By Nicole Blevins, Madelyn Hanes, Lily Marks, Stephen Prager, Victoria Rhemrev, Rachel Stickelmaier

Sheri Priddy knew something was seriously wrong. For the three days in November 2023, her symptoms had been getting stranger and stranger.

It began with some double vision, something she’d experienced before due to her chronic migraines. But by the third day, her condition was far different from any migraine she’d ever experienced. She was unable to read her phone, barely able to see her husband, and could not bring herself to the bathroom. She decided she needed to go to the emergency room.

Priddy’s husband drove her nearly an hour from their home in Crane to Indiana University Health in Bloomington. She waited sevenhours for a CT scan. All the beds were taken, so she spent that time in an uncomfortable blood-draw chair. Things only got worse.

“I couldn’t see to walk hardly. I had to cover one eye, and I had to lie on my side to watch TV,” Priddy, 47, said.

After the scan came back negative, she was told there was “nothing there.” Even though she wasn’t feeling any pain and insisted the symptoms were not normal, the doctor gave Priddy a migraine cocktail, told her to drink lots of water, and sent her on her way. She was unable to walk, and her husband had to help her to the car.

Sheri Priddy at her home in rural Greene County. (Photo by Anne Kibbler)

Priddy returned to the emergency room several more times over the next year and racked up an estimated $80,000 in medical bills.But despite all the telltale signs — pressure in Priddy’s head, soreness in her arms, and numbness on the side of her face — it took more than a year for IU Health to figure out what was really going on.

She’d suffered a stroke, one that would leave her with permanent damage.

IU Health Bloomington declined to comment.

Priddy fell victim to systemic problems within the Indiana emergency care system, which has faced chronic underfunding and reduced staffing, deficits further amplified by the pandemic.

As a result, hospital and Emergency Medical Services (EMS) staff are burdened with longer hours, and many are leaving the field due to burnout. Meanwhile, patients face longer wait times, and hospitals have too few beds to place them. The quality of care has suffered, sometimes with disastrous outcomes.

Gary Miller, executive director of the Indiana Emergency Medical Services Association, called it a “circular nightmare,” where each bottleneck slows down every other part of the process.

“Everything gets backed up,” Miller said. “They can’t get the patients off the floor. They can’t get them out of the ER. And so that’s why ambulances have to divert to a different hospital. And, of course, when that happens, usually it’s a little bit further distance, and that creates longer transport times for patients, which means that these ambulances can’t turn around and take the next patient as quickly.”

All of this, Miller said, stems from one fundamental problem: There simply aren’t enough people working in hospitals, or in emergency medical services.

IU Health Bloomington Hospital (Photo by Limestone Post)

EMS consistency a ‘constant challenge’

In 2024, emergency medical services in Indiana went on more than one million runs, according to Indiana Department of Homeland Security data. On average, EMS took approximately eleven minutes to arrive at the scene and 22 minutes to transport patients to their destination, typically a hospital.

Weather, traffic congestion, road construction, high call volumes, limited EMS staff, and hospital availability all contribute to longer response times, a 2024 state survey of EMS providers found.

Indiana does not have a consistent structure for ambulance services, and who staffs and pays for the services varies across the state.

“Different counties prioritize EMS in different ways, and the quality is reflected in that,” said Eric Yazel, the chief medical director for Indiana EMS. “Trying to help the well-funded places keep raising the bar, while also helping some of those others get to where they need to be, is kind of the constant challenge that we’re looking at in Indiana.”

The 2024 survey of EMS operations found:

• 34.1% are operated by volunteer fire departments
• 19.5% are operated by paid fire departments
• 17.6% are combined paid and volunteer departments
• 11.4% are municipally based non-fire services
• 8.9% are hospital-based services
• 6.2% are privately operated services
• 2.3% are other, industrial-based services or not available

Of those services, 68.1% are paid for with government funds, 24% receive health care funding, and 7.9% are funded through other sources, according to a state report.

The average EMS organization employs seventeen emergency medical technicians, eight paramedics, two A-EMTs, and three non-EMS certified drivers, according to the report.

The average career of a paramedic is only five to six years. In a 2025 EMS workforce assessment conducted by the state, employees cited burnout and low pay as top reasons for leaving the industry.

“The level of compensation, when you compare it to the knowledge expectation, the level of stress it puts on your body, and things like that, is completely out of proportion,” Yazel said.

Critical cases take priority in Indiana ERs

While Priddy’s seven-hour wait for a CT scan was exceptional, it’s not unusual for Hoosiers to wait for hours in the emergency room before receiving care. Hoosiers typically spend just over two hours sitting in waiting rooms for nonpsychiatric emergencies.

The average Indiana county has fewer than two hospital beds for every thousand people.

“There is a nationwide issue with long wait times — waiting to be treated or waiting to be admitted or waiting to be discharged,” Miller said.

Not every call requires a trip to the emergency room, Yazel said, and EMS can better triage patients based on their care needs to free up ambulances and hospital space.

Overall, Indiana performs better than average with patients in critical condition. Seventy-eight percent of Hoosiers who show symptoms of a stroke receive a brain scan within 45 minutes, according to data from the Centers for Medicare & Medicaid Services.

But that comes at the cost of treating those facing non-life-threatening emergencies.

“People who are injured but aren’t in life-threatening danger, those are the people waiting out in the hallway,” Miller said.

When ambulances arrive with new patients, there is often nowhere to put them.

“There are many factors that contribute to the potential overcrowding of emergency departments, which is a problem across the country due to an aging population, more complex patients, and challenges that impact staffing levels,” said Steve Cooke, senior director of public relations for the Indiana Hospital Association, in a written statement.

