Mandatory ECGs for Flagler County’s Student-Athletes: It’s About Life, Not ‘Parental Rights’

For the past few years AdventHealth has made free ECGs a voluntary part of student athletes’ physical. Tuesday evening the Flagler County School Board is voting on whether to make ECGs mandatory. Three board members–Will Furry, Sally Hunt, Christy Chong–are opposed. They say an ECG should be a parent’s choice. They’ve wrapped the issue under the banner of “parental rights,” as if ECGs were the same as masking during Covid, or whether to teach kids sex-ed. 

Their reasoning is flawed, and may cost lives.

There is nothing speculative, ideological or intrusive about ECGs. They are opposing a life-saving improvement in medical technology that merely updates athletes’ physicals in line with what we now know about one of the leading killers of young men and women, and with the increasing intensity and heat of competition. Opposition to ECGs on “parental rights” grounds is as absurd as opposing doctors using a stethoscope without parental consent or opposing a teacher’s requirement that students research their assignment on their laptop instead of at the public library. (See: “Free EKG Could Save a Student Athlete’s Life. School Board’s Furry, Hunt and Chong Oppose Mandating It With Physical.”

The three opponents would have stronger arguments against mandatory ECGs if they relied on the reasoning of the American Academy of Pediatrics, the American Heart Association or the American College of Cardiology, all of which support ECGs only for students who show concerning symptoms or who have a family history of heart issues. ECGs are not fail-safe, they can yield false positives or unnecessary follow-up interventions, which can be expensive, and there’s no equity in health care access–all fair and strong arguments.

But the three board members are not making those arguments. Even if they were, the ECGs, which generally cost around $80 to $90, are provided free by AdventHealth’s annual physicals for Flagler’s student-athletes. Mandatory ECGs do not equate to mandatory treatment: that’s when parental rights kick in. And the international consensus has moved toward mandatory ECGs for athletes (the European Society of Cardiology and the International Olympic Committee both require it). 

So is the Central Florida consensus. The Volusia County School Board approved making ECGs mandatory for its 5,300 middle and high school students starting in 2022-23.  It was a 5-0 vote. Six other Florida school districts had done likewise as of 2021–Seminole, Orange, Suwanee, Highlands and Brevard, though Brevard still has an opt-out. 

It’s puzzling why these board members want parental consent for an ECG but not for a physical, which is mandatory. No physical, no athletic privileges. The required physical is non-invasive, but not non-intrusive. It includes questions about the student’s and the student’s family’s medical history, medication history and drug use. Height, weight, blood pressure, pulse, vision and other physical attributes are evaluated, so is strength, flexibility, posture and other anatomical characteristics. It can be uncomfortably so. 

An ECG is not. It’s a five-minute procedure that simply reads the heart’s electrical activity through sticky electrodes on different parts of the body. 

According to AdventHealth, up to one in 300 student athletes have an undetected heart condition that puts them at risk of sudden cardiac arrest and death (the ratios are debatable, but alarming regardless). The condition claims 8,500 young lives a year. Only those deaths that occur on the field draw attention. But student athletes die of the condition while jogging, or in the gym, or simply going about their routine activities. Physicals as they are now provided do nothing to detect potential risks. 

Florida lawmakers are acknowledging that heart issues are posing a danger to young athletes. But the state is addressing the problem with half a brain: Starting July 1 it requires coaches to be certified in CPR and first aid, an excellent improvement, and it is requiring them to know how to use defibrillators. But the requirements stop there. In essence, the state won’t enact a requirement that could prevent cardiac episodes anywhere. It only cares about what happens on the field. Even there, it’ll only  defibrillate and get the kid off the field to avoid a lawsuit. The game can go on. (The state’s approach is identical to its “resiliency” policy with floods and hurricanes: keep building on flood-prone shores. Just build higher. Prevention is for suckers.) 

Last June, when the local school board was first discussing whether to make ECGs mandatory, April Adams wrote Board member Colleen Conklin about her own experience with her son, a senior at Flagler Palm Coast High School and a member of the soccer team. 

“Yesterday was the one year anniversary of the scariest phone call I have ever received,” Adams wrote. “We signed up for the free physicals they were offering for high school kids. Between the huge crowd, forgetting our paperwork and therefore needing to fill it out again, and trying to figure out how to register for the new app the district was using, I’ll admit I was a bit grumpy. We got to the end of the various stations for his physical, and we had an option for a free ECG screening. I wasn’t in the mood, but the volunteer at the table told me it was at most another 5-10 minutes, so I figured we might as well.”

The ECG came back abnormal. Her son was diagnosed with Wolff-Parkinson-White Syndrome with SVT. He was put on a heart monitor for two weeks. “We scheduled a heart ablation several weeks later to correct his abnormal electrical pathway,” Adams wrote. “He spent several hours on the operating table and the remainder of the day in the PICU recovering before we were released to go home.  A week later he was able to return to normal activities and resume soccer.”

Hunt, Furry and Chong say no one is keeping parents from taking advantage of the free ECGs, as most parents and students do. They’re right. But they’re missing Adams’s point: making the ECG an opt-in is a mistake. “It would have been way too easy for me to pass on the screening that day and this could have become an issue for him on the field with very different results,” she wrote. 

It’s not parental rights. It’s as common sense as  physicals, with better technology. And this, of course, is where Superintendent LaShakia Moore can step in to make her own recommendation in line with AdventHealth’s, as superintendents should on policy matters. It’s puzzling that she has remained silent–or that none of the board members have even asked her for her recommendation. Punting is not like her. If she keeps silent, and if one of these three School Board members doesn’t break rank Tuesday, their decision will cost lives, recklessly and needlessly.

Pierre Tristam is the editor of FlaglerLive. A version of this piece airs on WNZF.