from 11 states reported
that the need for specialty care
constituted the majority of inpatient
medical issues that were sent
off-site. In five states, prisoners with

●	

●	

cardiac problems (e.g., chest pain)
were sent off-site. Respondents from
seven states reported that their prison
system included at least one hospitallevel inpatient facility. The intake
facility in one state had a dedicated
hospital unit. Another state operated
three general acute care hospitals
throughout the state, each with an
emergency department.
Dental care: Approximately four
out of five of the participating states
(37 states) provided dental care
services both on-site and off-site.
Seven states delivered this type of
care exclusively on-site. None of
the states provided all dental care
off-site.
Emergency care: Respondents from
almost two-thirds of participating
states (29 states) indicated that,
although their prison systems
sent most emergencies off-site,
some level of emergency care was
available on-site. In 18 of these
states, the only types of emergency
care provided on-site involved triage,
stabilization, and basic suturing.
Fifteen states sent all emergency care
off-site. None of the states delivered
emergency care exclusively
on-site. Respondents from three
states indicated that their prison
system had at least one emergency
room or emergency department.
Chronic care: More than two-thirds
of participating states (31 states)
delivered all care for prisoners with
common chronic diseases on-site,
while approximately one-quarter
(13 states) delivered care both
on-site and off-site. States provided
these services either in the infirmary
setting or at dedicated clinics housed
in a facility within their prison
system that served patients with a
specific chronic disease or a specific
group of chronic diseases. In most
states that had dedicated chroniccare clinics, the care provided at
each clinic covered a wide range of
diseases. In a few states, each clinic
provided care for only one or a small
number of specific diseases (Table 3,
Figure 5).
Long-term or nursing home
care: Long-term or nursing home
care was delivered on-site only in

National Health Statistics Reports  Number 96  July 28, 2016

Page 6	

45

1

1

1

1

1

1

40
14
35

Number

30

Don't know
25
29

3

25

Off-site only

37

38	

Both on-site
and off-site

On-site only

44
20
15

27

10

19
15

5
0


4


7

2
Inpatient mental
health

Outpatient mental
health

Inpatient medical Outpatient medical
health
health

Dental

Emergency

Type of care
NOTE: Counts are based on responses from 45 participating states only. 

SOURCE: NCHS, National Survey of Prison Health Care, 2011.


Figure 4. Number of participating states providing mental health and general medical health care services, by location: United States, 2011

35 of the participating states. Of
these, 18 states provided additional
information: 12 states delivered this
type of care in dedicated units and
6 states in reserved beds on-site.
Security costs and the reluctance
of hospitals or nursing homes to
accept inmates for long-term stays
were commonly cited issues with
providing long-term care off-site.
One state provided long-term care
off-site through a sister agency. In
the eight states that occasionally sent
prisoners off-site, the types of care
that could not be provided on-site
included TBI rehabilitation, care for
ventilated patients, and intensive
physical therapy.
●	 Hospice care: Hospice care followed
a pattern similar to that of longterm or nursing home care, with 35
participating states providing hospice
care exclusively on-site. Of these, 12
had either a specific hospice program
or reserved beds for hospice care in
at least one facility, and 6 of the 12
states jointly provided hospice care
and long-term care in shared units or

beds. The other 23 states providing
hospice care on-site did not provide
any qualifying information with their
response. Respondents from nine
states reported that hospice care was
provided both on-site and off-site,
though most stated that off-site
care was rarely used. Two of the
nine states sent all or most female
prisoners off-site for long-term or
hospice care to ensure the safety
of female prisoners who would
otherwise be cared for in areas with
mostly male prisoners.

Location of specialty health
and diagnostic services and
telemedicine utilization
●	 Cardiology: Twenty-five of the
participating states had cardiology
services available exclusively
off-site. Seventeen states had
services available both on-site and
off-site, and two states had cardiac
services available exclusively on-site.
In states that had care available both

on-site and off-site, respondents
mentioned that prisoners were
typically sent off-site for cardiac
procedures or surgeries (Figure 6).
●	 Psychiatry: Thirty-nine participating
states had all psychiatric care
available on-site, and four states
had care available both on-site and
off-site. No states had psychiatric
care available exclusively off-site.
Respondents often indicated that
their prison system used telemedicine
in rural or geographically remote
facilities to reduce travel for
psychiatric providers and to
communicate among facilities within
their prison system.
●	 Dialysis: Twenty-four participating
states had all dialysis services
available on-site. Ten states had
dialysis available exclusively
off-site, and 10 states had dialysis
available both on-site and off-site.
Three states provided qualifying
information for sending prisoners
off-site: Two states frequently sent
female prisoners off-site for dialysis

