COLUMBIA - A handful of S.C. schools have gone to extraordinary lengths in recent years to help their young athletes determine whether they have a hidden disease that could cause them to die suddenly without symptoms.

Hypertrophic cardiomyopathy has killed at least four high-school students in the past year. Three of the four were playing basketball when they collapsed.

According to a survey by The [Columbia] State newspaper, 12 of 133 schools responding to questions have defibrillators on campus, devices that can be used to restart hearts.

And, even though the state has some of the toughest physical requirements for student-athletes, tests that can detect the deadly heart disease can cost as much as $1,500.

"I think it's ridiculous when I hear districts say it's too costly," said Mack Harvey, Dutch Fork High's certified trainer. "When you talk about the amount of money you need to actually staff a certified trainer and stock a facility, people would probably be amazed at how little you have to spend."

Although it's important to have a trainer on site who can notice an athlete succumbing to the symptoms of a heart condition, experts say schools need to have equipment such as defibrillators on hand.

Neither Camden High nor Dutch Fork High had defibrillators on hand when Marcus Warren or Vic Sims collapsed. Both schools now have the devices, but they might not be the only solution.

"It sounds like, in most cases, whether you have a defibrillator or not, they're gone," Dutch Fork boys basketball coach Leon Hogan said. "You have to diagnose it, then prevent it from happening."

In South Carolina, doctors have to answer 11 questions about a student's health before the athlete is allowed to participate, according to S.C. High School League rules. If any question elicits a "yes" answer, the patient must be referred for a heart screening, which sometimes upsets parents.

"We don't see a lot of kids, but when we have, there have been parents who get very indignant with me over whether Junior is going to miss his game tomorrow night," said Lynne Rerucha, a registered diagnostic cardiac sonographer at Columbia's S.C. Heart Center. "That's how thorough the exams are. You can't be too careful."

Again, cost is a factor. Basic heart rhythm tests - electrocardiograms - can detect arrhythmia and other irregularities in heart rates, but not an enlarged heart or a faulty valve. Echocardiograms can do that, but cost $800 to $1,500 and insurance plans often don't cover the cost unless a doctor makes a referral.

Some groups are trying to fix that. Holly Morrell is executive director of a nonprofit, California-based agency called A Heart For Sports. Morrell has hypertrophic cardiomyopathy and has an internal defibrillator to restart her heart if it needs it. Her group works to help lower the cost of echocardiograms for student-athletes.

"Awareness out there is minimal, relatively speaking. But HCM is the No. 1 cause of sudden cardiac death," said Morrell, who has lost five family members to the disease. "Early detection is the key. These kids are dying in vain."