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 

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). 

Keywords: prison admissions testing • health care delivery • National Survey of 

Prison Health Care (NSPHC) 

Introduction 

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 

u.S. depaRtmeNt of HealtH aNd HumaN SeRviceS
 

centers for disease control and prevention
 

National center for Health Statistics
 
Page 2 National Health Statistics Reports  Number 96  July 28, 2016 

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 

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	 Page 3 

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 

 

 

 

 

 

 

 

Figure 1. Percentage of prison admissions occurring in states testing for selected 

infectious diseases: United States, 2011 

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 

 

 

 

 

 

 
 

 

Page 4	 National Health Statistics Reports  Number 96  July 28, 2016 

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. 

 

 

 

 

 

 

 

 

 

 

 

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 

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 
Page 6	 National Health Statistics Reports  Number 96  July 28, 2016 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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	 Page 7 

services and one state reported that it 34 states that had obstetric services 

always did. available both on-site and off-site, 29 

●	 Oral surgery: About two-thirds sent prisoners off-site for deliveries 

of the participating states (31 when possible. 

states) had oral surgery available ● Optometry: Thirty-four of the 

both on-site and off-site, and participating states had all optometry 

the difficulty or complexity of a services available exclusively on-site. 

procedure determined the location Ten states had optometry care available 

of the surgery. Four states had all both on-site and off-site. 

oral surgeries available exclusively ● Ophthalmology: Five participating 

on-site, while nine states had all oral states had ophthalmology services 

surgeries available exclusively available exclusively on-site, 23 

off-site. Respondents most states exclusively off-site, and 16 

commonly stated that procedures states had services available both 

of high difficulty or complexity, on-site and off-site. 

as well as those requiring general ● Orthopedics: Thirty participating 

anesthesia, were done off-site. states had orthopedic services 

●	 Gynecology: Sixty percent or available both on-site and off-site. 

27 of the participating states had One state had all orthopedic care 

gynecological services available both available exclusively on-site, and 

on-site and off-site. Respondents 13 states had services available 

frequently stated that prisoners were exclusively off-site. Among the 

taken off-site for gynecological 30 states that had orthopedic services 

procedures. Fourteen states had all available both on-site and off-site, 

gynecological services available 14 states sent prisoners off-site for 

exclusively on-site, while three states orthopedic surgeries, although a few 

had gynecological services available of the respondents from these states 

exclusively off-site. mentioned that their system had 

●	 Obstetrics: More than three-quarters some surgical procedures available 

of participating states (34 states) on-site. 

had obstetric services available ● Oncology: Twenty-six participating 

both on-site and off-site. Nine states states had oncological services 

had obstetrical care available only available exclusively off-site, and 

off-site, while one state had all care 18 states had services available both 

available only on-site. Among the on-site and off-site. None of the 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 
Page 8	 National Health Statistics Reports  Number 96  July 28, 2016 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. 

Telemedicine 

●	 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 

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. 

Specialty health services 

●	 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	 Page 9 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 
Page 10 National Health Statistics Reports  Number 96  July 28, 2016 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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	 Page 11 

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

High blood 

State Hepatitis A Hepatitis B Hepatitis C Tuberculosis Elevated lipids pressure Electrocardiogram Mental health 

Alabama Yes Yes Yes Yes Yes Yes Yes Yes Arizona Yes Yes No Yes Yes Yes No Yes 

Arkansas Yes Yes Yes Yes Yes Yes Yes Yes 

California Yes Yes Yes Yes Yes Yes Yes Yes 

Colorado No No No Yes Yes Yes Yes Yes Connecticut No No No Yes No Yes No Yes 

Delaware No No No Yes No Yes Yes Yes 

Florida Yes Yes Yes Yes Yes Yes Yes Yes 

Georgia Yes Yes Yes Yes Yes Yes Yes Yes 

Hawaii No No No Yes No No No Yes 

Idaho Yes Yes Yes Yes Yes Yes No Yes 

Illinois No No No Yes No Yes Yes Yes 

Indiana No No Yes Yes Yes Yes Yes Yes 

Iowa Yes Yes Yes Yes Yes Yes Yes Yes 

Kansas Yes Yes Yes Yes Yes Yes Yes Yes Kentucky Yes Yes Yes Yes Yes Yes Yes Yes Louisiana Yes Yes Yes Yes Yes Yes Yes Yes Maine Yes Yes Yes Yes Yes Yes Yes Yes Maryland Yes Yes Yes Yes Yes Yes Yes Yes 

Michigan No Yes Yes Yes No Yes Yes Yes 

Minnesota Yes Yes Yes Yes No Yes No Yes 

Missouri Yes Yes Yes Yes Yes Yes Yes Yes Montana Yes Yes Yes Yes Yes Yes Yes Yes Nebraska Yes Yes Yes Yes Yes Yes Yes Yes 

