On Friday morning, Ayala visited Dr. Lewis Yocum in Southern California, and he discovered that Ayala, 28, has an ulnar-collateral ligament sprain in his right elbow. Yocum is the same doctor who removed a bone spur from Ayala's right elbow this past offseason.
The news of Ayala needing Tommy John surgery left the Nationals organization upset with Ayala and Major League Baseball. Weeks before the World Baseball Classic began, the Nationals, according to team president Tony Tavares, appealed to Major League Baseball twice about not allowing Ayala to play for Mexico because the club thought his elbow was not strong enough to play in any games in early March. Tavares said both appeals were denied.
Rob Manfred, MLB's executive vice president of labor relations and human resources, said on Friday that an appeal from the club was received and jointly was acted upon by officials from Major League Baseball and the Players Association.
"The medical information that we received from the club was insufficient to keep the player out of the tournament," Manfred said. "The information that we received from the player was that he was able to play, and we made our best judgment based on all that information. Are we happy about this? No. But injuries happen."
Tavares also feels that blame should be placed on Ayala, because he was told by the organization that he was not ready to pitch. Tavares believes Ayala was pressured by his countrymen to play. Ayala was not available for comment on Friday.
"He was strong enough to pitch on the mound [during bullpen sessions], but he wasn't, in my opinion, ready to go into a game," said Nationals trainer Tim Abraham. "He did not face hitters [before he left for the World Baseball Classic]. Just like any other pitcher that comes into our camp, he was ready to throw batting practice, and that is the next step before getting into a game, which he had not done. So was he ready to pitch in a game? Not when he left.
"We cautioned him the whole time. We said, 'Louie, you are coming off surgery. We want you to be healthy for the whole year,' and that's all you can tell him."
Ayala had soreness in the elbow in late February and was contemplating not playing for Mexico. But after a week of rest, Ayala declared himself fit to play catch and throw in the bullpen. After a few of those sessions, Ayala decided at the last minute to represent his country.
While Ayala was away, pitching coach Randy St. Claire said on Wednesday he was concerned for Ayala because the Mexican team was not using him the way the Nationals prescribed. Washington expected him to pitch often, like Chad Cordero and Gary Majewski did for the United States. At that time, Ayala had pitched just one-third of an inning.
"In my view, there are a couple of things: The player should have known better. We told him that the rehab process wouldn't allow him to participate [in the games]," Tavares said. "And then we filed the same information to Major League Baseball, saying we don't want this player to play in the World Baseball Classic because of his surgery. We wanted to bring him along slowly and put him in a strengthening program, and they denied it.
"We then appealed that decision and then sent a doctor's report to go along with it. Major League Baseball made a terrible judgment that resulted in a significant loss to this club. What are they going to do, say, 'I'm sorry'? Sorry doesn't get it."
Tavares wasn't the only one who felt Ayala was at fault. Second baseman Jose Vidro warned his teammate to prepare for the regular season and not to go to the Classic. Vidro was invited to represent Puerto Rico in the same event, but after talking things over with his family, Vidro turned it down because he wanted to make sure that his right knee, which has hampered him for more than two years, was healthy so he could play 150 or more games for the first time since 2002.
"You don't prepare the same way this early in Spring Training and go [the World Baseball Classic] and prepare for a game," Vidro said. "I thought about it a long time, and I thought it was best for me to stay here. We felt the same thing about Ayala. Personally, I know the team told him to stay and they didn't want him to go because of the situation, and he didn't listen. Hopefully, he learns from this."
The Nationals were looking at Ayala as one of three setup men, along with Majewski and Felix Rodriguez. Last season, Ayala was one of the best setup men in baseball, going 8-7 with a 2.66 ERA. However, he missed most of September because of bone spurs in the elbow.
Now, more than likely, Rodriguez is going to replace Ayala. The Nationals are hoping that Rodriguez returns to being the pitcher that was 9-1 with a 1.68 ERA with the Giants in 2001.
A few weeks ago, Tavares gave general manager Jim Bowden permission to add payroll and acquire right-hander Pedro Astacio to replace the injured Brian Lawrence, who is out for the season because of a torn rotator cuff and labrum.
Asked if he would add more payroll and get another pitcher, Tavares said, "You don't go into a five-and-dime and buy a pitcher. It's easier said than done. Nobody is giving you a pitcher who has the quality of an Ayala unless you are prepared to trade something, and that's the position we get put in."
"In the future, a player that has surgery should be blocked from participating in the Classic the following year," Bowden said.