FMC Butner: Care Levels, Visiting, Mail and Oversight

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

FMC Butner at a glance

FMC Butner is the Federal Bureau of Prisons hospital on the Butner complex: an administrative-security federal medical center for men and one of the federal prisons in North Carolina. It held 801 people as of September 2026, the Bureau’s sickest men and, under the same roof, men whom federal courts have sent for psychiatric evaluation or committed as mentally ill and dangerous.

Official name	Federal Medical Center, Butner
BOP code	BUH · complex BUX
Security level	Administrative; men
Population	801 (as of September 2026)
Visiting	Saturdays, Sundays, and federal holidays, 8:30 a.m.–3:00 p.m. · see which schedule controls
Inmate mail	Inmate name and register number · FMC Butner · Federal Medical Center · P.O. Box 1600 · Butner, NC 27509
Send money	Lockbox · Western Union (code city FBOP, DC) · MoneyGram (receive code 7932)
Phone	919-575-3900 · Fax 919-575-4801
Street address	Old NC Highway 75, Butner, NC 27509 · Granville County
Judicial district	Eastern District of North Carolina
BOP region	Mid-Atlantic
Designated capacity	923
Housing	2 buildings, 21 units: 4 single-cell, 15 multiple-occupancy cell, 2 open dormitory
Special Housing Unit	See special housing at a hospital
Medical care level	Level 4 · see what the Bureau’s own chart says
Mental health care level	Level 4
RDAP	None; the complex’s two residential drug programs are at FCI Butner Medium I and FCI Butner Medium II
UNICOR	See work, and the UNICOR question
Camp	None; the Butner camp belongs to FCI Butner Medium I

It is one of four federal prisons on the Butner complex in Granville County, about nine miles up Interstate 85 from Durham, in the Bureau’s Mid-Atlantic Region.

Is FMC Butner the same as FCI Butner?

No: FMC Butner is the hospital, one of four separate prisons on the Butner Federal Correctional Complex, with its own switchboard, post office box, and visiting room. Press reports, court opinions, and directory sites call all four “Butner” or “FCI Butner,” and a letter or a visitor that goes to the wrong gate is turned away, not passed along.

Institution	Code	What it is	Population	Mail to	Phone
FMC Butner (this page)	BUH	Administrative-security medical center	801	P.O. Box 1600	919-575-3900
FCI Butner Medium I, with the satellite camp	BUT	Medium; the camp is minimum	823 (536 at the FCI, 287 at the camp)	P.O. Box 1000	919-575-4541
FCI Butner Medium II	BTF	Medium	1,304	P.O. Box 1500	919-575-8000
FCI Butner Low	BUF	Low; the complex’s documents still call it the LSCI	942	P.O. Box 999	919-575-5000

On the Bureau’s Inmate Locator a man held here appears as “Butner FMC,” and a man at one of the other three as “Butner Medium I FCI,” “Butner Medium II FCI,” or “Butner Low FCI,” so the words after “Butner” are the whole answer. The Bureau’s records put several names often attached to FMC Butner elsewhere. R. Kelly appears as “Butner Medium I FCI,” register 09627-035, projected release January 31, 2046. Nicodemo Scarfo and Carmine Persico, both reported to have died at the medical center, have records under Medium I’s code, BUT, and the screen shows each only as “Deceased:” with a date, January 14, 2017, and March 7, 2019. John Hinckley also has a record under BUT, shown as “Not in BOP Custody as of: 08/18/1981.” Read every Butner document asking which of the four it means.

How does someone end up at FMC Butner?

People reach FMC Butner through a physician’s classification, not a security score. “Administrative” security means an institution with a special mission that holds people of every custody level; the Bureau’s own gloss for the FMC is that it “houses all security levels.” Three legal routes lead to the same buildings, and which one a person is on decides who can get them out.

Care levels, and who assigns them

The Bureau sorts every person in its custody, and every institution, into one of four medical care levels under a 2019 clinical guidance document, Care Level Classification for Medical and Mental Health Conditions or Disabilities. Level 1 is a generally healthy person under 70; Level 2 a stable outpatient; Level 3 “complex, and usually chronic” illness. Level 4 is the FMC’s population: people who “require services available only at a BOP Medical Referral Center (MRC), which provides significantly enhanced medical services and limited inpatient care,” whose functioning “may be so severely impaired as to require 24-hour skilled nursing care or nursing assistance.”

Who does the sorting matters as much as the categories. At sentencing, the Designation and Sentence Computation Center assigns a provisional Level 1 or 2 from the presentence report, but for Levels 3 and 4 the Office of Medical Designations and Transportation “performs the initial (provisional) classification and designation,” and after arrival “a nonprovisional care level is assigned by BOP clinicians.” A judge’s recommendation of FMC Butner is only a recommendation. For someone already in prison, the move is a medical transfer under Chapter 7 of the Bureau’s security designation rules, Program Statement 5100.08: health services staff complete form BP-770, the Warden authorizes it, and the Central Office Medical Designator decides; the transfer code, 331, “requires a change to a CARE 4 assignment.” Three rules in the 2019 guidance decide arguments families lose: a Level 3 patient is “ordinarily” not redesignated within twelve to eighteen months of the projected release date; refusing treatment “solely for the purpose of reducing their care level” does not reduce it; and “the need for a wheelchair or assistance in pushing a wheelchair are not care level criteria and are not indications for a medical transfer.”

What the Bureau’s own chart says about the level

The Bureau does not post a table of institution care levels on its website, but it has released one. Its 2024 chart, Institution Care Levels for Medical Assignment, prints the FMC, under the complex code BUX, at Care Level 4 in its regional table; the chart’s own summary page contradicts that, listing “BUX – FMC” under Care Level 3 and the complex, “BUX,” under Care Level 4. The undated mental-health chart released with it gives the FMC mental-health Care Level 4. The medical chart is more than two and a half years old and the other cannot be dated, and under the Bureau’s patient care policy, Program Statement 6031.06 (2026), the Health Services Division “assigns institution care levels,” so a level can change without a new public chart. The Bureau’s medical-care page says only that it “operates seven (7) medical referral centers providing advanced care,” and the 2019 guidance describes how institutions are classified without naming one. The Inspector General had earlier quoted the Bureau’s classification: “FMC Butner, as a Medical Care Level 4 institution, houses and cares for inmates with the most serious medical conditions. FCI I (including the Camp), FCI II, and the LSCI are all Medical Care Level 3 institutions” (Report 21-031, January 2021). Its March 2022 contract audit calls the FMC “a Care Level III/IV facility” in one place and one of “the BOP’s six FMCs that are classified as Care Level IV facilities” in another, without explaining the difference. Our guides to medical designations and federal medical centers explain the system.