Nevada Yes Yes Yes Yes Yes Yes No Yes 

New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes New Jersey Yes Yes Yes Yes Yes Yes No Yes 

New Mexico Yes Yes Yes Yes No Yes No Yes 

New York Yes Yes Yes Yes Yes Yes Yes Yes 

North Carolina Yes Yes Yes Yes Yes Yes Yes Yes 

North Dakota No No Yes Yes No Yes No Yes 

Ohio Yes Yes Yes Yes Yes Yes Yes Yes 

Oklahoma Yes Yes Yes Yes Yes Yes Yes Yes Oregon No No Yes Yes No Yes No Yes 

Pennsylvania No No Yes Yes Yes Yes No Yes 

Rhode Island No No Yes Yes No Yes No Yes 

South Carolina Yes Yes Yes Yes No Yes Yes Yes 

South Dakota Yes Yes Yes Yes Yes Yes Yes Yes 

Texas Yes Yes Yes Yes No Yes Yes Yes 

Utah Yes Yes Yes Yes No Yes Yes Yes 

Vermont No No No Yes Yes Yes No Yes 

Virginia Yes Yes Yes Yes Yes Yes Yes Yes 

Washington No Yes Yes Yes No Yes No Yes 

Wisconsin No No No Yes Yes Yes No Yes 

Wyoming No No No Yes No Yes No Yes 

Total “Yes” 30 32 36 45 30 44 29 45 

Total “No” 15 13 9 0 15 1 16 0 

Total “Don’t know” 0 0 0 0 0 0 0 0 

Total missing 0 0 0 0 0 0 0 0 

--- 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, MississiFederal Bureau of Prisons.
SOURCE: NCHS, National Survey of Prison Health Care, 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 

Inpatient mental 

State health Outpatient mental health Inpatient medical Outpatient medical Dental Emergency 

Alabama On-site On-site Both Both On-site Both 

Arizona Off-site On-site Off-site On-site Both Both 

Arkansas On-site On-site On-site On-site Both Off-site 

California On-site On-site Both On-site Both Both 

Colorado Both On-site Both On-site On-site Both 

Connecticut On-site On-site Both Both Both Both 

Delaware Both On-site Both On-site On-site Off-site 

Florida On-site On-site Both On-site Both Both 

Georgia Both On-site Both On-site Both Both 

Hawaii Off-site On-site Off-site Both Both Both 

Idaho On-site On-site Both Both Both Both 

Illinois On-site On-site Both On-site Both Both 

Indiana On-site On-site Both Both Both Off-site 

Iowa On-site On-site Both On-site Both Off-site 

Kansas Both On-site Both Both On-site Both 

Kentucky On-site On-site Both Both Both Off-site 

Louisiana Both On-site Both Both On-site Both 

Maine On-site On-site Both Both Both Both 

Maryland On-site On-site Both Both Both Both 

Michigan On-site On-site Both On-site Both Both 

Minnesota Both On-site Both Both Both Off-site 

Missouri On-site On-site Both Both Both Both 

Montana On-site On-site Both Both Both Both 

Nebraska On-site On-site Both On-site Both Both 

Nevada On-site On-site Both On-site Both Both 

New Hampshire On-site On-site Both Both Both Off-site 

New Jersey Both On-site Both Both Both Both 

New Mexico Both On-site Both Both Both Both 

New York Both On-site Both On-site Both Both 

North Carolina On-site On-site Both On-site Both Both 

North Dakota On-site On-site Both Both Both Both 

Ohio Both On-site Both On-site Both Both 

Oklahoma On-site On-site Off-site On-site On-site Both 

Oregon On-site On-site Off-site Both Both Off-site 

Pennsylvania On-site On-site Both Both Both Off-site 

Rhode Island Both On-site Both Both Both Off-site 

South Carolina Both On-site Both On-site Both Off-site 

South Dakota Off-site On-site Both Both Both Off-site 

Texas Don’t know Don’t know Don’t know Don’t know Don’t know Don’t know 

Utah Both On-site Both On-site Both Both 

Vermont Both On-site Both Both Both Both 

Virginia On-site On-site Both Both Both Off-site 

Washington On-site On-site Both Both Both Both 

Wisconsin On-site On-site Both Both Both Off-site 

Wyoming On-site On-site On-site On-site On-site Off-site 

Total “On-site” 27 44 2 19 7 0 

Total “Off-site” 3 0 4 0 0 15 

Total “Both” 14 0 38 25 37 29 

Total “Don’t know” 1 1 1 1 1 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. 
Page 14 National Health Statistics Reports  Number 96  July 28, 2016 

Table 3. Location of chronic, long-term or nursing home, and hospice care services, by state: United States, 2011 

