Trips to local hospitals are treated similarly, except for reliance on reports from the prisons that identified telemedicine patients who would otherwise have been sent to a hospital. In the conventional care cost equation, patients who visit specialists in the local community are charged the full cost of an external consultation. Because it is assumed that all of these external consultations are averted by telemedicine, each external consultation in the telemedicine equation is replaced by the estimated telemedicine cost for the appropriate specialty. (See equation B.5.)