The forensic route: evaluation and civil commitment

The second way in has nothing to do with a sentence. Federal courts send defendants here under 18 U.S.C. § 4241 to find out whether they are competent to stand trial; the Bureau’s internship brochure states that the Forensic Evaluation Service “is housed at FMC Butner” and that “FCC Butner has the largest competency restoration program in the BOP.” The third route can outlast the criminal case. When a defendant cannot be restored, or a sentence is about to end, the facility’s director may certify under 18 U.S.C. § 4246 that the person has a mental disease or defect as a result of which release “would create a substantial risk of bodily injury to another person or serious damage to property of another.” The certificate is filed in the district of confinement, the Eastern District of North Carolina, whatever court the charges came from, and a person committed under it stays in federal hospital custody until a state accepts responsibility for him or his condition improves enough that release, or conditional release under a treatment regimen, would no longer create that risk; discharge ordinarily begins with a certificate from the facility director to the committing court. The FMC’s handbook notes that part of its mental health population is committed under 18 U.S.C. § 4243 or § 4246.

The Fourth Circuit described the machinery in 2025, in the case of a Michigan defendant who, after being found unrestorable, “was placed on a waiting list to be evaluated at FMC Butner. At the time, Butner was one of only two facilities nationwide that was equipped to conduct § 4246 evaluations, and it was inundated with a backlog of cases. It was also experiencing a staffing shortage and was subject to numerous time-consuming restrictions related to the COVID-19 pandemic.” The court held a five-month wait for the certificate reasonable in those circumstances (United States v. Berry, 142 F.4th 184, 4th Cir. June 24, 2025). The brochure, describing the FMC’s Forensic Treatment Services team, is candid about who this population is: “A majority of the individuals receiving treatment at FMC Butner are individuals civilly committed as a result of mental disease and dangerousness or due to dangerousness following a Not Guilty by Reason of Insanity finding. The current inpatient population is approximately 150 individuals diagnosed with a severe mental illness” (2025).

What medical and psychiatric care does FMC Butner provide?

FMC Butner provides inpatient medical care and inpatient psychiatric care. In the Bureau’s summary, from its 2025 brochure, the FMC treats “individuals detained both voluntarily and involuntarily with mental health needs,” provides “forensic evaluation services for pretrial and presentence detainees,” and “delivers a range of inpatient medical care specializing in oncology, diabetes, dialysis services, surgery, and evaluations for organ transplant candidates.” The same brochure counts “300 medical and 300 psychiatric inpatient beds” across the complex; the FMC is the only hospital on it.

The medical side

The Inspector General’s March 2022 audit of the Bureau’s contract with the University of Massachusetts Medical School, which supplied the FMC’s specialist physicians, calls the place “a full functioning hospital” that “provides all specialty areas of medicine, as well as being the primary referral center for all inmates requiring oncology, chemotherapy, or radiation therapy.” The contract for FMC Butner alone was valued at $175,515,071. The Inspector General’s January 2021 remote inspection lists what the population receives: nursing care for the elderly, “radiation, chemotherapy, dialysis, and physical therapy,” and “orthopedic and other minor surgeries that can be performed at the FMC.” Its December 2024 inspection of FMC Devens counts FMC Butner among the Bureau’s four institutions with a dialysis unit.

The FMC’s 2009 handbook is the only Bureau document that describes the daily mechanics: an Ambulatory Care Clinic on the second floor, with sick call there for the work cadre and third-floor patients four mornings a week and everyone else signing up on their own unit; chronic care clinics; consultant clinics where “certain medical specialists are scheduled routinely to come into the institution”; and a Medical Social Worker serving the third, fourth, and fifth floors. One rule matters to a family sending money: the $2.00 health-care co-payment does not apply to “inmates in inpatient status at a Medical Referral Center,” and it is not charged for staff referrals, chronic-care follow-up, emergencies, mental health care, or substance-abuse treatment.

The psychiatric side

The FMC is also a psychiatric hospital, and it is the part of Butner that produces court cases. The Bureau’s mental-health care levels run parallel to the medical ones under its mental illness treatment policy, Program Statement 5310.16: CARE4-MH is “inpatient psychiatric care” for a person who “is gravely disabled and cannot function in general population in a CARE3-MH environment.” The brochure describes interns involved in “involuntary medication due process hearing and procedures.” Two things follow. Involuntary medication of a committed patient is decided at an administrative hearing inside the institution, while medicating a pretrial defendant to restore competency takes a court order. And a “residential” mental-health program is not the hospital: the Bureau’s Mental Health Step Down unit at Butner is at Medium I, not the FMC, according to the August 2026 First Step Act guide.

How medical information reaches a family

Slowly, and only through channels the patient opens. The Privacy Act bars the Bureau from releasing information from its records without the person’s written consent; the patient can sign a release, form BP-A0192, or name a health-care agent under the power of attorney described below. The handbook’s statement of health-care rights adds that “you and your family are encouraged to report any safety or quality of care concerns,” and, if the institution cannot resolve them, to contact “the Joint Commission on Accreditation of Healthcare Organizations.” In September 2023 NPR reported that the Joint Commission’s accreditation of the Bureau’s medical centers had expired in September 2021, and the January 2026 PREA audit form for the complex ticks accreditation by the American Correctional Association only.

