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 Fiscal Policy
BILL: CS/CS/CS/SB 1070
INTRODUCER: Fiscal Policy Committee; Health Policy Committee; Education Pre-K - 12 Committee;
and Senator Simon
SUBJECT: Electrocardiograms for Student Athletes
DATE: April 3, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Sabitsch Bouck ED Fav/CS
2. Brown Brown HP Fav/CS
3. Sabitsch Siples FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/CS/SB 1070 amends Florida law to require electrocardiogram (EKG) assessments for
student athletes participating in interscholastic athletic competitions at Florida public and private
schools. Specifically, the bill:
• Provides that, once enacted, it may be cited as the “Second Chance Act.”
• Amends s. 1002.20, F.S., to require that prior to participating in athletics a student must
receive an EKG, when applicable under s. 1006.20, F.S., with exceptions.
• Amends s. 1006.20, F.S., to provide that the bylaws adopted by the Florida High School
Athletic Association (FHSAA) must require that, beginning with the 2028-2029 school year,
all students participating or seeking to participate in interscholastic athletic competition for
the first time must pass an EKG screening prior to participation based on standards
established by the FHSAA’s Sports Medicine Advisory Committee.
• Requires the FHSAA to further develop the preparticipation physical evaluation and history
form to include information about the practitioner performing the EKG, information related
to referrals based on the EKG, and advisement to students concerning the results of the EKG.
The bill requires a section of the form to record medical clearances for participation in
athletics based on the results of the medical evaluation and EKG or recommendations for
follow-up treatment by a health care practitioner with specific training.
• Requires the FHSAA to develop a standard form for exceptions to the required EKG that
documents exemptions based on religious grounds or a medical exemption when documented
REVISED: BILL: CS/CS/CS/SB 1070 Page 2
by a physician, and requires submission of a notarized form signed by the parent and
received by the FHSAA prior to participation.
• Adds the required EKG to limitations on liability when there is an exemption based on
religious grounds or a medical exemption.
The bill provides an effective date of July 1, 2025.
II. Present Situation:
About Electrocardiograms
An electrocardiogram (EKG)
1
is 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 medical
problem.
2
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 health care setting.
3
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 who are taking antiarrhythmics or 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.
4
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:
5
• 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.
1
EKG and ECG are both used as abbreviations for electrocardiogram.
2
National Library of Medicine, National Center for Biotechnology Information, Electrocardiogram,
https://www.ncbi.nlm.nih.gov/books/NBK549803/ (last visited Mar. 17, 2025).
3
Id.
4
Id.
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 2. (last visited Mar. 17, 2025). BILL: CS/CS/CS/SB 1070 Page 3
• 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:
• 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.)
6
The OPPAGA 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 percent of diagnoses related to sudden
cardiac death.
7
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 OPPAGA report contained information from a study conducted by the Brevard County
School District that showed that fewer than one 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 (3.4 percent) of those students had
abnormal EKG assessment results, but only eight (one-tenth of one percent) reported a diagnosis
that put them at risk of sudden cardiac arrest.
8
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.
9
The OPPAGA report provided information from two other states, Texas and Pennsylvania, that
at that time had passed recent legislation to address the 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.
10
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 standard 12-lead
EKG
11
or echocardiogram
12
in mandatory pre-participation screening programs. Instead, the
6
Id. at slide 4.
7
Id. at slide 5.
8
Id. at slide 19.
9
Id. at slide 18.
10
Id. at slide 11.
11
The standard EKG provides a comprehensive view of the heart’s electrical activity from 12 different angles using 10
electrodes. Simplified versions use six leads or only one lead under certain circumstances.
12
An echocardiogram uses sound waves to show how blood flows through the heart and heart valves. BILL: CS/CS/CS/SB 1070 Page 4
AHA claims 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 health care
system, access to testing, and the rate of false-positive results.
13
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.
14
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. Such participation 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. The medical evaluation must be conducted by a
practitioner licensed under ch. 458 or ch. 459, F.S.,
15
a practitioner licensed under ch. 460, F.S.,
16
or an advanced practice registered nurse licensed under s. 464.012, F.S.,
17
and such practitioner
must be in good standing with his or her regulatory board.