National Health Statistics Reports  Number 96  July 28, 2016	
services and one state reported that it
always did.
●	 Oral surgery: About two-thirds
of the participating states (31
states) had oral surgery available
both on-site and off-site, and
the difficulty or complexity of a
procedure determined the location
of the surgery. Four states had all
oral surgeries available exclusively
on-site, while nine states had all oral
surgeries available exclusively
off-site. Respondents most
commonly stated that procedures
of high difficulty or complexity,
as well as those requiring general
anesthesia, were done off-site.
●	 Gynecology: Sixty percent or
27 of the participating states had
gynecological services available both
on-site and off-site. Respondents
frequently stated that prisoners were
taken off-site for gynecological
procedures. Fourteen states had all
gynecological services available
exclusively on-site, while three states
had gynecological services available
exclusively off-site.
●	 Obstetrics: More than three-quarters
of participating states (34 states)
had obstetric services available
both on-site and off-site. Nine states
had obstetrical care available only
off-site, while one state had all care
available only on-site. Among the

45
40
35

1	

13

●

●

●

●

34 states that had obstetric services
available both on-site and off-site, 29
sent prisoners off-site for deliveries
when possible.
Optometry: Thirty-four of the
participating states had all optometry
services available exclusively on-site.
Ten states had optometry care available
both on-site and off-site.
Ophthalmology: Five participating
states had ophthalmology services
available exclusively on-site, 23
states exclusively off-site, and 16
states had services available both
on-site and off-site.
Orthopedics: Thirty participating
states had orthopedic services
available both on-site and off-site.
One state had all orthopedic care
available exclusively on-site, and
13 states had services available
exclusively off-site. Among the
30 states that had orthopedic services
available both on-site and off-site,
14 states sent prisoners off-site for
orthopedic surgeries, although a few
of the respondents from these states
mentioned that their system had
some surgical procedures available
on-site.
Oncology: Twenty-six participating
states had oncological services
available exclusively off-site, and
18 states had services available both
on-site and off-site. None of the

1

1

8	

9

1

Number

●	

●	

●	

●	
Don't know

Off-site only

25

On-site only

20
31

35

35

10

●	

5
0


●	

Both on-site
and off-site

30

15

Page 7

Chronic

Long-term or nursing
home

Type of care


Hospice


NOTE: Counts are based on responses from 45 participating states only. 

SOURCE: NCHS, National Survey of Prison Health Care, 2011.


Figure 5. Number of participating states providing long-term or nursing home, hospice, and
chronic disease care, by location: United States, 2011

states surveyed had all oncological
services available exclusively
on-site. Respondents from seven
states explicitly mentioned that
chemotherapy was available on-site
in at least some cases.
Cardiac catheterizations: In the
44 participating states, cardiac
catheterizations were available
exclusively off-site (Figure 7).
Sigmoidoscopies: Thirty-three
participating states had sigmoidoscopies
available exclusively off-site, and three
states had the procedure available
exclusively on-site. Six states had
sigmoidoscopies available both
on-site and off-site, depending on
the resources available to a particular
facility. Respondents from two states
said that sigmoidoscopies were not
available because, according to the
respondents, it was an “outdated”
procedure.
Colonoscopies: Thirty-seven
participating states had colonoscopies
available exclusively off-site, and six
states had the procedure available
both on-site and off-site. One
state had colonoscopies available
exclusively on-site.
Colposcopies: About one-half of the
participating states (23 states) had
colposcopies available exclusively
off-site. Nine states had colposcopies
available exclusively on-site. Twelve
states had the procedure available
both on-site and off-site.
Computed tomography (CT):
Thirty-four participating states had
CT scans available exclusively
off-site, and three states had them
available exclusively on-site. Seven
states had CT scans available both
on-site and off-site, depending on
the resources available in a particular
facility. Of the states with on-site
availability, five states reported using
mobile units for some on-site
CT scans.
Electrocardiogram (ECG): More
than two-thirds of participating
states (33 states) had ECGs
available exclusively on-site. Of
these, respondents from two states
specifically mentioned that every
facility had (or had access to) on-site
ECG equipment, and a respondent
from one other state noted that a

National Health Statistics Reports  Number 96  July 28, 2016

Page 8	
Don't know
45

1	

1

1

1

1

16

17

10


20


1

27
31

18

30
34

39
34

3

25

23

26

24

10


9


5

0

1

On-site only

10

25


15


1

10	

30


Number

1

Off-site only

4

40

35


1


Both on-site and off-site

4

2
Cardiology Psychiatry1

14

Dialysis

13

9
5

1

Oral surgery Gynecology

Obstetrics

1

Optometry Ophthalmology Orthopedics

Oncology

Type of service
1
Total adds to 44 because one state did not respond to the question.

NOTE: Counts are based on responses from 45 participating states only. 

SOURCE: NCHS, National Survey of Prison Health Care, 2011. 