The law changes that picture at the worst moment. The Bureau’s compassionate release policy, Program Statement 5050.51 (2026), implements 18 U.S.C. § 3582(d) and is specific about a terminal diagnosis. The clock starts “once the Clinical Director of an institution makes a terminal diagnosis.” The Bureau must then, “not later than 72 hours after the diagnosis notify the inmate’s attorney, partner, and family members of the inmate’s condition” and tell them they may submit a sentence-reduction request on the patient’s behalf; must “not later than seven days after the date of the diagnosis” give the partner and family, “including extended family,” an opportunity to visit in person; must help prepare the request if asked; and must process a request submitted by the family within 14 days. If you learn of a terminal diagnosis at FMC Butner any way other than a call from the institution, the 72-hour rule has already been missed, and that belongs in the first sentence of the compassionate-release request.

Advance directives are handled under North Carolina law, and the handbook devotes two pages to them. A living will under the state’s Right to a Natural Death Act needs two witnesses who are not relatives and not Bureau staff, plus a notary; the social workers hold the forms and “arrange for the necessary independent witnesses.” A health-care power of attorney names an agent to decide when the patient cannot, with the one restriction that matters in a prison: the agent “can not be another inmate or a staff member.” Raise it on the first visit rather than the last. The handbook also tells patients to give their families the institution’s number so that a family emergency can be phoned in, verified by a chaplain, and passed on.

Who are the notable inmates at FMC Butner?

The best-known people the Bureau’s records place at FMC Butner are men who died here, among them Theodore Kaczynski, Bernard Madoff, and Peter Gotti; several other names often attached to the FMC were never held here.

Name	Register number	Bureau record	Case
Theodore J. Kaczynski	04475-046	BUH; died June 10, 2023, aged 81	The Unabomber; four life sentences; moved here from the ADX at Florence and found unresponsive in his cell
Bernard L. Madoff	61727-054	BUH; died April 14, 2021, aged 82	Ponzi scheme into which investors had put an estimated $17.5 billion; 150 years; a 2020 request for release on the strength of end-stage renal disease was denied
Peter Gotti	99109-012	BUH; died February 25, 2021, aged 81	Gambino boss after his brother John; serving a 25-year sentence for racketeering and other charges
Harry J. “Taco” Bowman	26595-039	BUH; died March 3, 2019, aged 69	Head of the Outlaws motorcycle club; serving life
Omar Ahmad Rahman	34892-054	BUH; died February 18, 2017, aged 78	The “Blind Sheikh,” convicted in 1995 of seditious conspiracy; the FMC cited coronary artery disease and diabetes
Bernie Lazar Hoffman (Tony Alamo)	00305-112	BUH; died May 2, 2017, aged 82	Evangelist convicted in 2009 of taking girls across state lines for sex; 175 years
John A. Walker Jr.	22449-037	BUH; died August 28, 2014, aged 77	Navy warrant officer who spied for the Soviet Union for more than 17 years; life sentence in 1986
Frank J. Calabrese Sr.	49955-079	BUH; died December 25, 2012, aged 75	Chicago Outfit hitman; serving life

The Frank Calabrese who died here was Frank Calabrese Sr., not his son. Arthur Walker, the spy’s brother, died on July 5, 2014, seven weeks before John; the Locator record for him carries the low’s code, BUF. Eric Brown, who was transferred here in the Ashanti Billie case, is now carried at FMC Rochester (RCH).

How do I find someone at FMC Butner?

To find someone at FMC Butner, search the Bureau’s free Inmate Locator by eight-digit register number if you have it, or by the committed first and last name; the number is the reliable key because the Locator matches the name on the judgment. The result you want reads “Located at: Butner FMC.” Two results are peculiar to a medical center. A pretrial defendant sent for a competency evaluation may show a projected release date of “UNKNOWN,” because there is no sentence to compute. And a person moved here for treatment may show as “Butner FMC” for weeks and then reappear under his parent institution’s name: the FMC’s January 2026 audit form records 3,099 admissions in twelve months, only 905 of them stays of 72 hours or more, against a resident population of about 850. The suffix on the register number identifies the sentencing district; our guide to register numbers decodes it.

How do I write to someone at FMC Butner?

Address mail for someone at FMC Butner to P.O. Box 1600, with the committed name and register number on the first line. That is the box on the Bureau’s page for FMC Butner and in the FMC’s own handbook.

Mailing address	Inmate Name & Register Number FMC Butner Federal Medical Center P.O. Box 1600 Butner, NC 27509

Both visiting supplements the Bureau has published for this institution, the complex-wide one of April 1, 2026, and the FMC’s own of November 14, 2017, print “Federal Medical Center, P.O. Box 1500, Butner, NC 27509” beside the FMC’s hours. Box 1500 is Medium II‘s, and a family copying the address from the document the Bureau links as the visiting rules will send a letter to the wrong prison.

Mail is processed at a consolidated mail room the handbook places at FCI Butner, so a letter is handled twice before it reaches a bed. Under the Bureau’s correspondence rules, general correspondence may be read. Legal mail is opened only in front of the person it is addressed to and is not read, but only when the envelope identifies the sender as an attorney or a court and is marked “Special Mail — Open only in the presence of the inmate”; otherwise, the handbook warns, “staff may treat the mail as general correspondence.” Outgoing special mail goes to Receiving and Discharge between 10:30 and 11:00 a.m. on weekdays; patients on the fifth floor and in the 1E, 2F, and J units hand it to the unit officer. Our guides to attorney-client communication and writing to someone in federal prison cover the rest.

How do I send money to someone at FMC Butner?

Money for someone at FMC Butner goes to the Bureau’s national lockbox or one of two wire services, not to Butner, and each route needs the committed name and the eight-digit register number.

Route	Details
Postal money order, government check, cashier’s or certified check, business check	Federal Bureau of Prisons Committed Name Eight-Digit Register Number Post Office Box 474701 Des Moines, Iowa 50947-0001. A U.S. postal money order or government check posts without a hold; the handbook warns that anything else waits “a minimum 15 business day” period. No personal checks, no cash
Western Union Quick Collect	Code city FBOP, DC; the handbook says funds post within two to four hours
MoneyGram ExpressPayment	Receive code 7932, company name Federal Bureau of Prisons, Washington, DC

Two local details from the handbook: withdrawals over $250 need an Associate Warden’s signature, and the FMC tells people paying for subscriptions to address the envelope “C/O FMC Cashier P.O. Box 999,” the low’s box, so money leaving the FMC and letters arriving at it use different boxes. The fees of each route are compared in our guide to sending money to a federal prisoner.

