Analysis revealed that a substantial number of nursing referrals to physicians were unnecessary. Of the physician clinic visits, only about a third were judged by the physicians to be medically necessary. The remainder were generated by inmates' desires to obtain prison "perks" or by system or institutional mandates. One of the suggestions for addressing the overuse of medical services by inmates is to make clear prison sick-call nursing protocol. The exact cut-offs for soft or hard findings, the time interval for referral, and the type of provider to refer to need greater attention to detail. Also, nursing education on sick-call outcomes and the referral process is essential. Weekly or monthly trending of individual nurses' referral scores, to be discussed privately with the charge nurse or the clinic director, may help. The author recommends as well that the fiscal impact of system mandates be factored in at the time of budgeting or contracting for correctional health care. The policies for access to emergency medical services should be fine tuned to permit such visits while deterring the use of emergency services as a substitute for sick call. Four references