In the first national survey on health care services in prisons conducted by the Centers for Disease Control and Prevention (CDC), the agency found some inconsistency in how care is provided to a population which has higher rates of mental illness, chronic conditions and infectious diseases.

Forty-five states participated in the survey in 2012, based on conditions in prisons in 2011. Corrections departments were asked whether services like mental health, radiology and hospice care were offered on- or off-site, if at all, how many full-time medical employees were on staff, and what medical tests were included in the admissions process.

On-site services were more common in several categories, like inpatient mental health services (27 states) and outpatient (44 states), chronic disease care (31 states), long-term care (35 states) and hospice care (35 states). 29 states said they offered some level of emergency care on-site, though none offered it there exclusively, and 15 states.sent all emergency cases off-site. For diagnostic and specialty services, on-site availability was generally smaller, such as cardiology (offered exclusively off-site in 25 states) and oncology (26 states).

Women’s health needs were far less likely to be offered on-site. Only 14 states offered gynecology services exclusively on-site and only a single state offered obstetrics exclusively on-site.

The majority of the states utilized telemedicine for at least one specialty or diagnostic category, most commonly for psychiatric care (28 states).

For admissions, the survey found a few inconsistencies around testing some incoming prisoners. There was high availability of testing in some categories: all 45 states screened at least some inmates for tuberculosis, mental health and suicide risk, and 44 tested for high blood pressure. For traumatic brain injury (TBI), however, only 23 states screened at least prisoners, and 53.3 percent of the admissions for TBI among prisoners came from the states that don’t screen for the injury, which the report identified as a problem area in its conclusion.

“Research indicates that the incarcerated population reports TBI at higher rates than the general population, and that routine screening is needed to help identify TBI history and TBI-related issues,” the report said.

The survey did have several notable limitations. First, it collected data only at the statewide level, so the level of services at different facilities wouldn’t be reflected. Second, it didn’t measure to what extent services would be offered on or off-site. Many categories saw prisons report a service was offered both on- and off-site, but that could mean “extreme cases involving surgeries would be sent off-site, but all other care was provided on-site.” Third, the survey can’t measure how many prisoners were screened for conditions upon admissions, as a “yes” answer could mean the facility has universal screening or only tested based on clinical indication.