Figure 6. Number of participating states with specialty health services available, by location: United States, 2011

mobile unit came to each facility
every other week. Eleven states had
ECGs available both on-site and
off-site.
●	 Mammography: Ten participating
states had mammography available
on-site only, 18 states had it available
off-site only, and 16 states had it
available both on-site and off-site.
Seventeen of the states that had
mammography available on-site used
mobile units for these services, while
the remaining state with on-site
services had on-site equipment at one
facility. In states that used mobile
units, respondents said that prisoners
with urgent or unscheduled needs
were sent off-site for mammography,
as the mobile units typically
conducted only scheduled tests.
●	 Magnetic resonance imaging
(MRI): MRI scans were available
off-site only in 34 participating
states. Two states had MRI scans
available on-site only, and eight
states reported that scans were
available both on-site and

off-site. Of the 10 states with on-site
availability, 5 used mobile units for
on-site MRI scans.
●	 Ultrasounds: Ultrasounds were
available exclusively off-site in 25
participating states and exclusively
on-site in 6 states. Thirteen states had
ultrasounds available both on-site
and off-site.

services (Figure 8, Tables 4 and 5).
●	 All 30 states reporting any
telemedicine use used it in
combination with on-site care,
off-site care, or both (Table 5).
●	 Six participating states reported
using telemedicine in combination
with exclusive off-site care for at
least one service.

Telemedicine

Specialty health services

●	 Two-thirds or 30 of the participating
states reported using telemedicine
for at least one specialty health or
diagnostic service in their system
(Tables 4 and 5).
●	 One-third or 15 of the participating
states reported that their system did
not use telemedicine or answered
“don’t know.”
●	 No state reported using telemedicine
for a service not otherwise provided
within their system.
●	 Participating states reported using
telemedicine for 11 different
specialty health or diagnostic

●	 Approximately one-quarter of
participating states (12 states) had
cardiology-related services available
by telemedicine (Figure 8, Tables 4
and 5).
●	 Almost two-thirds of participating
states (28 states) had psychiatricrelated services available by
telemedicine.
●	 One state had dialysis-related
services available by telemedicine.
●	 Two states had gynecological-related
services available by telemedicine.

National Health Statistics Reports  Number 96  July 28, 2016	
Don't know
45

1

Both on-site and off-site
1

1

1

Page 9
Off-site only
1

On-site only
1

1

1

1
6

40

7

6

8

11

12

13

16

35

Number

30
25
44
20

33

23

37

34

18

34

25

33

15
10
5

10

9
3

1
0
Cardiac Sigmoidoscopy1 Colonoscopy
catheterization

6

3
Colposcopy

Computed
tomography

2
ElectroMammography Magnetic
cardiogram
resonance
imaging

Ultrasound

Type of service
Total adds to 43 because two states reported that sigmoidoscopy procedures were not available. 

NOTE: Counts are based on responses from 45 participating states only. 

SOURCE: NCHS, National Survey of Prison Health Care, 2011.

1

Figure 7. Number of participating states with specialty diagnostic services available, by location: United States, 2011

●	 Three participating states had
obstetric-related services available
by telemedicine.
●	 Three participating states had
ophthalmology-related services
available by telemedicine.
●	 Seven participating states had
orthopedic-related services available
by telemedicine.
●	 Seven participating states had
oncology-related services available
by telemedicine.
Specialty diagnostic services
●	 One participating state had
colonoscopy-related services
available by telemedicine (Figure 8,
Tables 4 and 5).
●	 One participating state had
colposcopy-related services available
by telemedicine.
●	 One participating state had ECGrelated services available by
telemedicine.

Conclusion
NSPHC served as a first step in
understanding the structure, provision,
and delivery of prison health care in the
United States. The survey successfully
obtained responses via telephone
interviews from officials in 43 states and
written questionnaires from respondents
in 2 states detailing the structure and
capacity of health care delivery in state
prison systems. Appropriate respondents
were easily identified and were very
knowledgeable about their states’
correctional health care systems.
Admissions testing and screening
practices in participating states varied by
condition. Most, but not all, states tested
at least some prisoners for hepatitis A,
B, and C; TBI; and cardiovascular risk
during the admissions process. These
testing practices are consistent with
research indicating that prisoners have
greater rates of certain infectious diseases
than the general population (4–6). All
participating states conducted mental

health screening and screening for suicide
risk. All 45 states also tested at least some
prisoners for tuberculosis during the
admissions process.
A majority of the admissions in
participating states in 2011 occurred in
states that tested at least some prisoners
for infectious diseases and cardiovascular
risk during the admissions process.
Similarly, a majority of the admissions
in participating states in 2011 occurred
in states that conducted mental health
screening and screening for suicide risk
on at least some prisoners. Even though
approximately one-half of participating
states screened for TBI during the
admissions process, the majority of
admissions occurred in states that did not
screen for TBI. Research indicates that
the incarcerated population reports TBI at
higher rates than the general population
(8–10), and that routine screening is
needed to help identify TBI history and
TBI-related issues (11,12).
The location of procedures and
diagnostic services also varied among

