Commentary

Dr. James Andrews still works on the cutting edge

Updated: September 20, 2007, 6:53 PM ET
By John Helyar | ESPN.com

BIRMINGHAM, Ala. -- Dr. James Andrews placed the arthroscope in anesthetized Drew Brees, then looked up to view his shredded shoulder on the monitor.

"Oh, my goodness," Andrews said in his Louisiana twang to his assisting surgeons. "How are we goin' to fix all this?"

When he saw it happen, he knew it was bad. Andrews, a huge sports fan, was watching Denver play San Diego on New Year's Eve 2005 when Brees, then with the Chargers, fumbled on the goal line, then dove for the ball. As he extended his arm, a ton or so of football players landed on Brees' exposed right shoulder.

As TV viewers winced watching Brees leave the field, his right arm grotesquely extended, Andrews instead diagnosed: subluxation erecti. That's the clinical term for a dislocation that occurs when the arm is extended upward. The arm pops out of the bottom of the shoulder joint, causing a particularly horrific separation.

Five days later, in his operating room in Birmingham, Andrews surveyed the damage. The worst was the labrum, a ring of tissue surrounding the end of the shoulder blade -- it had a 360-degree tear. The undersurface of Brees' rotator cuff was also a disaster.

Dr. James Andrews
Matthew Williams for ESPN.comDr. James Andrews performs elbow surgery at St. Vincent's in Birmingham, Ala. Andrews has done 40,000 surgeries, mostly on knees, shoulders and elbows.
What's worse, this complex repair job required the medical equivalent of a two-minute drill. The surgery had to be completed within two hours or tissue would begin swelling.

Andrews didn't think about the patient's name or contract. He focused on how to implant a series of anchors in Brees' shoulder. Working with his full set of arthroscopic tools, checking a monitor above the operating table, quarterbacking his team of surgeons, Andrews implanted 12 of those anchors, which reattach torn tissue to bone. That was the the most anchors he had ever used in an operation, and when it was over -- when they'd beaten the two-hour clock and sewn up the shoulder -- Andrews and his assistants walked out of the operating room and did what people do here in the Bible Belt.

They prayed.

When Brees came back to lead the New Orleans Saints to the NFC Championship Game a year later, it wasn't just a matter of divine intervention. It happened because an all-world surgeon was in the zone the day of his surgery. After that operation, Andrews told the quarterback's agent, Tom Condon, "I did it about as well as it can be done."

Says Condon, who has known Andrews for decades: "That's the only time I've ever heard Doc come close to bragging."


A great surgeon is like a great athlete -- with extraordinary physical skills, exceptional powers of concentration, an ability to work through adversity and embrace, not shrink from, a challenge. All of that describes James Rheuben Andrews, 65, who has been patching up athletes for nearly as long as Joe Paterno has been coaching Penn State and is still at the top of his game.

Dr. James Andrews
Matthew Williams for ESPN.comAndrews averages 30 surgeries a week, and many of those involve athletes.
Hordes of top-tier athletes -- among them Troy Aikman, Charles Barkley, Roger Clemens, Allen Iverson, Bo Jackson, Michael Jordan, Jack Nicklaus, Emmitt Smith, John Smoltz and Doug Williams -- have made their way to his practices in the Deep South, where he happened to land in the early 1970s at the dawn of modern sports medicine. And with a diagnosis of season-ending surgery or the prospect of rehab instead, he is at once Grim Reaper and medical Good Housekeeping Seal of Approval.

Andrews' numbers are as awesome as his celebrity patients. He's logged 40,000 lifetime surgeries, mostly on knees, shoulders and elbows. They're not all on superstars, of course. Pro and college athletes compose 20 to 25 percent of his practice. But the man has done 2,500 Tommy John surgeries alone, with a 90 percent success rate. That's to say nothing about the number of influential opinions he has rendered -- just last week on Eli Manning's shoulder when Andrews concurred with New York Giants physicians that the quarterback could play.