“The fact is, Hoosiers spend less time in emergency rooms compared to patients in most states,” Cooke wrote. “According to data from the Centers for Medicare & Medicaid Services, from June 1, 2023, through June 30, 2024, Indiana ranked eleventh in the nation for the lowest wait times.”

Low pay, long hours lead to staff shortages

Staffing shortages for Indiana EMS peaked in 2022 as the country was still reeling from the COVID-19 pandemic. Although the shortages have eased three years later, the most recent EMS report by the Indiana Department of Homeland Security found that they are still a problem.

“It has eased a little bit, but I still feel that we’re behind the eight ball and we still need to catch up to where we were,” Miller said.

Indiana still has just ten nurses for every 1,000 people, according to data from the Bureau of Labor Statistics. Last year, the Indiana Hospital Association estimated that in order to meet future health care demands, the state will need an additional 5,000 nurses by 2031.

The average Indiana EMT makes just $19 an hour, averaging out to a yearly salary of just over $40,000.

“You are talking about an hourly wage for an EMT that is less than what you’d make at Chick-fil-A, and you’re working a 24-hour shift where you might see a child die,” Yazel said.

Miller said some hospitals have moved away from 24-hour shifts, citing employee fatigue. But that has meant more paramedics are needed to cover the same number of hours.

No matter how the hours are sliced up, the job remains grueling. And as fewer students enter the field to fill the gaps, it’s only getting worse.

In 2023, the rate of enrollment in nursing programs dropped by 1.4%, according to a national survey by the American Association of Colleges of Nursing. Remaining employees have to shoulder even greater workloads, and the industry has increasingly relied on nursing students to pick up the slack.

When Priddy was taken to the hospital, she said the emergency room was so understaffed that it appeared to be relying on poorly trained interns to provide care.

She said a “little teenage girl,” a pre-med student in training, took her blood. Priddy asked the trainer if someone more experienced could take her blood but was told she’d be fine.

The trainee asked her supervisor which vein to pick and where to insert the needle. The supervisor held down Priddy’s arm while the student jammed it in.

“I start screaming,” Priddy said. “The next thing I know, my whole arm swells up.”

The staff were shocked to find that the needle stick caused a large hematoma. “It’s black all the way down. I’m freaking and I’m bawling,” she said.

As a result, the nurses told her they’d give her an IV drip later, after the swelling reduced. Priddy never received an IV.

Funding a top priority to support emergency services

Advocates point to many ways emergency services can be made more efficient, like having ambulances serve greater numbers of hospitals and increasing the use of mobile health care.

For many Hoosiers, access to primary care services is limited, leaving them to rely on emergency rooms or urgent care facilities. A study by the Cicero Institute in 2024 found 71 of the state’s 92 counties have a shortage of health care professionals.

Another 2024 Cicero Institute study argued to expand services through community pharmacies to fill the primary care gap. The study found that 30% of people nationwide don’t have a primary care physician but 90% live within five miles of a pharmacy.

Indiana is one of eighteen states that define EMS as an “essential service,” according to the National Conference of State Legislatures, but does not have a unified system. That model leaves funding EMS services to individual counties and municipalities.

In April, the Indiana General Assembly passed new legislation that attempts to deal with staffing shortfalls by allowing nursing students to begin their training while still in high school.

But advocates say there is a much broader problem that needs to be addressed: funding.

“It would be nice to have consistent funding,” said Yazel. “Honestly, at the very simplest level, it would be nice if most services couldget a level of reimbursement from insurance, Medicaid, things like that, to pay for the services they provide.”

Starting in 2024, Medicaid began reimbursing Indiana hospitals at the same rate as Medicare, which was the first increase in fourteen years.

Miller said this increase has made things “somewhat bearable” but that financial strain is still severe.

Medicaid changes in the recently signed federal budget reconciliation bill will affect eligibility for services, create work requirements, and alter fee schedules, among other sweeping changes to the program, according to KFF, a health policy nonprofit organization.

While they call for more state and federal funding, advocates say the real culprits are for-profit insurers, which are incentivized to pay hospitals as little as possible.

“They have dragged their feet as far as increasing their reimbursement,” Miller said.

As a result of the low reimbursements, hospitals have begun billing patients directly, leaving them with giant, surprise bills.

In 2022, Anthem, one of Indiana’s largest insurers, was ordered to pay out $4.5 million after it spent years denying hospitals’ claims for ER visits it deemed unnecessary. However, hospitals say Anthem still owes more than $12 million for tens of thousands more claims that it wrongly downgraded.

“The insurance companies aren’t paying their fair share,” Miller said. He said the only way to fix the funding shortfall is for the General Assembly to hold these companies accountable.

Making Indiana’s hospital system more efficient and affordable won’t fix what happened to Priddy. The delay in treating her stroke has left the 47- year-old to suffer from lifelong complications. She now suffers from vertigo, her eyesight is ruined, and she struggles to walk. She can no longer do basic tasks for herself, like driving to the grocery store, and says her thought processing is much slower.

“I feel like a little grandma,” she said. “I’m watched all the time. Because I don’t know when the symptoms are going to come.”

She said she believes that if she’d been able to get the tests she needed sooner, her stroke could have been detected before the worst occurred.

“You get angry because you feel like things have been taken from you and you can’t get them back,” she said. “My whole goal is to help someone else because I don’t want anybody to have to do this.”

This story was written by journalists at the Arnolt Center for Investigative Journalism at Indiana University in partnership with the Limestone Post.