National Health Statistics Reports  Number 96  July 28, 2016

Page 10
Don't know
45

1

1

No telemedicine

1

1

1

1

43

42

41

41

2

3

3

Telemedicine
1

1

37

37

1

1

1

43

43

43

1
Colonoscopy

1
Colposcopy

1
Electrocardiogram

40
15

35
30

Number

32
25
20
15

28

10
5
0

12
7
Cardiology Psychiatry1

1
Dialysis

Gynecology Obstetrics

Ophthalmology

7

Orthopedics Oncology

Type of service
Total adds to 44 because one state did not respond to the question.
NOTE: Counts are based on responses from 45 participating states only.
SOURCE: NCHS, National Survey of Prison Health Care, 2011.
1

Figure 8. Number of participating states providing specialty health or diagnostic services, by telemedicine utilization: United States, 2011

participating states. For several general
health care services such as inpatient and
outpatient mental health and medical
care, dental care, emergency care, chronic
care, long-term or nursing home care,
and hospice care, states were more often
able to deliver services either exclusively
on-site or using a combination of on-site
and off-site services. Emergency care
was more commonly available off-site
only, and no state reported providing
emergency care on-site only. Diagnostic
services such as cardiac catheterization,
MRI, CT scans, and colonoscopies were
more often delivered off-site. The major
exception to this was the availability of
ECG technology on-site in almost
three-quarters of participating states.
Among the participating states,
telemedicine was most commonly used
for psychiatric services (62.2%) and
cardiology services (26.6%).
This study is subject to several
limitations. Data were gathered at the
state level; therefore, any facility-level
variation in services was not captured.

For example, if urban facilities within
a state had different screening practices
than the state’s rural facilities, this was
not captured in the data collected through
NSPHC.
Another limitation of the survey is
the inability to identify or measure the
extent to which services were provided
in a certain location. For example, some
states responded to the questions about
the location of a service as “both on-site
and off-site” simply because extreme
cases involving surgeries would be sent
off-site, but all other care was provided
on-site. States sending their prisoners
off-site one-half of the time would
also respond “both.” In some cases,
the qualitative information collected
helped to distinguish between these two
situations, although exact counts were not
obtained or necessarily available.
Similarly, data collected through
NSPHC do not capture how often
screening tests were conducted in many
cases. For example, states responding
“yes” to whether they tested for

hepatitis C during the admissions process
might have differed in that one state
tested universally during the admissions
process while the other state tested only
upon clinical indication. Again, in some
cases, the qualitative data collected
helped to distinguish between these
different approaches on the part of the
DOCs.
Information collected by NSPHC
may be useful in designing and
implementing future data collections.
Additionally, some of the data gathered
could be of interest to researchers,
state DOCs, federal agencies, and
policymakers. The information gathered
through NSPHC serves as a first step
toward filling existing gaps in research on
the structure and provision of health care
in the U.S. prison system.

National Health Statistics Reports  Number 96  July 28, 2016	

References
1.		 Carson AE. Prisoners in 2013. Bureau of
Justice Statistics. 2014. Available from:
http://www.bjs.gov/content/pub/pdf/p13.
pdf.
2.		 American Civil Liberties Union.
At America’s expense: The mass
incarceration of the elderly. 2012.
Available from: https://www.aclu.org/files/
assets/elderlyprisonreport_20120613_1.
pdf.
3.		 Human Rights Watch. Old behind bars:
The aging prison population in the United
States. 2012. Available from: http://
www.hrw.org/sites/default/files/reports/
usprisons0112webwcover_0_0.pdf.
4.		 James DJ, Glaze LE. Bureau of Justice
Statistics special report: Mental health
problems of prison and jail inmates. 2006.
Available from: http://bjs.ojp.usdoj.gov/
content/pub/pdf/mhppji.pdf.
5.		 Maruschak LM. Bureau of Justice
Statistics bulletin: HIV in prisons, 2005.
2007. Available from: http://www.bjs.gov/
content/pub/pdf/hivp05.pdf.
6.		 Weinbaum CM, Sabin KM, Santibanez
SS. Hepatitis B, hepatitis C, and HIV
in correctional populations: A review
of epidemiology and prevention. AIDS
19(Suppl 3):S41–6. 2005.
7.		 Carson EA, Sabol WJ. Bureau of Justice
Statistics bulletin: Prisoners in 2011.
2012. Available from: http://www.bjs.gov/
content/pub/pdf/p11.pdf.
8.		 Slaughter B, Fann JR, Ehde D. Traumatic
brain injury in a county jail population:
Prevalence, neuropsychological
functioning and psychiatric disorders.
Brain Inj 17(9):731–41. 2003.
9.		 Morrell RF, Merbitz CT, Jain S, Jain S.
Traumatic brain injury in prisoners. J
Offender Rehabil 27(3–4):1–8. 1998.
10. Silver JM, Kramer R, Greenwald S,
Weissman M. The association between
head injuries and psychiatric disorders:
Findings from the New Haven NIMH
Epidemiologic Catchment Area Study.
Brain Inj 15(11):935–45. 2001.
11. Sarapata M, Herrmann D, Johnson
T, Aycock R. The role of head injury
in cognitive functioning, emotional
adjustment and criminal behaviour. Brain
Inj 12(10):821–42. 1998.
12. Fowles GP. Neuropsychologically
impaired offenders: Considerations for
assessment and treatment. Psychiatr Ann
18(12):692–7. 1988.