What are the visiting hours at FMC Butner?

Visiting hours at FMC Butner are 8:30 a.m. to 3:00 p.m. on Saturdays, Sundays, and federal holidays, under Complex Supplement BUX 5267.09A of April 1, 2026. That supplement rescinded the October 2025 version and is the document the Bureau’s page for the FMC links as its visiting rules. There is no weekday or evening visiting at the medical center.

Three schedules, and the one that controls

The April 2026 complex supplement controls: it is the current document, and the Bureau’s page for the FMC links it. Older Bureau documents give other schedules, and one is still on the Bureau’s server. The FMC’s own Institution Supplement BUH 5267.09.03A (2017) gives Friday as a visiting day and rations visits with sixteen points a month; the Bureau’s FMC page linked it as the visiting schedule as recently as August 2026, and the file still opens at its old address.

Document	Year	Days it gives for the FMC	Limit on visits
Complex Supplement BUX 5267.09A (controls; linked from bop.gov)	2026	Weekends and all federal holidays, 8:30 a.m.–3:00 p.m.	“No limitations are placed on the frequency of visits”
Institution Supplement BUH 5267.09.03A (superseded; still served)	2017	Friday, Saturday, Sunday, and all federal holidays, 8:30 a.m.–3:00 p.m.	16 points a month; Friday 1 point, Saturday or Sunday 4, holidays free
Admission & Orientation Handbook	2009	Monday, Thursday, and Friday 2:00–8:30 p.m.; Saturday, Sunday, and holidays 8:30 a.m.–3:30 p.m.	None stated

Visitor processing stops at 9:15 a.m. on weekends and holidays until the 10:00 a.m. count clears, and visitors who arrive in that window “must return to their vehicles.” Call 919-575-3900 before you travel, and say that you mean the medical center.

Visiting someone who is an inpatient

The complex supplement answers this under the heading “Institution Hospital (FMC).” A request for a visit to someone “housed in the inpatient area” may be made by the patient or by the family and goes to the Unit Team. The decision belongs to the Clinical Director, “or in his/her absence the Hospital Administrator,” consulting the Unit Team, the Captain, and the SIS office, who “shall determine whether a visit may occur, and if so, whether it may be held in the hospital.” Normally only immediate family are allowed into the inpatient area. If a visit is refused because the patient has an infectious disease, “is in a psychotic or emotional episode which makes a visit inadvisable, or is otherwise not in a condition to see visitors,” the reason is explained to the visitor and documented in the privacy folder of the patient’s central file. A refused family should therefore ask for the reason in writing: the supplement requires the record to exist.

The superseded 2017 supplement adds detail the 2026 version dropped, and the Unit Team can say whether it still holds: bedside visits lasted one hour and could be approved outside normal hours “based on the inmates medical condition,” with “comfort care and/or (ACU) Advanced Care unit” listed as grounds for a special visit. Put the terminal-diagnosis rule beside that: the Bureau’s compassionate release policy, Program Statement 5050.51, requires the Bureau to offer the family, “including extended family,” an in-person visit within seven days of a terminal diagnosis. A family told a visit is impossible should ask whether such a diagnosis has been made.

Who can visit, and how many

• No limit on how often a patient at the FMC may be visited, though the Warden may limit visits “to avoid chronic overcrowding.” Medium II rations visits by points; the medical center does not.
• Three adults at a time, an adult being anyone sixteen or older, with no limit on children under sixteen.
• Immediate family verified from the presentence report go on the list automatically; ten friends may be added. During admission and orientation, only immediate family may visit.
• When the room is overcrowded, visits are ended with regard to distance traveled; the 2017 FMC supplement said visitors “within a 50-mile radius will be among the first to be terminated.”
• Special visits for clergy, prospective employers, and attorneys go through the Unit Team to the Warden; attorney visits are visually but not aurally monitored.

What visitors can wear and bring

Knee length, meaning the garment touches the knee while standing, is the rule for shorts and dresses. Prohibited under the April 2026 supplement: khaki, camouflage or ranger green, outerwear, anything revealing or form-fitting, sleeveless shirts, and open-toed shoes; the 2017 FMC version added scrubs, spandex, and gray sweats. You may bring twenty dollars in coins, no paper money, in a clear plastic bag no bigger than eight by six by two inches, plus a wedding ring set, a religious medallion, and stud earrings; watches, bags, pens, photographs, food, any communication device, and all tobacco or nicotine stay in the lockers the FMC provides. Baby food, diapers, and bottles are allowed for a child of three or under, but no stroller or carrier.

Identification and screening

Everyone sixteen and over shows valid government-issued photo identification, and the handbook says birth certificates are not identification. Every visitor signs the Notification to Visitor form, BP-224, and refusing ends the visit before it begins. The 2017 supplement required medical documentation for implants that set off the metal detector. Inside, the patient wears a visiting-room jump suit, and embracing and kissing are permitted at the start and end of the visit only. The national rules are in the Bureau’s visiting regulations and our guides to federal prison visitation and to searches, shakedowns, and contraband.

Getting there

From Durham, take Interstate 85 north about nine miles to exit 189, turn left on Central Avenue, follow it to Veazy Street, turn right, and at the stop sign turn left onto Old Highway 75. After about a mile the complex begins on the right: the low and Medium I at the first turning, the camp at the second, and the medical center at the third. The supplement lists commercial operators for visitors without a car.

How do phone calls and email work at FMC Butner?

Calls from FMC Butner go out, never in, to an approved list of up to thirty numbers. The national allowance is 510 minutes a calendar month under the Bureau’s telephone regulations, Program Statement 5264.09, issued September 3, 2026, which rescinded the 2008 policy: 300 of those minutes are free to anyone eligible for First Step Act telephone incentives, and anyone, eligible or not, may buy the other 210 after using up the 300. A single call should generally not exceed fifteen minutes, and the new statement carries no equivalent of the 2008 policy’s extra hundred minutes in November and December. The FMC handbook’s figure, “a Bureau wide limit of 300 minutes per month,” is the superseded one.