State Chronic Long-term care or nursing home Hospice 

Alabama Both On-site On-site 

Arizona On-site Both Both 

Arkansas Both On-site On-site 

California On-site Both On-site 

Colorado On-site Both On-site 

Connecticut Both On-site On-site 

Delaware On-site On-site On-site 

Florida On-site On-site On-site 

Georgia Both On-site Both 

Hawaii Both On-site On-site 

Idaho Both On-site On-site 

Illinois On-site Both Both 

Indiana On-site On-site On-site 

Iowa Both On-site On-site 

Kansas On-site On-site On-site 

Kentucky On-site On-site On-site 

Louisiana On-site On-site Both 

Maine On-site On-site On-site 

Maryland On-site On-site On-site 

Michigan On-site On-site On-site 

Minnesota On-site Both Both 

Missouri On-site On-site On-site 

Montana Both On-site On-site 

Nebraska On-site On-site On-site 

Nevada On-site On-site On-site 

New Hampshire On-site On-site On-site 

New Jersey Both On-site On-site 

New Mexico Both On-site On-site 

New York On-site On-site On-site 

North Carolina On-site Both Both 

North Dakota On-site On-site On-site 

Ohio On-site On-site On-site 

Oklahoma On-site On-site On-site 

Oregon On-site On-site On-site 

Pennsylvania On-site On-site On-site 

Rhode Island Both Off-site On-site 

South Carolina On-site On-site Both 

South Dakota On-site On-site On-site 

Texas Don’t know Don’t know Don’t know 

Utah On-site On-site On-site 

Vermont On-site Both Both 

Virginia Both On-site On-site 

Washington On-site On-site On-site 

Wisconsin Both Both Both 

Wyoming On-site On-site On-site 

Total “On-site” 31 35 35 

Total “Off-site” 0 1 0 

Total “Both” 13 8 9 

Total “Don’t know” 1 1 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. 
Table 4. Utilization of telemedicine for specialty health or diagnostic services, by state: United States, 2011

State Cardiology Psychiatry Dialysis Gynecology Obstetrics Ophthalmology Orthopedics Oncology Colonoscopy 

Alabama No No No No No No No No No 

Arizona Yes Yes No No No No No Yes No 

Arkansas No Yes No Yes Yes No No No No California Yes Yes No No No Yes Yes Yes No 

Colorado No Yes No No No No No Yes Yes 

Connecticut No No No No No No No No No 

Delaware No No No No No No No No No 

Florida No No No No No No No No No 

Georgia Yes Yes No No No No No No No 

Hawaii No No No No No No No No No 

Idaho No No No No No No No No No 

Illinois No Yes No No No No No No No 

Indiana No No No No No No No No No 

Iowa No Yes No No No No Yes No No 

Kansas No Yes No No No No No No No 

Kentucky No Yes No No No No No No No 

Louisiana Yes Yes No No No Yes No No No 

Maine No Yes No No No No No No No 

Maryland No No No No No No No No No 

Michigan No Yes No No No No No No No 

Minnesota No No No No No No No No No 

Missouri Yes No No No No No Yes Yes No 

Montana No Yes No No No No No No No 

Nebraska No Yes No No No No No No No 

Nevada No Yes No No No No No No No 

New Hampshire No No No No No No No No No 

New Jersey Yes No No No No No No Yes No 

New Mexico No Yes No No No No No No No 

New York No --- No No No No No No No 

North Carolina Yes Yes No No No No No No No 

North Dakota No Yes No No No No Yes No No 

Ohio Yes Yes Yes No Yes Yes Yes Yes No 

Oklahoma No Yes No No No No No No No 

Oregon No Yes No No No No No No No 

Pennsylvania Yes Yes No No No No Yes Yes No 

Rhode Island No No No No No No No No No 

South Carolina No No No No No No No No No 

South Dakota No No No No No No No No No 

Texas Don’t know Don’t know Don’t know Don’t know Don’t know Don’t know Don’t know Don’t know Don’t know 

Utah Yes Yes No Yes Yes No Yes No No 

Vermont No Yes No No No No No No No 

Virginia Yes Yes No No No No No No No 

Washington No Yes No No No No No No No 

Wisconsin No Yes No No No No No No No 

Wyoming Yes Yes No No No No No No No 

Total “Yes” 12 28 1 2 3 3 7 7 1 

Total “No” 32 15 43 42 41 41 37 37 43 

Total “Don’t know” 1 1 1 1 1 1 1 1 1 

Total missing 0 1 0 0 0 0 0 0 0 

--- Data not available (answer was not provided).
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 displayed include: Alaska, Massachusetts, Mississippi, Tennessee, West Virginia, and the Federal Bureau of Prisons.
SOURCE: NCHS, National Survey of Prison Health Care, 2011.
 