And if you thought Trevor Hoffman has a lot of career saves, think of how many careers Andrews has saved. Of Roger Clemens' 354 wins, 95 percent came after Andrews scoped his shoulder in 1985. In 2000, John Smoltz thought a throbbing elbow might end his career. Andrews performed Tommy John surgery that year, and Smoltz set a National League saves record (55) two seasons later.

Yet the big numbers and the big names tell only part of the Jim Andrews story -- maybe not even the best part. He has been at the forefront of a 30-year revolution that has transformed sports medicine. Andrews has been on the cutting edge of new surgical technologies and rehab techniques that enable players to play longer and recover from injuries faster.


Hall of Fame Talk

Will Carroll, an author of "Baseball Prospectus," writes that Dr. James Andrews belongs in the Baseball Hall of Fame for his contributions to the sport.

And he's had a profound influence in other ways, too. His nonprofit American Sports Medicine Institute (ASMI) has produced some of the field's most influential research. An ASMI study on teen pitchers correlated a combination of their overthrowing in games and their overlong competitive seasons with increased arm surgeries. Andrews then lobbied Little League for pitch-count limits, which it adopted this year. (Eleven and 12-year-olds must quit at 85 pitches and take three days off before next pitching.)

ASMI also puts six aspiring sports orthopedists, called "Andrews Fellows," through a rigorous apprenticeship each year under the master. More than 200 fellows are now practicing on their own, though they remain very much in Andrews' orbit.

Andrews isn't the only elite sports orthopedist, of course. The Kerlan-Jobe Orthopaedic Clinic -- its co-founder Frank Jobe invented Tommy John surgery -- has a stable of name-brand surgeons in Los Angeles. The Steadman Hawkins Clinic is renowned for knee surgeries -- and is located conveniently close to skiing mishaps, in Vail, Colo. There are others, too. The modest Andrews would demur, in fact, that he's merely part of a generation of sports orthopedists who combined to vault that specialty far forward.

But Andrews' ubiquity and energy set him apart.

He is the alpha doc at the center of a sports-medicine network that extends well beyond doctors. Every athletic trainer, physical therapist, strength-and-conditioning coach in the land seems to have Andrews' cell phone number. And he seems to take their every call, on a 24/7 basis. His wife, Jenelle, has something in common with Brees. She's a saint.

At first blush, Andrews seems less a roaring dynamo than an unremarkable Rotarian. His salt-and-pepper hair has gone mostly to salt. His waistline barely holds its own against his fondness for hot dogs and other non-lean food products. But he climbs into scrubs, pulls on a pair of green surgical boots and is instantly in his element. The years drop away. The man's strides lengthen, and colleagues 30 years his junior straggle along hospital corridors in his wake. His pace accelerates in the operating room, where he requires nurses to have his tools ready two steps ahead of him. He handles those tools so deftly as to be an extension of himself.

Yet the man tosses out accolades to his support staff like he tosses out surgical gloves. Invoking an aphorism that sounds straight out of coach-speak, Andrews says, "'We' makes 'I' stronger."

Andrews' unwillingness to be a remote super-surgeon and his unfailing habit of spreading the credit around has helped spawn a culture of multidisciplinary teamwork in this field. "He is a great integrator of people and ideas," says Dr. Lanny Johnson, who pioneered arthroscopic surgery in the 1970s and mentored the young Andrews. "I like to say Jimmy saw my ideas and applied money to them."

Dr. James Andrews
Matthew Williams for ESPN.comAndrews examines baseball player Ryan Kochen's shoulder at Andrews' facility in Birmingham, Ala.
Talk about money and multidiscipline … take a gander at the new $50 million Andrews Institute. The 140,000-square-foot complex opened in May in Gulf Breeze, Fla. It is at once a surgical clinic, a medical-research facility, a biomechanics lab, an education clearinghouse and a training center for elite athletes. Although Andrews remains based in Birmingham, he spends Fridays at the institute.

The place is the ultimate testament to the power of Andrews as a brand and, says the doctor, "It's the pinnacle of my career."

