WRAL investigates a constitutional mandate with a high cost.
More than 33,000 convicted criminals live behind the razor wire and concrete of North Carolina's prisons. Taxpayers foot the bill for all their health care.
"It's quite expensive," said Dr. Paula Smith, who oversees health services for the 74 prisons within the North Carolina Department of Correction.
"I think many people think prisoners are just thrown in prison and the keys are thrown away. That is not what happens," Smith said.
At Central Prison's hospital, inmates get access to an emergency room and outpatient care. Inmates can be seen by specialists, like dentists, optometrists, podiatrists, cardiologists and psychiatrists. Smith said some of the inmates are among the sickest people in society.
"Chronologically, they may be 50, but physiologically their bodies may be 70," Smith said.
"Our issue is to keep them alive and to deal with their medical needs," said Tony Sanders, prison hospital administrator.
Those medical needs do not include cosmetic procedures. In some cases, a panel of doctors determine whether certain care and prescriptions are necessary.
Necessary can be expensive. Last year, taxpayers spent $325,000 to care for one inmate -- a convicted killer who had a series of strokes. The lifesaving procedures came just months before he was released on parole.
"It is difficult to accept, but I tell people it is constitutionally mandated," Smith said.
In the last fiscal year, the state spent $11.92 per day, per inmate. That compares to almost $13.79 for the general public, according to the Centers for National Health.
Still, under pressure from lawmakers, the Department of Correction must look for every way to cut costs -- from staffing to audits to contracts.
One recommendation to save taxpayer money would be to spend more taxpayer money.
The Department of Correction has proposed building a new $70 million hospital on a site at Central Prison. A $50 million mental health center is also on the drawing board.
The existing hospital is a crowded 40-year-old building that was not designed for medical care. Because the prison lacks equipment for such things as CT scans, MRIs and specialized surgery, inmates often have to go to outside hospitals.
Last year, taxpayers spent over $24,273,020 for those trips -- $7.5 million at UNC Hospitals alone.
"We firmly believe, in the long run, it will save the state of North Carolina a lot of money if we could provide the services here in house," Sanders said.
In rare instances, an inmate's health may play a role in early release to help avoid costs. Tougher sentencing guidelines will ensure the prison population stays behind bars longer and grows older.
Currently, 2,700 inmates are age 50 or older; one inmate is 92. Like it or not, each and every inmate --no matter the crime -- gets free healthcare. The law put them here and the law protects them at taxpayers' expense.
Prison officials hear healthcare complaints from both sides of the walls. While the public often criticizes high costs, some inmates complain that they do not get enough care.