The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Education Pre-K -12
BILL: CS/SB 1070
INTRODUCER: Education Pre-K - 12 Committee and Senator Simon
SUBJECT: Electrocardiograms for Student Athletes
DATE: March 12, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Sabitsch Bouck ED Fav/CS
2. HP
3. RC
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1070 requires electrocardiogram (EKG) assessments for student athletes participating in
interscholastic athletic competitions at Florida public and private schools. Specifically, the bill:
• Names the act the “Second Chance Act.”
• Adds an EKG, when applicable, to the annual medical evaluation that is required for
participation in interscholastic athletic competition but allows an exemption by written
statement from a physician.
• Requires the Florida High School Athletic Association (FHSAA) to identify student athletes
who, beginning in the 2026-2027 school year, must receive an electrocardiogram.
• Requires the bylaws adopted by the FHSAA to include a timeframe for student participants
in interscholastic athletic competitions or candidates for interscholastic athletic teams to
receive an EKG in subsequent years.
• Requires the FHSAA to develop a standard form for exemptions.
• Provides requirements for parents who object to an EKG on religious grounds and for the
licensed practitioner that may exempt a student from the requirement as well as for an
attorney preparing a release of liability.
The bill takes effect on July 1, 2025.
REVISED: BILL: CS/SB 1070 Page 2
II. Present Situation:
About Electrocardiograms
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 electrocardiogram 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.
The report stated that sudden cardiac death, while rare, is the leading cause of non-traumatic
deaths among young athletes and provided the following:
1
National Library of Medicine, National Center for Biotechnology Information, Electrocardiogram,
https://www.ncbi.nlm.nih.gov/books/NBK549803/ (last visited Mar. 4, 2025).
2
National Library of Medicine, National Center for Biotechnology Information, Electrocardiogram,
https://www.ncbi.nlm.nih.gov/books/NBK549803/ (last visited Mar. 4, 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. BILL: CS/SB 1070 Page 3
• 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
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. BILL: CS/SB 1070 Page 4
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.
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. 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.
12
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).
13
III. Effect of Proposed Changes:
CS/SB 1070, the “Second Chance Act,”
14
amends s. 1002.20, F.S., requiring that students
receive an electrocardiogram (EKG) before participating in athletics. The bill allows a parent to
provide a written statement from a physician stating that the student does not need an EKG.
The bill also amends s. 1006.20, F.S., regarding bylaws adopted by the Florida High School
Athletic Association (FHSAA) to identify each student in the 2026-2027 school year who
participates in interscholastic athletic competition or is a candidate for an interscholastic team
who must receive an EKG.
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.
12
Section 1006.20(2)(c), F.S.
13
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
14
The Act is named in honor of Chance Gainer, an 18-year old senior and Port St. Joe High School football player who died
after collapsing during a football game on September 6, 2024. BILL: CS/SB 1070 Page 5
The bill requires the FHSAA to adopt a schedule that, by the 2028-2029 school year, each
student who participates in or is a candidate for interscholastic athletic competition has received
at least one EKG as part of the required medical evaluation.
The bill requires the FHSAA to adopt bylaws that specify the student athletes who must receive
an EKG in the 2029-2030 school year and in subsequent years.
The bill also specifies that if a parent objects to the student receiving an EKG on the grounds of
the parent’s or student’s religious tenets or practices, the parent must provide a written release of
liability that has been prepared by an attorney in good standing with the Florida Bar. Alternately,
the parent may provide a written statement from a licensed practitioner under chapter 458 or 459
of Florida law, which governs medical and osteopathic physicians, and who is in good standing
with the practitioner’s regulatory board indicating that the student does not require the EKG.
Under those circumstances, the student would be allowed to participate in or be a candidate for
an interscholastic athletic team. The FHSAA is required to develop a standard form to document
exemptions from the required EKGs.
The bill takes effect on July 1, 2025.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None. BILL: CS/SB 1070 Page 6
B. Private Sector Impact:
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.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 1002.20 and
1006.20.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Education Pre-K – 12 Committee on March 11, 2025:
The committee substitute establishes the bill as the “Second Chance Act” and requires
that, beginning with the 2026-2027 school year, participating and prospective student
athletes identified by the Florida High School Athletic Association (FHSAA) must
receive an EKG as part of the student athlete’s medical evaluation. The amendment also
requires the FHSAA to develop a schedule that by the 2028-2029 school year all
participating and prospective student athletes have received at least one EKG and
requires the FHSAA bylaws to specify those students who must receive an EKG in the
2029-2030 school year and thereafter.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.