It's also something else. The Andrews Institute culminates its namesake's comeback from a period as painful in its own way as anything his patients have endured. Andrews' practice has weathered a series of crises since 2003, when corporate partner HealthSouth was battered by an accounting fraud scandal. Andrews had to find new backers and new quarters. He has worked out of cramped, temporary facilities since 2005. Andrews had a heart attack in 2006 and split with his partner of 21 years, Dr. Lawrence Lemak, earlier this year.

Now he's emerging from the storms, more energized than battered, more driven than ever. He is still doing a volume business -- 10 surgeries on NFL and MLB players in the past six weeks -- and he is still driven by his keen identification with athletes. A big part of his success lies with his extraordinary ability to communicate with them, whether it's explaining their anatomy or giving them pep talks.

"I tell 'em, 'Never give up your career, even though you may be injured,'" he says. "'Never give up your hopes and your dreams, because until you fulfill 'em, you'll always be wondering and wishing what you might have done if you'd kept going.'"

Andrews implores so strongly and relates so closely because his athletic career was cut short, though not by injury. His father got lung cancer and died during Andrews' sophomore year at LSU. He was a collegiate champion pole vaulter, but he gave that up to accelerate his studies and graduate from LSU after three years. He wanted to get a jump on med school, and earn doctor money to support his family.

Practicing sports medicine allowed him to combine the love of sports he got from his father, who coached football and track teams in Andrews' home town of Homer, La., and the aptitude for medicine he got from his grandfather, who was an unofficial, unlicensed healer in a rural part of the state with few doctors.

"I think I was born to be a physician," he says.


Few doctors were drawn to sports medicine in the early 1970s, when Andrews got his start. Sports wasn't a big business, and there weren't big bucks in this subspecialty. Sports orthopedics was mostly the province of physicians who liked hanging around athletes. Team doctors were mostly buddies of owners and inclined to do their bidding on treating injuries.

That irked a firebrand young baseball agent named Randy Hendricks, who thought his clients deserved better and who pushed hard for second opinions. It was a radical notion then, and it was a brave doctor who'd provide independent ones and risk offending the lords of baseball.

Hendricks discovered there was a young sports orthopedist in Columbus, Ga., who would do so. He began taking his injured clients there.

"What made Jim remarkable was that he'd provide [an opinion] and he'd call it as he saw it," Hendricks says. "Teams would get unhappy because we went to Jim, but he was our link to a state-of-the-art doctor."

That's how Andrews came to examine a scared-to-death kid named Roger Clemens in 1985.

Roger Clemens
Ronald C. Modra/Sports Imagery/Getty ImagesRoger Clemens poses in 1986 with a ball commemorating his 20 strikeout game against the Seattle Mariners on April 29. He wouldn't have done it without Andrews.
Then a second-year pitcher for the Boston Red Sox, Clemens would get shoulder pains and lose velocity after three or four innings. Local doctors couldn't diagnose anything, so his agent recommended seeing Andrews.

Clemens was amazed, not just at how quickly Andrews put his finger on the physical problem -- a torn labrum -- but at how quickly he reduced his mental stress.

"We hit it off," Clemens says. "His approach made me extremely comfortable. He gave me a CliffsNotes version of a course about the shoulder and how the big muscles and small muscles related."

Andrews both cleared up Clemens' problem with a then-novel arthroscopic surgery and lectured him on preventing recurrences.

"He gave me a stern father talk about doing shoulder exercises," Clemens recalled.

The regimen Andrews prescribed, with 3- to 5-pound weights, has been a major contributor to Clemens' longevity -- as, of course, was the operation. Eight months after it, Clemens set a major league record by striking out 20 Seattle Mariners.

He and Andrews have remained close since. The Rocket has been a huge referral source. He has returned for periodic checkups on his arm and to have his delivery analyzed at ASMI's biomechanics lab. He has not only endured on the mound but followed Andrews into his field. Last year, in conjunction with a Houston hospital, he opened the Roger Clemens Institute for Sports Medicine & Human Performance.

