The Red Sox decided back on March 19 that ace lefthander Chris Sale would undergo Tommy John surgery on his left elbow. Typically, his torn ligament would have been reconstructed a few days later to start the clock on a rehabilitation process that typically lasts 14-15 months.
But with medical resources stretched thin in parts of the country because of the coronavirus pandemic, the surgery did not happen until Monday morning in Los Angeles as the needs of a baseball team became entangled in medical ethics.
"Needless to say these are not normal times,” chief baseball officer Chaim Bloom said. "As a society we are facing some difficult challenges. We knew that to schedule this or any surgery would not be routine, that there might be scheduling or logistical difficulties.”
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Noted orthopedic surgeon James Andrews treated Sale when the pitcher first injured his elbow last season. But Andrews, who is based in Gulf Breeze, Fla., was not available for the surgery.
A spokesman said his clinic suspended elective procedures to comply with an executive order from Florida’s governor Ron DeSantis related to the pandemic.
That order, issued on March 20, prohibited "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.”
There were no such restrictions in California and Dr. Neal ElAttrache performed the surgery at the Kerlan-Jobe Institute in Los Angeles.
ElAttrache consulted on the case in March when Sale re-injured his elbow while facing hitters for the first time in 6½ months.
"It was important to all of us to do this in a way that would not place any undue burden on anyone suffering because of the coronavirus,” said Bloom, who spoke to ElAttrache to get that assurance.
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Asked what factors played into that determination, Bloom said the surgery was necessary for Sale to continue in his profession.
"We know that this is not life and death and that there are people who are suffering in situations that are life and death,” he said. "We’re aware it’s apples and oranges when you talk about this as opposed to something that’s life-threatening.”
Sale, who turned 31 on Monday, could return in June of 2021. In the meantime, he will stay his home in Naples, Fla., and rehab with the help of members of the Sox medical staff who live in the area.
The Fenway South complex remains closed in the wake of a minor league player having tested positive for COVID-19. But it could reopen only for injured players as soon as next week.
That minor league player, who has not been identified, is doing well and no other players had symptoms that required a test.
General manger Brian O’Halloran said fewer than 10 players in the organization remain in the Fort Myers area outside of those who reside there.
Sale went 6-11 with a 4.40 ERA last year before getting shut down in August with what the team said was inflammation in his elbow. He received a PRP injection from Andrews and was told to rest.
Sale had a normal offseason buildup but suffered a setback when he threw live batting practice in spring training. That changed after he tried throwing again 18 days later and immediately felt discomfort in his elbow that made the need for surgery obvious.
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The Red Sox signed Sale to a five-year, $145 million contact extension that was set to start this season. But under an agreement reached by Major League Baseball and the Players Association, all salaries will be prorated dependent on how many games are played this season.
If the season were canceled, players with guaranteed contracts would receive $150,000.
Two other injured players, righthander Collin McHugh (flexor tendon strain) and outfielder Alex Verdugo (stress fracture in is back), are doing well according to Bloom. McHugh has not started throwing, however.
Peter Abraham can be reached at peter.abraham@globe.com. Follow him @PeteAbe. Alex Speier can be reached at alex.speier@globe.com. Follow him @alexspeier.