I work in juvenile corrections and although we do provide some "medical" services, we mostly contract them out.
Even though my last facility had an acute unit, a skilled and various intermediate units, the real acute stuff was contracted out to a couple of local hospitals. While admitted there an inmate could expect a staffing ratio of 2:1. Almost any trip to an outside physician or other appointment requires a 2:1 ratio with the inmate in shackles.