Page 11

State

Hepatitis B

Hepatitis C

Tuberculosis

Elevated lipids

High blood
pressure

Electrocardiogram

Mental health

Suicide risk

Traumatic brain
injury

Yes
Yes
Yes
Yes
No
No
No
Yes
Yes
No
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
Yes
No
No
No
30
15
0
0

Yes
Yes
Yes
Yes
No
No
No
Yes
Yes
No
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
Yes
Yes
No
No
32
13
0
0

Yes
No
Yes
Yes
No
No
No
Yes
Yes
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
No
36
9
0
0

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
45
0
0
0

Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
No
No
Yes
No
No
Yes
Yes
No
Yes
No
30
15
0
0

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
44
1
0
0

Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
No
No
Yes
Yes
No
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
Yes
No
No
No
29
16
0
0

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
45
0
0
0

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
45
0
0
0

Yes
Yes
No
No
Yes
No
No
No
Yes
Yes
No
Yes
No
No
Yes
Yes
Yes
Yes
No
Yes
No
Yes
Yes
No
Yes
Yes
Yes
Yes
--­
No
No
Yes
Yes
No
No
No
--­
No
No
No
Yes
Yes
Yes
Don’t know
Yes
23
19
1
2

--- Data not available (answer was not provided).

NOTES: For mental health, suicide risk, and traumatic brain injury, states were asked whether they conducted a screening, not a test. Nonparticipating respondents not displayed include: Alaska, Massachusetts, Mississippi, Tennessee, West Virginia, and the 

Federal Bureau of Prisons.

SOURCE: NCHS, National Survey of Prison Health Care, 2011.


National Health Statistics Reports  Number 96  July 28, 2016

Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Michigan
Minnesota
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Total “Yes”
Total “No”
Total “Don’t know”
Total missing

Hepatitis A

Page 12

Table 1. Testing or screening conducted on at least some prisoners during the admissions process, by state: United States, 2011

National Health Statistics Reports  Number 96  July 28, 2016

Page 13

Table 2. Location of general health care services, by state: United States, 2011
State
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Michigan
Minnesota
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Total “On-site”
Total “Off-site”
Total “Both”
Total “Don’t know”

Inpatient mental
health

Outpatient mental health

Inpatient medical

Outpatient medical

Dental

Emergency

On-site
Off-site
On-site
On-site
Both
On-site
Both
On-site
Both
Off-site
On-site
On-site
On-site
On-site
Both
On-site
Both
On-site
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
Both
Both
Both
On-site
On-site
Both
On-site
On-site
On-site
Both
Both
Off-site
Don’t know
Both
Both
On-site
On-site
On-site
On-site
27
3
14
1

On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Don’t know
On-site
On-site
On-site
On-site
On-site
On-site
44
0
0
1

Both
Off-site
On-site
Both
Both
Both
Both
Both
Both
Off-site
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Off-site
Off-site
Both
Both
Both
Both
Don’t know
Both
Both
Both
Both
Both
On-site
2
4
38
1

Both
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
Both
Both
On-site
Both
On-site
Both
Both
Both
Both
Both
On-site
Both
Both
Both
On-site
On-site
Both
Both
Both
On-site
On-site
Both
On-site
On-site
Both
Both
Both
On-site
Both
Don’t know
On-site
Both
Both
Both
Both
On-site
19
0
25
1

On-site
Both
Both
Both
On-site
Both
On-site
Both
Both
Both
Both
Both
Both
Both
On-site
Both
On-site
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
On-site
Both
Both
Both
Both
Both
Don’t know
Both
Both
Both
Both
Both
On-site
7
0
37
1

Both
Both
Off-site
Both
Both
Both
Off-site
Both
Both
Both
Both
Both
Off-site
Off-site
Both
Off-site
Both
Both
Both
Both
Off-site
Both
Both
Both
Both
Off-site
Both
Both
Both
Both
Both
Both
Both
Off-site
Off-site
Off-site
Off-site
Off-site
Don’t know
Both
Both
Off-site
Both
Off-site
Off-site
0
15
29
1

NOTE: Nonparticipating respondents not displayed include: Alaska, Massachusetts, Mississippi, Tennessee, West Virginia, and the Federal Bureau of Prisons.
SOURCE: NCHS, National Survey of Prison Health Care, 2011.

