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Dr. James Andrews to suspend performing Tommy John surgery indefinitely

Dr. James Andrews stands on the field before

Dr. James Andrews stands on the field before an NFL game between the Redskins and the Steelers on Aug. 19, 2013, in Landover, Md. Credit: AP/Nick Wass

Amid a debate about the ethics of Noah Syndergaard having Tommy John surgery during a global pandemic, a notable piece of context emerged this week: Dr. James Andrews, perhaps the most famous orthopedic surgeon in baseball, has indefinitely paused such operations at his Florida facility.

Florida Gov. Ron DeSantis’ executive order on March 20 prohibited non-essential elective surgeries in an effort to preserve personal protective equipment — masks, gowns, etc. — as his state and others grapple with the new coronavirus outbreak. The Andrews Institute for Orthopaedics and Sports Medicine, located in the panhandle city of Gulf Breeze, Florida, made the move to adhere to that order.

“We are not performing any non-urgent or non-emergent procedures, including Tommy John surgery, in compliance with the governor’s executive order,” an Andrews Institute spokesperson told The Boston Globe on Monday. ”We are adhering to these restrictions and all such cases are suspended at this time.”

DeSantis’ order banned “any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety or well-being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

Last week, after the team announced that Syndergaard had a torn ulnar collateral ligament in his right elbow and needed Tommy John surgery to fix it, one Mets executive said Syndergaard’s “condition fits the essential surgery guidelines.” That was because in addition to the torn ligament, Syndergaard also was suffering from acute compression of his ulnar nerve.

In the case of Syndergaard, the guidelines for what is an essential surgery were determined by the Hospital for Special Surgery, the hospital with which the Mets have a long-standing partnership. Ligament and nerve issues were among the operations ruled essential by HSS.

Mets medical director Dr. David Altchek performed Syndergaard’s surgery Thursday at the Hospital for Special Surgery’s West Palm Beach, Florida, location.

 That came after a second opinion from Dr. Neal ElAttrache, the Dodgers’ physician who was adamant last week that Tommy John surgeries are OK in the current COVID-19 environment,

"I know that I'm going to get criticized for taking care of these kinds of guys, but it's essential to their livelihoods," ElAttrache told the San Francisco Chronicle last week. "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.”

If Syndergaard has a normal Tommy John rehabilitation, he is likely to return in the middle of the 2021 season. If he waited until the coronavirus pandemic abated, he would be at risk of missing the entire 2021 season, after which he is scheduled to be a free agent.

Mets first baseman Pete Alonso fiercely defended Syndergaard in a series of tweets Monday in response to a Sports Illustrated article that quoted medical ethicists about whether it is right for baseball players to have Tommy John surgery right now.

“No athlete wants to go through a serious surgery and grueling recovery process,” Alonso wrote. “This surgery is done when it is absolutely necessary for their arm.

“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 front lines battling this pandemic.”

Alonso acknowledged that medical supplies “are in high demand,” but added that he took issue with the article, suggesting, in his view, that it was players deciding when to get surgery.

“Medical staff and doctors at the hospital deem if the surgery is necessary or not,” Alonso wrote. “In order for a surgery to happen, there are guidelines and approvals that need to be made.”

Syndergaard isn’t the only pitcher to have Tommy John surgery recently. The Red Sox’s Chris Sale had the same operation — performed by ElAttrache — in Los Angeles on Monday, 11 days after the team announced he needed it. The Giants’ Tyler Beede had surgery in Texas on March 20.

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