Andrews is so tight with patients that some become regular houseguests. Two-sport star Bo Jackson spent so much time at the home of Andrews, with whom he'd been close since shoulder surgery at Auburn, he was practically a surrogate son. When Jackson suffered hip dysplasia as a Los Angeles Raiders running back in 1991, he participated in the discussion about what to do to come to terms with his injury. He and Andrews studied surgical options, the risks, the artificial-hip brands, the works.

Bo Jackson
Louis A. Raynor//Time Life Pictures/Getty ImagesAfter Bo Jackson hurt his hip -- on this play -- he participated in the discussion with Andrews about what to do. The process helped Jackson come to terms with the injury.
Andrews only assisted in the hip replacement operation -- a White Sox team physician took the lead -- but he thoroughly prepared Jackson for it, right down to getting him relaxed the day before. They grilled steaks, then caught a Chicago Bulls game.

"Dr. Andrews isn't going to B.S. you and tell you something is all right when it isn't," Jackson says. "And when he treats you, he takes care of you as if you were his own kid."

Some orthopedists privately sniped that hip replacement for Jackson, then 29, wasn't appropriate for such a young patient.

"Jim took heat for that operation; a lot of people thought he was grandstanding," says Tim Kremchek, an Andrews Fellow at the time. "But they weren't taking into account how well he knew Bo -- what made him tick and why that was the right approach."

The surgery provided sports fans one more dramatic Jacksonian moment -- a home run in his first at-bat back with the White Sox in 1993. But Jackson was reduced to a part-time player and retired after the 1994 season. Andrews couldn't regain the magic for Jose Rijo, either. He performed six elbow surgeries on the one-time star pitcher, starting in 1995, but Rijo never successfully came back.

Kremchek, now a prominent sports orthopedist in Cincinnati, closely modeled his own practice on Andrews' axioms. Example 1: You don't just operate on patients; you listen to them, read them, motivate them. Example 2: You don't just need to know tendons; you need to know and love sports. It certainly takes passion to satisfy another Andrews axiom: 24/7 availability.

In 1991, Andrews worked the Sugar Bowl in New Orleans one night, hopped a flight over to Dallas to operate on Troy Aikman's shoulder and elbow early the next morning, then flew back to Birmingham for his regularly scheduled surgeries the rest of the day. He couldn't take time off if he tried. He was hunting quail in south Alabama once when Emmitt Smith showed up to have him look at his bum shoulder. He was planning to take a Memorial Day weekend off once when Jerry Jones called to say he had to fly over and fix Michael Irvin's shoulder right now. How else would Irvin be ready to go by training camp time? Andrews did it.

Tom Condon, the NFL's top player agent, wouldn't use anyone else for second opinions. "Jim's not awed or starstruck with players," Condon says. "The players see him as a peer."

When a player's -- maybe a franchise's -- future hinges on a doctor's decisions and incisions, you don't want awed and starstruck. But Andrews acknowledges being intimidated a time or two earlier in his career.

"I remember having Jack Nicklaus draped out in the operating room," he says. "I looked down at his knee and said, 'My goodness, I've got Jack Nicklaus on the table.' And I thought, 'Have I got the right knee?'"

But then he caught himself and went about his business.


Notable Patients

Dr. James Andrews' patient list reads like a cross-sport hall of fame. He's a rundown of some of the most notable athletes who have been treated by Andrews:

Football players
• Bo Jackson: shoulder, 1984; hip, 1992
• Doug Williams: knee, 1988
• Bruce Smith: knees, 1990 and 1991
• Troy Aikman: elbow and shoulder, 1991
• Michael Irvin: shoulder, 1994
• Emmitt Smith: shoulder, 1994
• Trent Green: knee, 1999 and 2001
• Chad Pennington: shoulder, 2005 (twice)
• Deuce McAllister: knee, 2005
• Daunte Culpepper: knee, 2005 and 2006
• Takeo Spikes: achilles tendon, 2005
• Donovin Darius: ACL, 2005; shoulder, 2006
• Drew Brees: shoulder, 2006
• Byron Leftwich: ankle, 2006
• Donovan McNabb: knee, 2006
• Matt Hasselbeck: shoulder, 2007
• Joey Porter: knee, 2007
• Kenny Irons: knee, 2007
• Isaiah Kacyvenski: knee, 2007
• D.J. Shockley: knee, 2007