National Health Statistics Reports  Number 96  July 28, 2016

Page 14

Table 3. Location of chronic, long-term or nursing home, and hospice care services, by state: United States, 2011
State
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Michigan
Minnesota
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Total “On-site”
Total “Off-site”
Total “Both”
Total “Don’t know”

Chronic

Long-term care or nursing home

Hospice

Both
On-site
Both
On-site
On-site
Both
On-site
On-site
Both
Both
Both
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
Both
Both
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
Don’t know
On-site
On-site
Both
On-site
Both
On-site
31
0
13
1

On-site
Both
On-site
Both
Both
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
Off-site
On-site
On-site
Don’t know
On-site
Both
On-site
On-site
Both
On-site
35
1
8
1

On-site
Both
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
Both
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
On-site
On-site
On-site
On-site
On-site
Both
On-site
Don’t know
On-site
Both
On-site
On-site
Both
On-site
35
0
9
1

NOTE: Nonparticipating respondents not displayed include: Alaska, Massachusetts, Mississippi, Tennessee, West Virginia, and the Federal Bureau of Prisons.
SOURCE: NCHS, National Survey of Prison Health Care, 2011.

State

Cardiology

Psychiatry

Dialysis

Gynecology

Obstetrics

Ophthalmology

Orthopedics

Oncology

Colonoscopy

Colposcopy

Electrocardiogram

Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Michigan
Minnesota
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Total “Yes”
Total “No”
Total “Don’t know”
Total missing

No
Yes
No
Yes
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
No
No
Yes
No
No
No
No
Yes
No
No
Yes
No
Yes
No
No
Yes
No
No
No
Don’t know
Yes
No
Yes
No
No
Yes
12
32
1
0

No
Yes
Yes
Yes
Yes
No
No
No
Yes
No
No
Yes
No
Yes
Yes
Yes
Yes
Yes
No
Yes
No
No
Yes
Yes
Yes
No
No
Yes
--Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Don’t know
Yes
Yes
Yes
Yes
Yes
Yes
28
15
1
1

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
Don’t know
No
No
No
No
No
No
1
43
1
0

No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Don’t know
Yes
No
No
No
No
No
2
42
1
0

No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
Don’t know
Yes
No
No
No
No
No
3
41
1
0

No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
Don’t know
No
No
No
No
No
No
3
41
1
0

No
No
No
Yes
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
No
Yes
Yes
No
No
Yes
No
No
No
Don’t know
Yes
No
No
No
No
No
7
37
1
0

No
Yes
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
Yes
No
No
No
No
Yes
No
No
Yes
No
No
No
Don’t know
No
No
No
No
No
No
7
37
1
0

No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Don’t know
No
No
No
No
No
No
1
43
1
0

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Don’t know
Yes
No
No
No
No
No
1
43
1
0

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Don’t know
No
No
No
No
No
Yes
1
43
1
0

National Health Statistics Reports  Number 96  July 28, 2016

Table 4. Utilization of telemedicine for specialty health or diagnostic services, by state: United States, 2011

--- Data not available (answer was not provided).


SOURCE: NCHS, National Survey of Prison Health Care, 2011.


Page 15

NOTES: Oral surgery, cardiac catheterization, and sigmoidoscopy are not listed, because no state reported using telemedicine for these services. Telemedicine is utilized in combination with on-site care, off-site care, or both. Nonparticipating respondents not 

displayed include: Alaska, Massachusetts, Mississippi, Tennessee, West Virginia, and the Federal Bureau of Prisons.


State

Psychiatry

Dialysis

Gynecology

Obstetrics

Ophthalmology

Orthopedics

Oncology

Colonoscopy

Colposcopy

Electrocardiogram

Yes, both
No
Yes, both
No
Yes, both
No
No
No
No
Yes, off-site
No
No
Yes, on-site
No
No
No
Yes, on-site
No
Yes, on-site
No
Yes, off-site
No
No
Yes, off-site
Yes, off-site
No
Yes, on-site
No
No
Yes, on-site
5
4
3
18

Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, both
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
No
Yes, on-site
Yes, on-site
Yes, on-site
No
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
Yes, both
Yes, on-site
Yes, on-site
Yes, on-site
Yes, on-site
26
0
2
2

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes, both
No
No
No
No
No
No
No
No
No
0
0
1
29

No
Yes, both
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes, on-site
No
No
No
No
No
1
0
1
28

No
Yes, both
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes, both
No
No
No
Yes, off-site
No
No
No
No
No
0
1
2
27

No
No
Yes, both
No
No
No
No
No
No
Yes, off-site
No
No
No
No
No
No
No
No
No
No
Yes, off-site
No
No
No
No
No
No
No
No
No
0
2
1
27

No
No
Yes, both
No
No
No
Yes, both
No
No
No
No
No
Yes, both
No
No
No
No
No
No
Yes, both
Yes, off-site
No
No
Yes, both
Yes, off-site
No
No
No
No
No
0
2
5
23

Yes, off-site
No
Yes, both
Yes, both
No
No
No
No
No
No
No
No
Yes, both
No
No
No
Yes, both
No
No
No
Yes, off-site
No
No
Yes, both
No
No
No
No
No
No
0
2
5
23