The 2009 handbook is the only published account of how the phones run here: on from 6:30 a.m. to 11:30 p.m. daily, off fifteen minutes before each count, and no calls during working hours without written permission from both the counselor and the work supervisor. The person called must press 5, so an answering machine ends the call. The handbook gives three routes to an unmonitored attorney call: the attorney calls the Counselor to fix a time, the attorney accepts a collect call, or the patient pays. Calls on the ordinary phones, including to a lawyer on the list, are monitored; the national rules are in our guide to federal inmate phone calls. Electronic messaging runs on TRULINCS, reached from outside through CorrLinks: text only, no delivery until the recipient accepts the invitation, and no privilege for messages with an attorney.

What can people buy at the FMC Butner commissary?

The monthly commissary spending limit at FMC Butner is $460, plus $50 during the November–December holiday period for no more than one validation period. The limit is set nationally by the Bureau’s trust fund rules, Program Statement 4500.13, issued May 7, 2026, whose summary of changes records that it “increases spending limit from $360 to $460 per month.” The FMC’s 2009 handbook figure of $290 is obsolete, and listings that give $360 are out of date. The handbook also says “ITS credits, stamps and OTC medications” do not count against the limit, which is out of date: the current manual’s list of excluded items still includes stamps and over-the-counter medications, along with nicotine replacement products, copy cards, footwear, and a few other items, but not telephone credits. Our page on the federal prison commissary explains the exclusions and the Special Purpose Orders the manual allows.

The FMC’s own shopping list (2022) is a medical center’s list. It sells diabetic socks at $2.10 and a senior multivitamin at $6.95, stocks sweatpants to size 8X, and prices the over-the-counter shelf a hospital’s patients need: Aleve, ibuprofen, famotidine, loratadine, fiber tablets, and hemorrhoid cream. Religious headwear needs the chaplain’s approval: kufis, a Rastafarian crown at $10.95, and yarmulkes at $2.09. Kosher and halal items are flagged down the whole food list, and once an order is in there are no additions, substitutions, or returns. The handbook adds that shopping is one day a week per person, and that shoes are tried on at the window because “once you leave with them you own them.”

What programs are available at FMC Butner?

FMC Butner offers fewer programs than the FCIs across the road, because of its medical mission. The Bureau’s August 2026 First Step Act Approved Programs Guide is built in two halves, a narrative entry for each program and an institution-by-institution grid, and for the medical center the grid marks 22 evidence-based recidivism reduction programs, almost all of them ones the narrative half says “may be offered at all BOP institutions,” which is permission, not delivery. Whether a class is running, and whether a patient on a hospital floor can get to it, decides whether First Step Act time credits are being earned.

RDAP and drug treatment

There is no Residential Drug Abuse Program at the FMC, and on this every document agrees. The handbook tells patients residential treatment “is not offered at this facility, but is available at FCI Butner, another part of the complex”; the guide’s RDAP location list (June 2026) places the complex’s two programs at Medium I and Medium II. What the FMC runs is the forty-hour drug education class, compulsory under the handbook for anyone whose offense involved drugs or alcohol, and non-residential treatment, open to people whose sentence is too short for the residential program “and/or you have documented medical problems that would interfere with full program participation.” That clause is the FMC’s population in a sentence. Someone here who hopes for the § 3621(e) reduction of up to a year for completing RDAP has to be transferred to an institution that runs the residential program first; the Bureau’s RDAP policy sets out the program.

Education and vocational training

The FMC offers GED and English-as-a-second-language classes, the parenting program, and adult continuing education on the Bureau’s national terms. The handbook’s college classes came from Vance-Granville and Durham Technical community colleges, some of them by distance learning, and it allows correspondence courses from outside schools under the Bureau’s post-secondary education policy. The medical center is not one of the sixteen institutions the August 2026 guide names for Pell-funded post-secondary education. The handbook’s line about the law library is a small piece of history: “The Law Library at FMC Butner is one of the first electronic libraries at a Federal facility.” Our guides to prison education and vocational training explain the system.

Work, and the UNICOR question

Work begins once a person is medically cleared, and the handbook says the first assignment is generally food service. The FMC’s own documents never mention Federal Prison Industries, and the Bureau’s August 2026 guide contradicts itself about it. The guide’s narrative entry for Federal Prison Industries lists 55 institution codes, and three of the four Butner codes, BTF, BUF and BUT, are in it; the code that would sit between BUF and BUT in the alphabetical list, BUH, is not there, and in its place the code BUT is printed twice. The duplicate is in the Bureau’s PDF itself. The guide’s grid, meanwhile, marks Federal Prison Industries at the FMC. So the grid says yes, the narrative list as printed says no, and the duplicated code sits exactly where the FMC’s would fall. The guide does not say which half is right; ask the unit team in writing.

Faith-based, health, and reentry programming

One program in the entire August 2026 guide has “FCC Butner” as its only listed location: the Alternatives to Violence Project, an eighteen-hour productive activity run by volunteers through Chaplaincy Services, which the grid also marks at the FMC. Beyond it, the grid’s list for the medical center reads like a hospital’s: Illness Management and Recovery, cognitive behavioral therapy for chronic pain, Managing Your Diabetes, A Matter of Balance, Healthy Steps for Older Adults, Brain Health As You Age, a bereavement support group, and the Suicide Inmate Companion program, alongside Anger Management, Criminal Thinking, and four programs for veterans. The handbook’s palliative-care program, staffed partly by trained inmate volunteers under the Medical Social Worker, is the program that marks this out as a hospital.

What is daily life like at FMC Butner?

Daily life at FMC Butner depends on which of two populations a person belongs to. The dormitories in the audit’s count are the work cadre’s; the Inspector General noted in 2021 that “the FMC’s work detail inmates are housed in a dormitory-style housing unit,” and the handbook’s rules about cubicles, lockers and khaki uniforms are written for them. The hospital floors are the other population, which the handbook refers to by floor, third, fourth, and fifth, and by unit, 1E, 2F, and J. The only published timetable is the 2009 handbook’s; treat it as the pattern of the place, not this week’s schedule.