Baseball players
• Roger Clemens: 1985, shoulder, 1985
• David Wells: 1985, elbow, 1985
• Jimmy Key: elbow, 1988; shoulder, 1994, 1995
• Jose Rijo: elbow, 1995; five more elbow ops, 1996-2003
• Steve Karsay: elbow, 1995; shoulder, 2003
• Kerry Wood: elbow, 1999
• John Smoltz: elbow, 2000 and 2003
• Carl Pavano: elbow, 2001 and 2006
• Jon Lieber: elbow, 2002
• A.J. Burnett : elbow, 2003
• Andy Pettitte: elbow, 2004
• Gary Sheffield: shoulder, 2004
• Jim Thome: elbow, 2005
• Mark Prior: shoulder, 2007
• Anibal Sanchez: shoulder, 2007
• Freddie Garcia: shoulder, 2007
• Chris Ray: elbow, 2007

Basketball players
• Charles Barkley: shoulder, 1990
• Michael Jordan: shoulder (therapy, not surgery), 1994
• Penny Hardaway: knee, 1996
• Randy Livingston: knee, 1996
• Scottie Pippen: elbow, 2001
• Allen Iverson: elbow, 2001
• Aaron McKie: shoulder, 2001
• Chris Webber: knee, 2003
• Shaun Livingston: knee, 2007

Golfers
• Jack Nicklaus: knee, 1984
• Jerry Pate: shoulders, 1985, 1986, 2003, 2006
• Mark McCumber: shoulder, 1996


To Andrews, the key is to not do something extra special because of who the patient is, "because then you mess up. You treat them with your routine."

Dealing with athletes does require a special bedside manner, Andrews says.

"You don't sit there and give them miles and miles of lingo," he says. "They want the straight facts, and they want you to be positive. An athlete doesn't go into a game saying, 'Well, we may not be able to win this one.' They want their doctor to go into it like an athlete, too: 'We're going to get this fixed, and we're going to get you back on the road so you can play your sport again.'"

One reason Andrews communicates so well with athletes: He was a good one himself. He was the Southeastern Conference's pole vault champ as an LSU undergrad, clearing 15-feet 1-1/2 inches in the pre-fiberglass age when the world record was just scraping 16 feet. "I got a high out of clearing that bar," he says. "I still dream about clearing the bar. I've always regretted losing that last year of eligibility. That's why I can relate to athletes about their careers."

LSU will honor Andrews, in conjunction with the SEC's 75th anniversary celebration, by naming him one of its six most distinguished student-athlete alums.


As an older and richer man, his sport became sailing. He raced a 50-foot racing sloop called Abracadabra that won championships on the elite Southern Ocean Racing Conference circuit in the mid-'90s. A costly, futile run at the America's Cup in 2000 eventually sent him into hiatus, but he admits the sport is still in his blood. "I like the solitude," he says, "and I like to compete."

To Andrews, his principal job benefit is being part of the raw emotion and passion of sports -- getting athletes from their broken-down low points back to their competitive highs. He felt goose bumps when Jimmy Key, whom he somehow kept pitching through a series of shoulder and elbow operations, won the deciding games of the 1992 and 1996 World Series, with the Blue Jays and Yankees, respectively.

He derives that psychic income not just by patching up the stars but by taking care of athletes from Nowheresville. Part of the deal he negotiated with HealthSouth was that an athlete from anywhere in Alabama -- anybody -- would be treated by his clinic, health insurance be damned.

"I wanted to be sure if somebody got hurt playing football, HealthSouth would take care of him," Andrews says. "We probably had the greatest athletes of anywhere in the country but the poorest sports-medicine care. Especially in the rural areas, you had great athletes who got hurt and didn't get fixed. It wasn't fair."

Because of his attention to the local patient base, Andrews has attained a deified status in his adoptive state of Alabama: He's a team doctor for Alabama and Auburn. (His official titles: senior orthopedic consultant and co-medical director, respectively.) His rooting interests lie firmly with Auburn, with whom he has long been affiliated, and he takes sides (with the exception of the Auburn-Alabama game) when "covering" football games.