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 st

State Cardiology Psychiatry Dialysis Gynecology Obstetrics Ophthalmology Orthopedics Oncology Colonoscopy 

Arizona Yes, both Yes, on-site No No No No No Yes, off-site No 

Arkansas No Yes, on-site No Yes, both Yes, both No No No No 

California Yes, both Yes, on-site No No No Yes, both Yes, both Yes, both No 

Colorado No Yes, on-site No No No No No Yes, both Yes, off-site 

Georgia Yes, both Yes, both No No No No No No No 

Illinois No Yes, on-site No No No No No No No 

Iowa No Yes, on-site No No No No Yes, both No No 

Kansas No Yes, on-site No No No No No No No 

Kentucky No Yes, on-site No No No No No No No 

Louisiana Yes, off-site Yes, on-site No No No Yes, off-site No No No 

Maine No Yes, on-site No No No No No No No 

Michigan No Yes, on-site No No No No No No No 

Missouri Yes, on-site No No No No No Yes, both Yes, both No 

Montana No Yes, on-site No No No No No No No 

Nebraska No Yes, on-site No No No No No No No 

Nevada No Yes, on-site No No No No No No No 

New Jersey Yes, on-site No No No No No No Yes, both No 

New Mexico No Yes, on-site No No No No No No No 

North Carolina Yes, on-site Yes, on-site No No No No No No No 

North Dakota No Yes, on-site No No No No Yes, both No No 

Ohio Yes, off-site Yes, on-site Yes, both No Yes, both Yes, off-site Yes, off-site Yes, off-site No 

Oklahoma No Yes, on-site No No No No No No No 

Oregon No Yes, on-site No No No No No No No 

Pennsylvania Yes, off-site Yes, on-site No No No No Yes, both Yes, both No 

Utah Yes, off-site Yes, on-site No Yes, on-site Yes, off-site No Yes, off-site No No 

Vermont No Yes, both No No No No No No No 

Virginia Yes, on-site Yes, on-site No No No No No No No 

Washington No Yes, on-site No No No No No No No 

Wisconsin No Yes, on-site No No No No No No No 

Wyoming Yes, on-site Yes, on-site No No No No No No No 

Total “Yes, on-site” 5 26 0 1 0 0 0 0 0 

Total “Yes, off-site” 4 0 0 0 1 2 2 2 1 

Total “Yes, both” 3 2 1 1 2 1 5 5 0 

Total “No” 18 2 29 28 27 27 23 23 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, ancardiac 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 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 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 All 

contracted 

Some 

Contracted 

None (all 

DOC 

provided) 

Don’t 

know 

a) Mental health 

b) Pharmaceutical 

c) Dental 

d) Laboratory Services 

e) Radiology 

f) Medical (excluding all of the 

above) 

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□
 

 

Page 18 National Health Statistics Reports  Number 96  July 28, 2016 

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} 

Employee Type 

Number of FTE employees 

DOC 

If 

estimate, 

check box 

below 

Contracted 

If 

estimate, 

check box 

below 

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 _____ □ _____ □

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 _____ □ _____ □
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 

On-site Off-site/Community 

Yes No Don’t 

Know Yes No Don’t Know 

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 □ □ □ □ □ □
Page 20 National Health Statistics Reports  Number 96  July 28, 2016 

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 On-site 

Off-site/In 

Community Telemedicine 

Service Not 

Available 

Don’t 

Know 

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 □ □ □ □ □
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 Yes No Don’t 

Know 

a. Hepatitis A □ □ □

b. Hepatitis B □ □ □

c. Hepatitis C □ □ □

d. Gonorrhea □ □ □

e. Chlamydia □ □ □

f. Syphilis □ □ □

g. Tuberculosis (PPD) □ □ □

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 Yes No Don’t 

Know 

a. Pregnancy □ □ □

b. Elevated lipids □ □ □

c. High blood pressure □ □ □

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 Yes No Don’t 

Know 

a. Routine dental exam □ □ □

b. ECG (EKG) □ □ □

c. Chest x-ray □ □ □
Page 22 National Health Statistics Reports  Number 96  July 28, 2016 

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 Yes No Don’t 

Know 

a. Mental health problems 

(excluding suicide risk) □ □ □

b. Suicide risk □ □ □

c. Traumatic brain injury □ □ □

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? 
For more NCHS NHSRs, visit: 

http://www.cdc.gov/nchs/products/nhsr.htm. 

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 

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 

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. 

Copyright information 

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
 

July 28, 2016 

U.S. Department of 

HealtH & HUman ServiceS 

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 

FIRST CLASS mAIL

PoSTAge & FeeS PAId
 
 

CdC/NCHS 


PeRmIT No. g-284
 
 


 
 

National Health Statistics Reports  Number 96 