	Weekdays	Weekends and holidays
Official counts	Five: midnight, 3:00 a.m., 5:00 a.m., 4:00 p.m., 9:00 p.m.	The same, plus 10:00 a.m.
Stand-up counts	4:00 p.m., and 10:00 a.m. on weekends, “unless unable to do so for verified medical reasons”
Meals	Breakfast 6:00–7:00 a.m.; lunch 10:45–11:45 a.m.; dinner after the 4:00 p.m. count clears	Coffee 7:00–8:00 a.m.; brunch and dinner after counts
Telephones	6:30 a.m.–11:30 p.m., off fifteen minutes before each count

The handbook’s food-service page is direct: “Due to budget funding, meat items and entrees are limited to one portion per resident. The meat ration will normally be three ounces.” For medical reasons, elastic-waist pants may be issued for permanent wear. Recreation lists intramural sports, hobby crafts, a movie program and a wellness program, with health fairs twice a year.

Special housing at a hospital

Where a hospital patient goes when placed in administrative detention or disciplinary segregation is answered differently by three Bureau documents. The 2009 handbook names “1E, J Unit and the Special Housing Unit at the LSCI,” two units inside the FMC and the low’s segregation unit across the road; the FMC’s 2017 supplement refers to “secure housing at the FMC”; and the January 2026 audit counts every one of the complex’s 96 segregation cells at Medium II and none at the FMC or the low. A patient sent to Medium II or the low is under a different institution’s roof, with a different mailing address. The handbook’s rule that people in disciplinary segregation “shall be seen by a member of the medical staff daily, including weekends and holidays,” matters more here than anywhere.

What do inspectors say about conditions at FMC Butner?

The DOJ Office of the Inspector General has not conducted an on-site inspection of this facility. Its staff were inside the FMC in 2014, during fieldwork for a review of the aging prison population published in May 2015, which chose the Butner institutions “because they had the highest percentage of aging inmates in the BOP”; that was not an inspection of conditions here. On its own count in May 2026 (Report 26-055) it had inspected fourteen institutions since 2023, none of them the medical center, and as of September 2026 the only inspections on its list of ongoing work were at FCI Berlin and FCI El Reno. What it has published instead is a decade of audits in which the medical center keeps appearing.

The 2021 remote inspection

Report 21-031, published on January 28, 2021, with fieldwork from May 6 to July 25, 2020, was a remote inspection of the whole complex by telephone, staff survey, and document review, with no one on site. It is not an inspection of conditions; it is the most detailed independent account of how the hospital behaved under pressure. By July 25, 2020, the complex had 1,020 confirmed cases and 25 deaths; the medical center, with 884 people, had ten. The Inspector General set the open dormitories elsewhere against the FMC and FCI II, where “most inmates are confined in locked cells with solid doors.” The FMC “stopped the regular movements of inmates from FCI I, FCI II, the LSCI, and the Camp to the FMC for medical treatment,” with “limited exceptions, such as providing chemotherapy,” and sent its own staff out to keep dialysis and wound care running at the other prisons. From June 11, 2020, “hospitalized inmates participated in video teleconferencing (VTC) calls with family members” under a Bureau pilot here.

The medical contracts

The Inspector General has audited the complex’s outside medical contracting three times, in 2007, 2013, and 2022; the 2022 auditors visited FCC Butner, but none of the three was an inspection of care. The March 2022 audit of the University of Massachusetts contracts (Report 22-052) describes how care actually reaches a patient: UMass “did not always provide all the medical specialty clinics required,” so that in September and October 2019 alone seventeen vascular surgery appointments were sent off site; Butner officials told the auditors that many off-site appointments were rescheduled when emergency hospital trips tied up escort staff, an explanation the auditors found no documentation to support; and the Bureau “did not have a formal process in place to ensure the timeliness of the healthcare inmates received.” None of that is a finding that a particular patient was harmed; all of it is the reason a family’s account of a canceled appointment is plausible.

Restraints, deaths, and compassionate release

Three Bureau-wide reports carry figures for Butner. The Inspector General’s July 2025 audit of the Bureau’s oversight of restraints (Report 25-070) tabulated the institutions with more than 300 recorded use-of-force incidents involving ambulatory or four-point restraints between January 1, 2018, and January 16, 2024. Thirteen high-security penitentiaries head the list; fourteenth, with 317, is FMC Butner, the only medical center on it. The data was the Bureau’s own, unvalidated, and a medical center’s restraint use includes the psychiatric hospital’s; the number is not a finding of misuse. The February 2024 evaluation of inmate deaths (Report 24-041) counted the 344 deaths by suicide, homicide, accident, and unknown cause in Bureau institutions from fiscal 2014 to 2021, natural causes excluded, and FMC Butner had ten, fifth in the Bureau. Because natural causes are excluded, those ten deaths at a hospital are from the other causes.

When the Inspector General reviewed compassionate release in May 2013, it chose FMC Butner and FMC Carswell “because they received the highest number of compassionate release requests,” and its Butner interviewees included the “Social Worker and Chairperson of the Reduction in Sentence (Compassionate Release) FMC Butner Review Committee,” which matches the 2009 handbook, where the Medical Social Worker chairs the Compassionate Release Program. In September 2023 NPR published an investigation built on Bureau death records: at least 4,950 deaths over roughly a decade, “a quarter” of them at the Butner complex, which NPR attributed to the medical center being “the bureau’s largest cancer treatment facility” and to the Bureau’s habit of sending people to Butner late. Union officials told NPR that more than a fifth of roughly 200 nurse and paramedic positions at the complex were vacant, a figure the Bureau confirmed, and a member of the medical staff gave NPR the question the clinicians ask about arrivals with late-stage cancer: “What took them so long to get to us, and why did they send them to us when there’s nothing that we can do?”