"He'll pace the sidelines like a cat," says Dr. John Richardson, who has covered Auburn games with Andrews. "When they screw up, he'll yell, 'What the hell are they doing?' When he's mad at the officials, he'll throw down his hat and scream, 'That's the sorriest call I ever saw!'"

Dr. James Andrews
Matthew Williams for ESPN.comWhen he isn't in surgery, Andrews can probably be found making phone calls.
Andrews has been affiliated with the Tigers since he was a medical cub because his mentor, Dr. Jack Hughston, was Auburn's longtime team physician. Based in Columbus, Ga., he was one of the few prominent sports orthopedists in the 1960s and 1970s.

Andrews read a treatise by him about knee injuries while a second-year resident at Tulane University Medical Center, then called to see whether he could come over and watch him operate. Sure, Hughston said. He was so impressed with Andrews during the visit that he invited him to do his third-year residency at his clinic.

Andrews did, and ultimately joined the Hughston Clinic in 1973. Many of Andrews' guiding principles were originally Hughston axioms -- most prominently availability. Among other things, Hughston operated on Saturdays to provide prompt relief for players suffering injuries on Friday nights.

Andrews became zealously, ubiquitously available, even in the most obscure corners of the Deep South. R.T. Floyd, athletic trainer at West Alabama State University, recalls Andrews making evening flights to remote Livingston to examine football players for three or four hours. Floyd, in turn, once drove some injured players four hours to Columbus, where Andrews examined them in his living room at 11 p.m. He put up the ones requiring surgery in guest rooms.

Hughston believed physicians had to keep learning and keep up with the field. One of his signature sayings: "If you're green, you're growing. If you're ripe, you're next to rotten."

Andrews adopted that as one of his favorite aphorisms. Every six weeks, he'd fly in the clinic's plane to Lansing, Mich., to learn about a new technique called arthroscopic surgery. Lanny Johnson, an inventor of some of its key tools, practiced there. Andrews, on a stepladder in the operating room, watched Johnson.

Andrews also organized sports-medicine conferences to share and grow the slim body of knowledge in that field. For instance, he started a multiday, multidiscipline "Injuries In Baseball" course that marked its 25th anniversary this year.

By the 1980s, he was making quite a name for himself. He operated on Jack Nicklaus' knee and Bo Jackson's shoulder in 1984. He saw his MLB patient load spike after the shot in the arm he gave Clemens' career in 1985.

But jealousy stirred at the Hughston Clinic as the protégé's renown began to rival that of the mentor. Some partners looked askance at Andrews' embrace of arthroscopy. (Many surgeons, including Hughston, believed it inferior to traditional "open" surgery.) Some grumbled about peripatetic Andrews' heavy use of the practice's plane.

By the mid-1980s, with the mentor in his late 60s and the protégé in his mid-40s, Andrews should have been the logical successor to lead the practice. But some colleagues didn't want him in that role and Hughston wouldn't commit to him. Andrews once got his nerve up to ask, straight-out, who'd be the next leader and got no answer.

When a hospital in Birmingham recruited Andrews to start a sports-medicine center in 1986, he agreed. Andrews' father-son relationship with Hughston was blown like a ruptured ACL. The two remained distant until Hughston's death in 2004.


The vision of Andrews and his partner, Lawrence Lemak, for a super-practice was thwarted at first. The hospital didn't have the resources to fulfill its recruiting pitch. Then they met Richard Scrushy, who headed a chain of health care clinics called HealthSouth. He developed his own vision of affiliating with the high-profile sports surgeon and thereby vastly raising his obscure company's profile.

Scrushy bought the hospital and built Andrews his dream clinic. The centerpiece of Alabama Sports Medicine and Orthopaedic Clinic (ASMOC) was a suite of four operating rooms, with an area in the middle of them from which surgeries could be observed. (An Andrews Fellow also could watch on closed-circuit TV in a theater downstairs.) HealthSouth also funded a big chunk of the budget for ASMI, the nonprofit research and education arm.

