STORAGE NAME: h1135c.EEC
DATE: 4/3/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: CS/CS/HB 1135
TITLE: Electrocardiograms for Student Athletes
SPONSOR(S): Shoaf
COMPANION BILL: CS/CS/SB 1070 (Simon)
LINKED BILLS: None
RELATED BILLS: None
Committee References
Student Academic Success
16 Y, 0 N, As CS
Education & Employment
18 Y, 0 N, As CS
SUMMARY
Effect of the Bill:
The bill requires electrocardiogram (EKG) assessments for student athletes participating in interscholastic athletic
competitions at public high schools. The bill authorizes a parent exemption from an EKG for their student on the
basis of religious tenants or practices. The bill also requires the Florida High School Athletic Association (FHSAA)
bylaws to include, by the 2028-2029 school year, a requirement that students in grades 9-12 receive an EKG to join
an athletic team if the school district is able to obtain EKGs at a rate of less than $20 per student. Moreover, the EKG
requirement does not apply to students who live in a school district that is unable to obtain a public or private
partnership. The FHSAA must also adopt bylaws that prohibit students with abnormal EKG results from
participating in athletics until they obtain a medical clearance. Under the bill, a school district cannot be held liable
if a student who received medical clearance suffers injury or death as a result of a cardiac event arising from
participation in athletics.
Fiscal or Economic Impact:
The bill has a fiscal impact on the private sector as parents are responsible for the costs of the EKG assessments.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
The bill requires that public school students in grades 9-12 receive at least one electrocardiogram (EKG) from their
physician or school district before participating in athletics for the first time unless:
The parent objects in writing to the EKG on the basis of religious tenets or practices; or
The school district is unable to obtain a public or private partnership to provide EKGs to students for less
than $20 per student. (Section 1).
The bill mandates that the Florida High School Athletics Association (FHSAA) incorporate the EKG requirement
into its bylaws for student athletic participation in grades 9–12, beginning in the 2028–2029 school year. Under
the bill, the FHSAA bylaws must specify that the required EKG and medical evaluations for athletic participation
may be administered not only by medical practitioners licensed in Florida, but also by practitioners with active
equivalent licenses in another state where the EKG or medical evaluation is performed. (Section 2).
The bill also specifies that students may be exempt from the EKG requirement if it is contrary to their religious
tenants or practices and the student’s parent objects to the EKG in writing. If the student is exempt from the EKG
requirement, then no person or entity in a position to otherwise rely on the EKG results may be held liable for the
student’s injury or death arising from an undisclosed medical condition that would have been revealed by an EKG.
(Section 2).
The bill requires that the FHSAA adopt bylaws or policies that prohibit students with abnormal EKG results from
participating in athletics until the student submits a written medical clearance. The medical clearance must be
authorized by a health care practitioner trained in diagnosis, evaluation, and management of EKGs. The bill JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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specifies that there shall be no liability on the part of the school district that would otherwise rely on the medical
clearance in the event that a student’s injury or death arises from a cardiac event due to the student’s participation
in interscholastic athletics. (Section 2).
Under the bill, each school district must pursue public and private partnerships to provide low-cost EKGs to
students. The FHSAA bylaws’ EKG requirement also does not apply to students who reside in a school district that
is unable to obtain a public private partnership to provide EKGs at a rate of less than $20 per student. (Section 3).
The bill is effective on July 1, 2025. (section 4).
FISCAL OR ECONOMIC IMPACT:
PRIVATE SECTOR:
This bill does not have an impact to state revenues or expenditures. The bill requires an electrocardiogram as part
of the medical screening requirement for student athletes which could be a cost to the parent or health insurance.
RELEVANT INFORMATION
SUBJECT OVERVIEW:
Electrocardiogram
An electrocardiogram (EKG) represents a recording of the heart's electrical activity. An EKG is an integral part of
the initial evaluation of a patient suspected of having a cardiac-related problem.
1
The inventor of the EKG in 1902, William Einthoven was named the "father of electrocardiography" and was
awarded the Nobel Prize in Medicine in 1924 for his work that laid the foundation of the most fundamental
technique for investigating heart disorders. The EKG was soon recognized as a robust screening and clinical
diagnostic tool, and today it is used globally in almost every healthcare setting.