The 2026 PREA audit

The Bureau’s FMC page links a document labeled “FMC Butner PREA Report”; the document is the audit of the whole Federal Correctional Complex: one audit under the Prison Rape Elimination Act of all four prisons and the camp by an independent auditor, Brian Sutherland of Corrections Consulting Services, on January 13–15, 2026, with a final report dated February 26, 2026. The complex passed, 45 standards met and none unmet, and the allegation figures are complex-wide: thirteen allegations of sexual abuse and 46 of sexual harassment in twelve months, none of the abuse allegations substantiated. Forensic examinations are done at Duke Medical Center, and the outside victim advocate is the Durham Crisis Response Center. The form gives these figures for the medical center by itself:

Designated capacity / population	923 / 847 on January 13, 2026; average daily population 845 over the prior year
Admissions in 12 months	3,099, of whom 905 stayed 72 hours or more and 811 stayed 30 days or more
Average length of stay	726.6 days
Age range	19 to 89
Limited English proficient	55
Recorded disabilities	2 physical, 6 cognitive or functional, 1 blind or low vision, 2 deaf or hard of hearing

The eleven recorded disabilities are what the form’s authors entered under the audit’s definitions. The Government Accountability Office’s May 2026 report on sexual abuse in federal prisons (GAO-26-107343) gives the medical center 22 allegations against incarcerated people and 7 against staff for 2020 to 2024, from two Bureau systems that cannot be added together; they are allegations, not findings. The District of Columbia’s Corrections Information Council has published no inspection report on any Butner institution. Two Butner prosecutions belong to other institutions: the lieutenants indicted in September 2025 were assigned to the low, and their case is followed on our FCI Butner Low page; the lieutenant sentenced in April 2025 for ordering an assault worked in Medium II‘s segregation unit.

FMC Butner in the news

Recent news about FMC Butner centers on the Bureau’s new compassionate-release program statement and a 2025 Fourth Circuit decision on its forensic evaluations; older items concern NPR’s 2023 investigation of deaths at the complex, the Bureau’s 2020–2022 death releases, and the death of Bernard Madoff. Newest first:

• September 2026 — the Bureau’s new compassionate-release program statement, PS 5050.51, took effect on September 3, replacing PS 5050.50; the 72-hour family notification and seven-day visit rules for terminal diagnoses, already in the earlier statement, carry over.
• June 2025 — the Fourth Circuit, in United States v. Berry, recorded that FMC Butner was one of only two facilities in the country able to conduct § 4246 dangerousness evaluations in 2020, with a backlog and a staffing shortage.
• September 2023 — NPR reported that a quarter of the Bureau’s deaths in custody over roughly a decade occurred at the Butner complex and that the Joint Commission’s accreditation of the Bureau’s medical centers had lapsed in September 2021.
• November 2020 to September 2022 — the Bureau posted six news releases reporting the deaths of people held at FMC Butner; the Bureau’s releases are listed on its press release page.
• April 2021 — Bernard Madoff died at the FMC on April 14, aged 82, after a court refused his 2020 release request.

Frequently asked questions about FMC Butner

Problems at FMC Butner: where we can help

The problems that recur at FMC Butner are a medical center’s, not a penitentiary’s: a care-level system that decides who gets a bed here, a contract clinic system the Inspector General could not show was timely, a compassionate-release committee in this building, and a civil-commitment docket in Raleigh.

• Getting someone here, or keeping them here. A designation to the FMC is a Level 4 medical classification made in Central Office; the argument is made from the medical record against the Bureau’s own 2019 criteria, through the BP-770 referral rather than the unit team. See our guide to federal prison transfers.
• Care that is not happening. The route is a written request to staff, then the administrative remedy process, which the handbook says gives staff 72 hours to answer a complaint that threatens immediate health; where negligence has caused injury, the Federal Tort Claims Act form is a Standard Form 95 from the Counselor or the Safety Manager. See medical care in federal prison.
• Compassionate release. The request goes to the Warden, and the 2009 handbook puts the Medical Social Worker in charge of the program here; the sentencing court may be asked directly 30 days after the Warden receives the request. In an unpublished 2021 decision the Eleventh Circuit vacated a denial that rested only on a man’s transfer to FMC Butner, finding that fact “by itself insufficient to allow for meaningful appellate review” (United States v. Evans, No. 20-11768, 11th Cir. Aug. 19, 2021). See the Bureau’s compassionate release policy.
• Civil commitment under § 4246. The hearing is in the Eastern District of North Carolina, the standard is clear and convincing evidence, and the FMC’s risk-assessment panel and annual report are the government’s case.
• Visits refused. The complex supplement requires the reason for refusing an inpatient visit to be recorded, and the seven-day visit after a terminal diagnosis is a statutory duty.
• Disciplinary proceedings and special-housing placements, which at a hospital can mean a move to another institution’s segregation unit; advance directives under North Carolina law; First Step Act credits for people whose illness limits programming; and halfway-house placement, which is handled under the Bureau’s placement procedures by the Residential Reentry Management office for the district a patient is releasing to: RRM Raleigh for North Carolina’s three districts, and for a patient releasing anywhere else, the office that lists that district among the ones it serves.
• Challenges to the conviction or sentence itself, through a direct appeal or a § 2255 motion.

Elizabeth Franklin-Best, P.C. handles federal criminal defense, appeals and post-conviction matters nationwide, including compassionate-release motions and Bureau of Prisons medical and designation issues. Call (843) 620-1100 or contact us to talk through a specific situation.

Christopher Zoukis, JD, MBA, the firm’s Managing Director, writes and maintains the federal prison policy material on this site. He is not counsel of record; legal representation is provided by Elizabeth Franklin-Best.