Andrews recruited other sports-medicine all-stars, including Bill Clancy, a knee specialist who developed an innovative approach to ACL surgery, and Kevin Wilk, one of the nation's foremost athletic rehab specialists, who ran ASMOC's physical therapy department.

It all worked beautifully and synergistically until 2003, when Scrushy and other top executives were charged with inflating HealthSouth's earnings by $2.7 billion over a six-year period. Scrushy was acquitted in 2005 (15 other former executives pleaded guilty to stock fraud), but was forced out as CEO.

Kevin Wilk
Matthew Williams for ESPN.comKevin Wilk, chief of Andrews' rehab center, examines Peden Rucker six weeks after shoulder surgery. Rucker plans to pitch again next year for the University of South Carolina Aiken.
The new management had a new agenda: retrenching and trying to save the crippled company. That meant selling some hospitals, including the one housing ASMOC. Andrews had nothing to do with the fraud. ("It was an accounting fraud," says a spokesman for U.S. Attorney Alice Martin in Birmingham. "It had nothing to do with doctors.") But the scandal left him and his partners out on the street.

In 2005, the practice landed at St. Vincent's in Birmingham, but without the magnificent operating suites and closed-circuit TV. Physical therapists had one-third as much room as at HealthSouth. The operating quarters were cramped. The practice had to downsize, letting its hand and spine surgeons go.

Andrews also had to scramble to save ASMI, the nonprofit arm. HealthSouth had contributed an annual average of $431,000 from 2000 to 2003 -- and that also was gone. Other sources of funding would have to be tapped -- medical vendors, Andrews Fellows alumni and others -- to fill that gap.

Andrews' partner, Larry Lemak, usually handled money matters. While Andrews was solely focused on medicine, Lemak had a head for business. He had a host of things going on the side, in real estate, medical and sports enterprises, and managed the financial aspects of the HealthSouth relationship.

HealthSouth Corp.
AP Photo/Rainier EhrhardtAndrews wanted to make sure that if any player in Alabama got hurt, he could visit HealthSouth for treatment.
When ASMOC was uncoupled from that company, however, the partnership began to fray. For one thing, Lemak appeared less concerned with saving ASMI than with launching his own nonprofit institute, called The National Center for Sports Safety. While Andrews was losing sleep, feeling responsible for all the ASMOC and ASMI employees, Lemak seemed increasingly active in his outside ventures.

Some members of the practice were steamed at Lemak, but not Andrews. At least, not in any way he would acknowledge. He hates and avoids conflict. A disgusted Clancy, the top knee specialist, left in 2004.

"I was disenchanted with all the politics," says Clancy, who disagreed with Lemak's philosophy and who was frustrated by Andrews' reluctance to confront the partner. "He [Andrews] takes the punches like a punching bag."


The issue that surfaced underlying tensions was succession. Andrews was totally taken with two of his fellows in the late 1990s: Drs. Lyle Cain and Jeffrey Dugas. He asked them to stay after their year was up and join the practice. He would reach age 60 in 2002 and wanted to start grooming successors.

Dr. Lyle Cain, Dr. James Andrews, and Dr. Jeff Dugas
Matthew Williams for ESPN.comAndrews (center) with two of his proteges, Drs. Jeff Dugas (left) and Lyle Cain.
But when Lemak's son, David, joined the practice in 2005, his father pushed for him to be get the same kind of succession-track status as Cain and Dugas. It was more agony for a practice already roiled by HealthSouth.

Instead of dealing with those issues, Andrews burrowed even more deeply into tendons and labrums and his whirlwind of demands. To worried friends and family, he was taking on too much. During football season, he was flying to Washington Redskins games each Sunday, on top of his usual swirl of Saturday college games. He was helping out his friend Joe Gibbs, who, upon his 2004 return to the NFL sideline, wanted Andrews to be the team's orthopedic consultant.