No
No
No
Yes, off-site
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
0
1
0
29

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes, both
No
No
No
No
No
0
0
1
29

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes, both
0
0
1
29

NOTES: States not reporting any use of telemedicine (Alabama, Connecticut, Delaware, Florida, Hawaii, Idaho, Indiana, Maryland, Minnesota, New Hampshire, New York, Rhode Island, South Carolina, South Dakota, and Texas) are not listed. Oral surgery,
cardiac catheterization, and sigmoidoscopy are not listed, because no state reported using telemedicine for these services. Telemedicine is utilized in combination with on-site care, off-site care, or both. Nonparticipating respondents not displayed include: Alaska,
Massachusetts, Mississippi, Tennessee, West Virginia, and the Federal Bureau of Prisons.
SOURCE: NCHS, National Survey of Prison Health Care, 2011.

National Health Statistics Reports  Number 96  July 28, 2016

Arizona
Arkansas
California
Colorado
Georgia
Illinois
Iowa
Kansas
Kentucky
Louisiana
Maine
Michigan
Missouri
Montana
Nebraska
Nevada
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming
Total “Yes, on-site”
Total “Yes, off-site”
Total “Yes, both”
Total “No”

Cardiology

Page 16

Table 5. Utilization of telemedicine in combination with on-site, off-site, or both on-site and off-site care for specialty health or diagnostic services, by state: United States, 2011

National Health Statistics Reports  Number 96  July 28, 2016

Page 17

Technical Notes


NSPHC Interview Guide

OMB No. 0920-0935: Approval expires 06/30/2014

NATIONAL SURVEY OF PRISON HEALTH CARE QUESTIONS

1) Does your prison system have a contract agreement (e.g., with a private company, a university,
or other health care provider in the community) for the following health care services provided to
inmates?

Health care services
a) Mental health
b) Pharmaceutical
c) Dental
d) Laboratory Services
e) Radiology
f) Medical (excluding all of the
above)

□
□
□
□
□

□
□
□
□
□

None (all
DOC
provided)
□
□
□
□
□

□

□

□

All
Some
contracted Contracted

Don’t
know
□
□
□
□
□
□

National Health Statistics Reports  Number 96  July 28, 2016

Page 18

2) On December 31, 2011, how many full-time equivalent (FTE) employees did your prison system
have employed under the DOC or contracted (e.g., with a private company, a university, or other
health care provider in the community) for each of the following health care positions?
{If FTEs are not employed by DOC or contracted, please indicate with NOT
APPLICABLE}
Number of FTE employees
DOC

If
estimate,
check box
below

Contracted

If
estimate,
check box
below

_____
_____

□
□

_____
_____

□
□

_____

□

_____

□

_____
_____
_____

□
□
□

_____
_____
_____

□
□
□

_____
_____

□
□

_____
_____

□
□

_____
_____
_____

□
□
□

_____
_____
_____

□
□
□

Medical only
l) Physician assistants (PA)
m) Nurse practitioners (NP)
n) Other nurses (RN, LPN, LVN)
o) Surgeons (MD, DO)

_____
_____
_____
_____

□
□
□
□

_____
_____
_____
_____

□
□
□
□

p) All other physicians (MD, DO)
q) Other medical staff

_____
_____

□
□

_____
_____

□
□

Employee Type

Mental health
a) Psychiatrists (MD, DO)
b) Psychiatric physician assistants
c) Psychiatric nurses (PMHCNS,
NP)
d) Clinical psychologists (PhD,
PsyD, MS)
e) Clinical social workers (LCSW)
f) Other mental health staff
Pharmaceutical
g) Pharmacists (DPh, RPh)
h) Other pharmaceutical staff
Dental
i) Dentists (DDS)
j) Dental hygienists/assistants
k) Other dental staff

National Health Statistics Reports  Number 96  July 28, 2016

Page 19

3) Does your prison system provide the following health care services, either on-site or offsite/within the community?

Services
a. Inpatient mental health
(overnight)
b. Outpatient mental health
c. Inpatient medical health care
(overnight)
d. Outpatient medical health care
(i.e., infirmary or sick call)
e. Chronic care clinics
f. Dental Care
g. 24-hour physician or nurse
coverage
h. Emergency department care
i. Inpatient surgeries/operations
(overnight)
j. Outpatient surgeries/operations
k. Long-term/nursing home care
(geriatric, assisted living, etc.)
l. Hospice care

