Boston’s Chris Sale had Tommy John surgery on Monday in California, a week after the governor there called for the postponement of nonessential surgeries, including transplants, neurosurgery and operations related to cancer, cardiac, trauma or vascular issues. Michael Dwyer/Associated Press

James Andrews, a well-known specialist in the field of Tommy John surgery, has announced his practice is suspending the procedure amid the novel coronavirus pandemic.

With hospitals across the country either severely taxed with cases of COVID-19 or girding for the imminent arrival of that scenario, several states have issued restrictions on surgical procedures considered elective and/or nonessential. Major League Baseball pitchers who have recently had Tommy John surgery – including Boston’s Chris Sale – have taken flak for what critics have seen as a needless siphoning of crucial medical resources, including personal protective equipment, and they and their teams have defended their decisions.

Andrews, an orthopedic surgeon who has performed procedures on dozens of professional athletes over the past few decades, cited an executive order earlier in March by Florida Gov. Ron DeSantis that declared that “health care practitioners’ offices in the State of Florida are prohibited from providing any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or wellbeing at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

In a statement Tuesday reported by The Associated Press, the Andrews Institute said, “We are not performing any non-urgent or non-emergent procedures, including Tommy John surgery, in compliance with the governor’s executive order.” The practice, located in Gulf Breeze, Florida, where Andrews has been based in recent years after long working out of Birmingham, Alabama, added in its statement, “We are adhering to these restrictions and all such cases are suspended at this time.”

Noah Syndergaard

New York Mets starting pitcher Noah Syndergaard had Tommy John surgery in Florida after that state’s governor called for a halt to all nonurgent or nonemergency surgeries. Kathy Willens/Associated Press

Tommy John surgery replaces torn or damaged ulnar collateral ligaments in elbows and is named for the longtime MLB pitcher who first had the procedure in 1974. Six days after Gov. DeSantis’s decree, New York Mets starter Noah Syndergaard underwent the surgery in West Palm Beach, Florida.

The Hospital for Special Surgery, where Syndergaard went under the knife, indicated there was some urgency for the pitcher.

“The procedure in question – acute ligament injury with progressively worsening ulnar nerve symptoms – is defined as essential care,” a spokesperson told the Wall Street Journal.

In the case of Syndergaard, as well as of other pitchers who have recently had Tommy John surgery, including Sale of the Red Sox and Tyler Beede of the San Francisco Giants, there are major financial and competitive reasons to have it done as soon as possible. Given a recovery timetable of 12 to 18 months, all three would have been in danger of missing the entire 2021 season, let alone whatever version of a 2020 season MLB is able to play, if they were to have postponed the procedure.

However, the ethics of such a decision could be questioned, given the country’s ever-worsening medical crisis. On Tuesday, President Donald Trump offered his bleakest assessment to date, declaring from a White House podium that a best-case scenario could involve 100,000 to 240,000 fatalities in the United States.

“At the present time, I don’t think there’s even a question that it would be inappropriate and should not be done in any areas that are hit hard by (COVID-19),” David Magnus, a professor of medicine and biomedical ethics at Stanford, said of Tommy John surgery to Sports Illustrated in comments published Monday. “And I think it’s arguably a bad idea to do anywhere right now.”

In response to a Twitter post of the SI story, Mets first baseman Pete Alonso came to his teammate’s defense, writing on Monday: “Who is to judge someone’s medical needs in order to perform their job? Noah’s surgery, or any other athlete’s surgery during this time shouldn’t be scrutinized considering it is done by orthopedic surgeons, not those on the frontlines battling this pandemic.”

After Alonso heard from numerous other Twitter users, some of whom pointed to the desperate conditions in New York hospitals, he tweeted: “Medical supplies are high in demand. The issue isn’t Noah needing surgery and getting it. The issue I have is that the tone of this article suggests that players are making the decisions to get surgeries.”

Neal ElAttrache, a noted Tommy John specialist who recommended the surgery to both Syndergaard and Beede, said last week that it was “essential to their livelihoods.”

“If you have somebody’s career at stake and they lose two seasons instead of one, I would say that is not a nonessential or unimportant elective procedure,” ElAttrache, an orthopedist with Los Angeles’ Kerlan-Jobe Institute and the head team physician for the Rams and Dodgers, told the San Francisco Chronicle. He asserted that Kerlan-Jobe had drastically cut back on Tommy John procedures and that “socioeconomic factors” did not determine which patients were selected by an in-house panel for surgery.

Beede, who had his surgery performed in Arlington, Texas, on March 20 – two days before Texas Gov. Greg Abbott ordered the postponement of “all surgeries and procedures that are not immediately medically necessary” – said he did so while “not insensitive to what’s going on in the world.”

“If they said to me, ‘Hey, look, it’s either you get this surgery or we’ll use this equipment for someone else, someone (for whom) it’s life and death,’ I would have said, ‘I’ll wait. I’ll definitely postpone.’ And I would have,” Beede told the Athletic in comments published Monday. “But nobody raised the issue or told me that I’d be compromising anything at the time.”

The Red Sox reportedly sent Sale to Los Angeles to have his Tommy John surgery performed Monday by ElAttrache after learning that Andrews was suspending the procedure at his practice.

The team’s chief baseball officer, Chaim Bloom, strove to clarify that it was “important to us to make sure that we weren’t putting any burden on the health system that would be a negative for people who are battling the coronavirus or any other ailment.”

Just over a week before, Los Angeles County had issued guidelines recommending the postponement of surgeries that fell short of a “high acuity” classification. Procedures fitting that description, according to the county, included transplants, neurosurgery and operations related to cancer, cardiac, trauma or vascular issues.

“We know this is not life and death and that there are people who are suffering in situations that are life and death,” Bloom said, according to MassLive. He added of Sale’s elbow procedure, “It certainly is something we all know is necessary for his livelihood, but we’re aware it’s apples and oranges when you talk about this versus something that is life-threatening.”


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