House Bill 767 was approved by the Texas House of Representatives and is awaiting a hearing before the state Senate's Education Committee. If the committee approves the bill and it is passed by the Senate, every high school athlete would need to receive the cardiac assessment before their first and third years to be eligible to practice or play. The law would take effect for the coming 2015-2016 school year.
It's not the first time Texas legislature or organizations have considered the requirement.
The University Interscholastic League (UIL), the governing body in Texas that oversees high school athletic contests and would be responsible for administering the ECG tests, independently considered mandating tests as recently as 2013. The UIL Legislative Council, based on a recommendation by the organization’s Medical Advisory Committee, decided against it.
Instead, in August of 2013, the UIL created the Sudden Cardiac Arrest Awareness Form that must be signed annually by every student-athlete and their parent or guardian. It details what causes Sudden Cardiac Arrest, the ways to screen for it, and symptoms that include fainting, dizziness, unusual fatigue, chest pain and heart palpitation. But some victims of Sudden Cardiac Arrest never experience symptoms.
The push for the bill
As far as anyone knew, Cody Stephens was a healthy 18-year-old senior who played football at Crosby high school. Without any symptoms, he fell asleep at home and never woke up May 6, 2012. His autopsy revealed he had an enlarged heart, which gave out, according to the Associated Press.
Cardiomyopathy, which Cody suffered, is among the conditions ECG tests can detect, including congenital defects, arrhythmia and coronary heart disease.
"It's something that can affect and does affect everybody," Cody's mother, Melody Stephens, said. Her son's death was the first time she and her husband, Scott Stephens, had heard of Sudden Cardiac Arrest occurring in young people.
The two founded the Cody Stephens Go Big Or Go Home Foundation in his memory and have raised about $500,000 over the last three years to help provide ECG screenings. The foundation grants money to schools that can't afford to start a testing program, which are especially costly in the first year because all the student athletes are tested at the start.
Melody and Scott Stephens petitioned the UIL to make ECG screenings part of the required standard physical exams the organization already ensures every student athlete complete. When the Medical Advisory Committee considered mandatory ECG screenings in 2013 and did not recommend them, Melody and Scott began supporting state legislation charging the UIL to administer the heart screenings.
The efficacy and resource requirements of the test
The UIL Medical Advisory Committee is opposed to preventive ECG tests for the same reasons as the American College of Cardiology and the American Heart Association: resources and cost.
If Bill 767 is passed into law, the state's health care infrastructure might not be able to accommodate the new demand. Texas already has an insufficient number of ECG machines and pediatric cardiologists to interpret ECG reports and most of the 1,025 school districts in the state are part of the UIL, according to the House Research Organization.
The efficacy of the test also has been called into question because so few student athletes have cardiovascular conditions that make them at-risk for Sudden Cardiac Arrest. Cases among high school athletes range from 1 in 23,000 to as few as 1 in 300,000, according to studies considered by the House Research Organization. False positives and false negatives also limit how helpful ECGs are at identifying conditions.
In 2014 a Texas non-profit called The Cypress ECG Project screened about 30,000 student athletes and discovered 13 that required some form of corrective surgery due to a heart condition, spokesperson Mary DeBauche said. In the eyes of the organization, even finding one student at risk of Sudden Cardiac Arrest makes the time and effort worthwhile, but Debauche acknowledged challenges in providing ECG tests to all student athletes.
Costs for the ECG tests
In addition to resources, cost is a hurdle.
For people with health insurance, an ECG might cost as low as $65. However, health insurance companies generally will not cover the cost of an ECG performed as a preventive measure. Unless a doctor identifies a need and orders an ECG test, a patient would have to pay out-of-pocket if they wanted the exam, which can cost anywhere from $400 to $2,000.
The Texas House Research Organization collected information arguing the test could be offered for as low as an additional $15 to the standard physical exam.
The Cypress ECG Project only charges $15 per test, which DeBauche said is funded by school districts or paid for by the families of the student athletes. She added that the organization understands $15 per test can be a significant amount of money for some districts and families so they do their best to cover the cost entirely.
Those in favor of the bill argue the majority of students will have access to the test at a cost of $15. Students without health insurance can receive the ECG test and those with health insurance wouldn't use it because no one has a co-pay for an ECG as low as $15.
"I'm applying for grants all the time," DeBauche said. "We don't run into very many school districts that don't have a high percentage of free and reduced lunch families."
An amendment to the bill was suggested that would allow any parent or guardian to submit a written request to waive an ECG test for a student athlete for any reason.
UIL is not currently preparing to make any rule changes or take on the responsibility of ECG testing student athletes, which the bill would mandate, spokesperson Kate Hector said. The ruling body that would oversee the change meets again in June.
The Texas Department of Insurance did not have a comment on the bill or what impact, if any, it would have on insurance in the state because it has not been passed into law.