On-site

Off-site/Community

Yes

No

Don’t
Know

Yes

No

Don’t
Know

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□
□

□
□

□
□

□
□

□
□

□
□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

National Health Statistics Reports  Number 96  July 28, 2016

Page 20

4) Between January 1, 2011 and December 31, 2011, did your prison system have any of the
following health care services available on-site, off-site (i.e., in the community), by telemedicine, or
was the service not available?
Services
Specialty Services
a) Cardiology
b) Psychiatry
c) Dialysis
d) Oral surgery
e) Gynecology
f) Obstetrics
g) Optometry
h) Ophthalmology
i) Orthopedics
j) Oncology
Diagnostic Tests
k) Cardiac catheterization
l) High-sensitivity fecal
occult blood test (FOBT)
m) Hemoglobin AIC test
(HAIC)
n) Sigmoidoscopy
o) Colonoscopy
p) Colposcopy
q) CT scan
r) ECG (EKG)
s) Mammography
t) MRI
u) Ultrasound (excluding
hand-held dopplers and
bladder scanners)
v) X-rays
Therapies
w)Restorative/rehabilitati
on/physiatry
x) Physical/occupational
therapy

On-site

Off-site/In
Community

Telemedicine

Service Not
Available

Don’t
Know

□

□

□

□

□

□
□
□
□
□
□
□
□
□

□
□
□
□
□
□
□
□
□

□
□
□
□
□
□
□
□
□

□
□
□
□
□
□
□
□
□

□
□
□
□
□
□
□
□
□

□

□

□

□

□

□

□

□

□

□

□
□
□
□
□
□
□

□
□
□
□
□
□
□

□
□
□
□
□
□
□

□
□
□
□
□
□
□

□
□
□
□
□
□
□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

National Health Statistics Reports  Number 96  July 28, 2016

Page 21

5) How long is your prison system’s admissions process, in days? {Please provide a range if
necessary}
Physical Health
{Please answer the following questions according to the time frame provided in Question 5}
6) Does your prison system test inmates for the following infectious diseases during the admissions
process?

Infectious Diseases
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Gonorrhea
e. Chlamydia
f. Syphilis
g. Tuberculosis (PPD)

Yes

No

Don’t
Know

□
□
□
□
□
□
□

□
□
□
□
□
□
□

□
□
□
□
□
□
□

7) Does your prison system test inmates for the following health concerns during the admissions
process?
{Please answer the following questions according to the time frame provided in Question 5}

Health Concerns
a. Pregnancy
b. Elevated lipids
c. High blood pressure

Yes

No

Don’t
Know

□
□
□

□
□
□

□
□
□

8) Does your prison system conduct the following tests for inmates during the admissions process?
{Please answer the following questions according to the time frame provided in Question 5}

Tests
a. Routine dental exam
b. ECG (EKG)
c. Chest x-ray

Yes

No

Don’t
Know

□
□
□

□
□
□

□
□
□

National Health Statistics Reports  Number 96  July 28, 2016

Page 22

Mental Health
{Please answer the following questions according to the time frame provided in Question 5}
9) Does your prison system conduct the following mental health screenings during the admissions
process?

Tests
a. Mental health problems
(excluding suicide risk)
b. Suicide risk
c. Traumatic brain injury

Yes

No

Don’t
Know

□

□

□

□
□

□
□

□
□

Admissions
10) How many total inmates were in the custody of your state’s prison system on (END DATE
FOR ADMISSION RANGE)?
11) How many inmates were admitted to your state’s prison system between (INSERT DATE
RANGE HERE)?
12) What major challenges/issues is the DOC currently facing in regards to the delivery of health
care?

U.S. Department of
HealtH & HUman ServiceS

FIRST CLASS mAIL
 

PoSTAge & FeeS PAId
 

CdC/NCHS 

PeRmIT No. g-284
 


Centers for disease Control and Prevention
National Center for Health Statistics
3311 Toledo Road, Room 5419
Hyattsville, md 20782–2064
oFFICIAL BuSINeSS
PeNALTy FoR PRIvATe uSe, $300

For more NCHS NHSRs, visit:
http://www.cdc.gov/nchs/products/nhsr.htm.

National Health Statistics Reports   Number 96    July 28, 2016

Acknowledgments
Maria Owings, Ph.D. [formerly with the National Center for Health Statistics (NCHS)] provided technical assistance in creating the National Survey
of Prison Health Care data set. Frank McCormack (formerly with NCHS) led the semi-structured interviews with participating states and coded the
interviews into Q-Notes.

Suggested citation

Copyright information

Chari KA, Simon AE, DeFrances CJ,
Maruschak L. National Survey of Prison
Health Care: Selected findings. National
health statistics reports; no 96. Hyattsville, MD:
National Center for Health Statistics. 2016.

All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.

National Center for Health Statistics
Charles J. Rothwell, M.S., M.B.A., Director
Jennifer H. Madans, Ph.D., Associate Director
for Science
Division of Health Care Statistics
Clarice Brown, M.S., Director

Alexander Strashny, Ph.D., Associate Director 

for Science


For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
For questions or general information about NCHS: Tel: 1–800–CDC–INFO (1–800–232–4636) • TTY: 1–888–232–6348
Internet: http://www.cdc.gov/nchs • Online request form: http://www.cdc.gov/info
DHHS Publication No. 2016–1250 • CS265908