2
The EKG is a non-invasive diagnostic modality that has a substantial clinical impact on investigating the severity of
cardiovascular diseases. The use of an EKG has expanded from simple heart rate and essential rhythm monitoring
to interpreting complex arrhythmias, myocardial infarction, and other abnormalities. The EKG is increasingly being
used for monitoring patients on antiarrhythmics and other drugs, as an integral part of preoperative assessment of
patients undergoing non-cardiac surgery, and for screening individuals in high-risk occupations and those
participating in sports. Also, the EKG serves as a research tool for surveillance and experimental trials of drugs
with recognized cardiac effects.
3
Electrocardiograms for High School Student Athletes
In 2021 the Office of Program Policy Analysis and Governmental Accountability (OPPAGA) published a report that
collected information on the following topics:
4
Benefits and challenges of requiring EKG assessments for student athletes.
Cost of EKG assessments.
Accuracy of EKG assessments.
Current school district practices related to requiring or recommending EKGs for student athletes.
Nationally recognized or accepted criteria to identify athletes who should receive an EKG assessment.
1
National Library of Medicine, National Center for Biotechnology Information, Electrocardiogram,
https://www.ncbi.nlm.nih.gov/books/NBK549803/ (last visited Mar. 11, 2025).
2
National Library of Medicine, National Center for Biotechnology Information, Electrocardiogram,
https://www.ncbi.nlm.nih.gov/books/NBK549803/ (last visited Mar. 11, 2025).
3
Id.
4
OPPAGA Report, Office of Program Policy Analysis and Governmental Accountability, Electrocardiograms for High School
Student Athletes, (Dec. 2021), available at
https://oppaga.fl.gov/Documents/Presentations/OPPAGA%20Dec%201%202021%20Presentation%20Slides--EKG--
Sec%20Ed%20and%20Career%20Dev.pdf, at slide 2. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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The report stated that sudden cardiac death, while rare, is the leading cause of non-traumatic deaths among young
athletes and provided the following:
The incidence of sudden cardiac death among high school athletes ranges from 1 in 23,000 to 1 in 300,000.
Intense athletic activity can trigger sudden cardiac death.
Athletes often have no symptoms of obvious injury prior to sudden cardiac death.
Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in athletes and its prevalence
among athletes ranges from 1 in 1,426 to 1 in 1,667 (the prevalence in the general population is 1 in 500).
5
The report stated that EKG assessments may detect certain heart abnormalities by recording the heart’s electrical
signals and providing information on strength, speed, rhythm and number of heart beats. The EKG may help
identify 60% of diagnoses related to sudden cardiac death.
6 The EKG is non-invasive, only takes a few minutes, and
if abnormal results are found, the individual is recommended to seek follow-up with a cardiologist who is trained
in diagnosing and treating conditions of the heart and blood vessels.
The report contained information from a study conducted by the Brevard County School District that showed that
fewer than 1 percent of student athletes who received an EKG assessment in 2019-2020 had a heart condition that
put them at risk for sudden cardiac arrest. Of 5,877 students who received an EKG assessment, 199 or 3.4 percent
of students had abnormal EKG assessment results, but only 8 or .01 percent reported a diagnosis that put them at
risk of sudden cardiac arrest.
7 The Brevard County School District began requiring EKG assessments in the 2019-
2020 school year for grades 7-12 but authorized parents to opt out for any reason. In the 2020-2021 school year
35 percent of student athletes opted out of receiving an EKG assessment.
8
The report provided information from two other states, Texas and Pennsylvania, that at that time had passed
recent legislation to address use of EKG assessments. Neither state has mandated EKG assessments but have
stressed providing information to students and parents about sudden cardiac arrests and EKGs.
9
The American Heart Association (AHA) asserts that annual prescreening of competitive athletes can improve
detection of cardiac abnormalities and minimize the risks associated with athletic participation. However, the AHA
does not recommend the use of tests such as a 12-lead EKG or echocardiogram in mandatory preparticipation
screening programs. Instead, these tests are best used as follow-up if an initial screening raises suspicions about
the presence of a cardiovascular disease. Reasons given include the strain on the healthcare system, access to
testing, and the rate of false-positive results.
10
Regulation of Florida High School Athletics
The Florida High School Athletic Association (FHSAA) is designated in Florida law as a governing nonprofit
organization of athletics in Florida public schools.
11 Any high school in Florida, including charter schools, virtual
schools, and home education cooperatives, may become a member of the FHSAA and participate in the activities of
the FHSAA. Membership in the FHSAA is not mandatory for any school. A private school that wishes to engage in
high school athletic competition with a public high school can become a member of the FHSAA. Florida middle
schools may also become members of the FHSAA.