The guy couldn't say "no," couldn't turn off his cell phone. "I was riding with him once, and he was on the cell phone, as usual," says fellow Birmingham physician John Richardson. "The way he was talking, I thought it was a big shot from the NFL or something. It turned out to be a locker room attendant at the club he used to belong to in Columbus. He had Jim's number, too, and Jim had time for him."

In January 2006, his heart surgeon saw the results. He helped save Andrews' life after a major heart attack. On a Sunday morning at home, after returning from a Redskins playoff game, Andrews found himself gasping for breath, then being rushed by ambulance to St. Vincent's. A team of cardiologists was on hand after completing a rare Sunday procedure. They were soon joined by Richardson, who says speed saved Andrews from a form of heart attack that's almost always fatal.

As it was, Andrews soon was examining patients from his bed in the ICU. The Astros' Jeff Bagwell showed up for an appointment to check his bum shoulder, not knowing about Andrews' heart attack. Andrews insisted on seeing him. Same with Brees, whose shoulder he had repaired the previous week and who had stayed in Birmingham for rehab. Even after being sacked by a heart attack, Andrews seemed more interested in the quarterback's condition than his own.

Nonetheless, it was sobering and galvanizing for Andrews. He couldn't let this end up like the Hughston Clinic succession mess. "I sat with him in the ICU the day of the heart attack and he was very introspective," says Dugas, his protégé. "I think it made him think about refocusing on the things that were most important, like his legacy and his succession plan."

Andrews and Lemak announced the split in February 2007, with both parties downplaying hostilities. Lemak, though, declined to be interviewed for this story.

"This is very amicable; they remain very good friends," says Gene Hallman, executive director of a Lemak side venture, the Alabama Sports Foundation. "This came about because of Dr. Lemak's desire to have a separate practice with his son."

Nonetheless, they're in an awkward phase. The divorce has gone through, and Andrews' clinic now goes by Andrews Sports Medicine and Orthopaedic Center. But his practice and Lemak's are still temporarily under the same roof at St. Vincent's.

There is otherwise a sense of relief and renewal. St. Vincent's is constructing a Musculoskeletal Institute, which will house the Andrews practice. After its completion next summer, Andrews can expand his clinic, adding back specialists who had to be dropped in 2005. Clancy is set to return this fall. Andrews flies to the Florida panhandle on Fridays to work out of the institute bearing his name -- then heads out for a spin on his boat, moored a few hundred yards away.


Jenelle Andrews admits she has failed miserably to get her husband to decelerate. She got him a new recliner for Father's Day, but doubts he'll take the hint -- except when he's watching former and future patients on TV.

Andrews might not possess a lower gear. He appears locked in overdrive, still pushing himself -- and everyone in his vast sphere of influence -- to advance the state of the art in sports medicine.

That's sure what it sounded like in his speech at his "Injuries In Baseball" course this past January in Birmingham. Titled "What I have learned about the shoulder in the past 30 years," it could have been a paean to himself. Instead, it was a call to arms.

Dr. James Andrews
Matthew Williams for ESPN.comAndrews, at age 65, is still driven to advance the state of the art in sports medicine.
For all the advances of the past three decades, he told the 400 attendees, there were still injuries that seemed to defy repair.

"Do we have the answer to labral tears?" he asked. "No, a large percentage of these still don't heal. I think we have a long way to go."

For all the improvements in technology, he cautioned, there also has been a downside. It has given too many surgeons itchy scalpel fingers.

"If you want an excuse to operate on a baseball pitcher's throwing shoulder," he said, "just do an MRI."

For all they know about healing athletes today, versus the dark ages of the 1970s, there is still much to do.

"If you're still talking about what you did yesterday, you're not doing much today," he says. "Even today, in the twilight of my career, I'm still learning."

John Helyar is a senior writer for ESPN.com and ESPN The Magazine. He previously covered the business of sports for The Wall Street Journal and Fortune magazine and is the author of "Lords of the Realm: The Real History of Baseball."

John Helyar

Sports Business
John Helyar is a senior writer for ESPN.com and ESPN The Magazine. He previously covered the business of sports for The Wall Street Journal and Fortune magazine and is the author of "Lords of the Realm: The Real History of Baseball."