Sources and currency

Bureau of Prisons documents

• FMC Butner, Federal Bureau of Prisons, 2026.
• Complex Supplement BUX 5267.09A, Visiting Regulations, Federal Bureau of Prisons, Federal Correctional Complex Butner, 2026. Replaced the October 2025 complex supplement.
• FCC Butner Psychology Doctoral Internship 2026–2027, Federal Bureau of Prisons, Federal Correctional Complex Butner, 2025. Describes the Forensic Evaluation Service and Forensic Treatment Services at the FMC.
• FMC Butner Commissary Shopping List, Federal Bureau of Prisons, 2022.
• Institution Supplement BUH 5267.09.03A, Visiting Regulations, Federal Bureau of Prisons, FMC Butner, 2017. Superseded by the 2026 complex supplement; the Bureau still serves the file.
• FMC Butner Admission and Orientation Handbook, Federal Bureau of Prisons, 2009.
• Trust Fund/Deposit Fund Manual, Program Statement 4500.13, Federal Bureau of Prisons, 2026.
• Compassionate Release/Reduction in Sentence Procedures, Program Statement 5050.51, Federal Bureau of Prisons, 2026. Replaced Program Statement 5050.50 (2019).
• Inmate Security Designation and Custody Classification, Program Statement 5100.08, Federal Bureau of Prisons, 2006, as amended in 2026.
• Inmate Telephone Regulations, Program Statement 5264.09, Federal Bureau of Prisons, 2026.
• Treatment and Care of Inmates with Mental Illness, Program Statement 5310.16, Federal Bureau of Prisons, 2014, as amended in 2025.
• Patient Care, Program Statement 6031.06, Federal Bureau of Prisons, 2026.
• Care Level Classification for Medical and Mental Health Conditions or Disabilities, Federal Bureau of Prisons, 2019. The Bureau’s clinical guidance on care levels.
• First Step Act Approved Programs Guide, Federal Bureau of Prisons, Reentry Services Division, 2026. Includes the Residential Drug Abuse Program location list.
• Institution Care Levels for Medical Assignment and Institutional Mental Health Care Levels, Federal Bureau of Prisons, 2024. Released under Freedom of Information Act request 2024-03455 and published by the Washington Lawyers’ Committee.
• Medical Care, Federal Bureau of Prisons, 2026.
• Community Ties, Federal Bureau of Prisons, 2026. The Bureau’s mail, email, and money instructions.
• Press Releases, Federal Bureau of Prisons, 2020–2022. The Bureau’s index of its news releases.
• RRM Raleigh, Federal Bureau of Prisons, 2026. The judicial districts the Raleigh reentry office serves.

Audits and inspections

• PREA Audit Report: Federal Correctional Complex Butner, Corrections Consulting Services, 2026.
• Ongoing Work, U.S. Department of Justice, Office of the Inspector General, 2026.
• Inspection of the Federal Bureau of Prisons’ U.S. Penitentiary Canaan, U.S. Department of Justice, Office of the Inspector General, 2026. Report 26-055, cited for its count of institutions inspected since 2023.
• Audit of the Federal Bureau of Prisons’ Documentation of its Compliance with Select National Menu Requirements, U.S. Department of Justice, Office of the Inspector General, 2026. Report 26-021.
• Federal Prisons: Improvements Needed to Prevent, Detect, and Address Sexual Abuse, U.S. Government Accountability Office, 2026. Report GAO-26-107343; tables 7 and 8 count allegations at the FMC.
• Audit of the Federal Bureau of Prisons’ Oversight of the Use of Restraints, U.S. Department of Justice, Office of the Inspector General, 2025. Report 25-070.
• Inspection of the Federal Bureau of Prisons’ Federal Medical Center Devens, U.S. Department of Justice, Office of the Inspector General, 2024. Report 25-009, cited for its count of the Bureau’s dialysis units.
• Evaluation of Issues Surrounding Inmate Deaths in Federal Bureau of Prisons Institutions, U.S. Department of Justice, Office of the Inspector General, 2024. Report 24-041.
• Audit of the Federal Bureau of Prisons’ Comprehensive Medical Services Contracts Awarded to the University of Massachusetts Medical School, U.S. Department of Justice, Office of the Inspector General, 2022. Report 22-052.
• Remote Inspection of Federal Correctional Complex Butner, U.S. Department of Justice, Office of the Inspector General, 2021. Pandemic Response Report 21-031.
• The Impact of an Aging Inmate Population on the Federal Bureau of Prisons, U.S. Department of Justice, Office of the Inspector General, 2015, revised 2016. Evaluation and Inspections Report 15-05.
• Follow-up Audit of Medical Development International’s Performance Under the Federal Correctional Complex Butner Medical Services Contract, U.S. Department of Justice, Office of the Inspector General, 2013. Audit Report 14-02.
• The Federal Bureau of Prisons’ Compassionate Release Program, U.S. Department of Justice, Office of the Inspector General, 2013. Report I-2013-006.

Court records

• United States v. Berry, 142 F.4th 184, U.S. Court of Appeals for the Fourth Circuit, 2025.
• United States v. Evans, No. 20-11768, U.S. Court of Appeals for the Eleventh Circuit, 2021. Unpublished.

News and other sources

• 1 in 4 Inmate Deaths Happens in the Same Federal Prison. Why?, NPR, 2023. By Meg Anderson.
• Ted Kaczynski, Known as the Unabomber for Years of Attacks That Killed 3, Dies in Prison at 81, Associated Press, 2023.
• Ponzi Schemer Bernie Madoff Dies in Federal Prison at 82, Associated Press (PBS NewsHour), 2021.
• Gambino Crime Family Elder Peter Gotti Dies in NC Prison, Associated Press (WLOS), 2021.
• ‘Taco’ Bowman, Ex-Head of Outlaws Biker Gang, Dies at 69, The Detroit News, 2019.
• Omar Abdel-Rahman, Radical Cleric Connected to 1993 World Trade Center Bombing, Dies, NPR (KNKX), 2017.
• Former Evangelist, Child Sex Abuser Tony Alamo Dies in Prison, Associated Press (UALR Public Radio), 2017.
• John Walker Jr., Spy Family Ringleader, Dies in Prison at 77, Associated Press (The Columbian), 2014. Also reports Arthur Walker’s death at Butner in July 2014.
• John Walker Jr., Cold War Spy for Soviets, Dies at 77, NPR (KERA News), 2014.
• Mob Hitman Frank Calabrese Sr. Dies in Prison, WGN-TV, 2012.
• 18 U.S.C. § 3582(d), Imposition of a sentence of imprisonment, U.S. Code (Legal Information Institute).
• 18 U.S.C. § 3621(e), Imprisonment of a convicted person, U.S. Code (Legal Information Institute).
• 18 U.S.C. § 4241, Determination of mental competency to stand trial or to undergo postrelease proceedings, U.S. Code (Legal Information Institute).
• 18 U.S.C. § 4243, Hospitalization of a person found not guilty only by reason of insanity, U.S. Code (Legal Information Institute).
• 18 U.S.C. § 4246, Hospitalization of a person due for release but suffering from mental disease or defect, U.S. Code (Legal Information Institute).

Sources reviewed September 2026.

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026