5
OPPAGA Report, Office of Program Policy Analysis and Governmental Accountability, Electrocardiograms for High School
Student Athletes, (Dec. 2021), available at
https://oppaga.fl.gov/Documents/Presentations/OPPAGA%20Dec%201%202021%20Presentation%20Slides--EKG--
Sec%20Ed%20and%20Career%20Dev.pdf, at slide 4.
6
OPPAGA Report, Office of Program Policy Analysis and Governmental Accountability, Electrocardiograms for High School
Student Athletes, (Dec. 2021), available at
https://oppaga.fl.gov/Documents/Presentations/OPPAGA%20Dec%201%202021%20Presentation%20Slides--EKG--
Sec%20Ed%20and%20Career%20Dev.pdf, at slide 5.
7
Id. at slide 19.
8
Id. at slide 18.
9
Id. at slide 11.
10
American Heart Association, Pre-participation Cardiovascular Screening of Young Competitive Athletes: Policy Guidance,
available at https://www.heart.org/-/media/Files/About-Us/Policy-Research/Policy-Positions/Healthy-Children-and-
Schools/Athlete-Screening.pdf.
11
Section 1006.20(1), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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The FHSAA is required to adopt bylaws that, unless specifically provided otherwise by statute, establish eligibility
requirements for all students who participate in high school athletic competition in its member schools. The
FHSAA is specifically required to adopt bylaws that require all students participating in interscholastic athletic
competition or who are candidates for an interscholastic athletic team to satisfactorily pass a medical evaluation
each year before participating in interscholastic athletic competition. The medical evaluation must be administered
by a healthcare practitioner who is licensed in Florida.
12 This includes engaging in any practice, tryout, workout,
conditioning, or other physical activity, during or outside the school year, associated with the student’s candidacy
for an interscholastic athletic team. As a result, students must have a Preparticipation Physical Evaluation form
(form) on file—complete with a healthcare provider’s signature and certification that the student is physically fit to
participate in interscholastic athletics—that is valid for 365 days.
13 The form asks 29 medical history questions,
including 10 questions about heart health history.
14 The form also notes that the FHSAA Sports Medicine Advisory
Committee strongly recommends that student athletes undergo a medical evaluation of risk factors for sudden
cardiac arrest, which may include an EKG.
15
The FHSAA conducts an annual Sports Participation Survey. The most recent survey found that for the 2023-2024
school year, there were 299,383 student athletes among 19 different sports from an overall student enrollment
population of 873,804 from member schools (grades 9-12).
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BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Student Academic Success
Subcommittee
16 Y, 0 N, As CS 3/18/2025 Sanchez Blank
THE CHANGES ADOPTED BY THE
COMMITTEE:
Authorized the administration of student medical evaluations and EKGs
by medical practitioners who are licensed in another state.
Education & Employment
Committee
18 Y, 0 N, As CS 4/2/2025 Hassell Blank
THE CHANGES ADOPTED BY THE
COMMITTEE:
Specified that the FHSAA’s bylaws must require students in grades 9-12
to receive an EKG before participating in athletics beginning in the
2028-2029 school year.
Required that the FHSAA bylaws or policies prohibit a student who
receives abnormal EKG results from participating in athletics until
receiving medical clearance from a healthcare practitioner.
Specified that there shall be no liability for school districts in a position
to otherwise rely on the results of an EKG in the event of a student’s
injury or death arising from a cardiac event due to participating in
athletics.
Required that school districts pursue public and private partnerships
to provide low-cost EKGs.
Exempted students who live in a school district that is unable to secure
a partnership to obtain EKGs for less than $20 per student from the
EKG requirements.
12
Section 1006.20(2)(c), F.S.
13
Florida High School Athletic Association, Preparticipation Physical Evaluation Form, available at
https://fhsaa.com/documents/2023/3/3/EL2_Form.pdf; Florida High School Athletic Association, Bylaws of the Florida High
School Athletic Association, at 31, available at 2425_handbook_2_21_25.pdf.
14
Florida High School Athletic Association, Preparticipation Physical Evaluation Form, available at
https://fhsaa.com/documents/2023/3/3/EL2_Form.pdf.
15
Id.
16
Florida High School Athletic Association, Sports Participation Survey (2023-2024), available at
https://fhsaa.com/documents/2024/7/11//2023_24_Total_Participation_Study_for_website.pdf?id=5591. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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THIS BILL ANALYSIS HAS BEEN UPDATED TO INCORPORATE ALL OF THE CHANGES DESCRIBED ABOVE.
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