A review of the literature showed that there is no published information on prison medical librarianship. Utilizing the case study methodology, the writer of this paper, a solo librarian working in a prison hospital, presents and analyses the operations of the medical library, at the Federal Medical Center in Butner, North Carolina. The functions of budgeting and financing, marketing, collection development and resource access, as well as user education are examined. The study reveals peculiar challenges of working in this environment as is evident in the operation of the Library and Training Committee, the librarian's position as a contract employee, and the issues involved in meeting the needs of a tangential clientele--prison inmates. A strategic plan framework is presented as a means of addressing the shortcomings manifested in the current state of affairs. The framework presents a vision, identifies the strengths, weaknesses, opportunities and threats that impact on this medical library, and lists goals and objectives towards the future development of this unique library.