18
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).
19
13
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 (last visited Mar. 16, 2025)
14
Section 1006.20(1), F.S.
15
Chapter 458, F.S., is the Medical Practice Act, and chapter 459, F.S., is the Osteopathic Medicine Practice Act. Allopathic
physicians, osteopathic physicians, physician assistants, anesthesiologist assistants, and medical assistants are all practitioners
who are licensed under those two chapters.
16
Chapter 460, F.S., is the Chiropractic Medicine Practice Act. Chiropractic physicians and certified chiropractic physician’s
assistants are practitioners licensed under that chapter.
17
Chapter 464, F.S., is the Nurse Practice Act, and governs licensure for a registered nurse or licensed practical nurse.
18
Section 1006.20(2)(c), F.S.
19
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 (last visited
Mar. 16, 2025) BILL: CS/CS/CS/SB 1070 Page 5
III. Effect of Proposed Changes:
CS/CS/CS/SB 1070, the “Second Chance Act,”
20
amends s. 1002.20, F.S., requiring that students
receive an electrocardiogram (EKG) before participating in athletics, as applicable under Florida
High School Athletics Association (FHSAA) requirements in s. 1006.20, F.S. The bill includes
the EKG requirement in the current exception that applies to the requirement for a medical
evaluation, i.e., when a student’s parent objects in writing based on religious tenets or practices.
The bill also creates an additional exception to the EKG requirement if a student’s parent
provides a written statement from a physician licensed under ch. 458 or ch. 459, F.S.,
21
stating
that the student does not require an EKG, in accordance with s. 1006.20(2)(d), F.S.
The bill requires the FHSAA to require that, by the 2028-2029 school year, each high school
student who participates or seeks to participate in interscholastic athletic competition has
received at least one EKG prior to participation for the first time.
The bill also specifies, in s. 1006.20(2)(d), F.S., 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 an objection in writing as well as a required FHSAA form. Additionally, a parent may
provide a certificate of medical exemption prepared by a physician licensed under ch. 458 or ch.
459, F.S., in good standing with either the Board of Medicine or Board of Osteopathic Medicine
in addition to the required FHSAA form.
The FHSAA is required by the bill to develop a standard form for exceptions to the bill’s EKG
requirement and the existing requirement for a medical evaluation.
The bill provides an effective date of 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.
20
The bill provides this citation 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.
21
Supra, note 15. BILL: CS/CS/CS/SB 1070 Page 6
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
The bill requires an EKG as part of the medical evaluation requirement for student
athletes, which could be a cost to the student’s parent or health insurance, unless the EKG
is provided free of charge or one of the bill’s exceptions applies.
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/CS/CS by Fiscal Policy on April 2, 2025:
The committee substitute clarifies provisions in the bill by:
• Clarifying that the Electrocardiogram (EKG) is a separate requirement from the
annual medical examination and is required prior to participation in athletics.
• Setting requirements for the Florida High School Athletic Association (FHSAA) to
adopt bylaws for the required passage of an EKG beginning in the 2028-2029 school
year for each first-time high school participant in interscholastic athletic competition.
• Requiring modifications to the preparticipation physical evaluation and history form
related to EKGs, requires the development of a specific form for exemptions based on
religious beliefs or a medical exception, and requires the submission of forms by
parents. BILL: CS/CS/CS/SB 1070 Page 7
• Maintaining provisions to limit liability for injury or death when a student is
participating in athletics under an exemption.
CS/CS by Health Policy on March 18, 2025:
The committee substitute clarifies provisions in the underlying bill by:
• Specifying that a written medical opinion designed to trigger an exception to the bill’s
EKG requirement must be issued by a physician licensed under ch. 458 or
ch. 459, F.S., not by other types of physicians or practitioners; and
• Providing that the FHSAA must include in its bylaws the criteria for determining
which students must have an EKG, as opposed to specifying the students who must
have one.
CS by Education Pre-K – 12 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, unless one of the
underlying bill’s exceptions applies. The bill requires the FHSAA to develop a schedule
to require that, by the 2028-2029 school year, each participating and prospective student
athlete has received at least one EKG prior to participation. The bill also 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.