Sources: Records had key evidence

The story of how Manny Ramirez was nabbed by baseball's drug-testing policy is rooted as much in the language of the collective bargaining agreement as it is in the fact that the Los Angeles Dodgers' slugger had synthetic testosterone in his body when he was tested this past spring.

Ultimately, Ramirez was brought down by his own private medical records -- records that the Major League Baseball Players Association turned over on his behalf, as required under the sport's Joint Drug Prevention and Treatment Program.

The Ramirez saga, as described by three sources with direct knowledge of the case, began to play out in spring training when the 36-year-old outfielder provided a urine sample for testing.

The test came back showing elevated levels of testosterone. Every individual naturally produces testosterone and a substance called epitestosterone, typically at a ratio of 1-to-1. In Major League Baseball, if the ratio comes in at 4-to-1 during testing, a player is flagged. In Ramirez's case, his ratio was between 4-to-1 and 10-to-1, according to one source.

At that point, MLB notified Ramirez of his elevated levels and began further investigation, including taking two primary actions:

First, MLB asked the World Anti-Doping Agency lab in Montreal, which conducts its testing, to perform a carbon isotope ratio test to determine whether the testosterone spike resulted from natural variations within Ramirez's body or from an artificial source. The test revealed the testosterone was synthetic -- in other words, it was ingested somehow.

Secondly, as per the drug-testing policy, MLB requested all of Ramirez's medical records, including those from doctors he might have consulted outside of MLB. Addendum C of the policy is authorization by every player to provide "health information" from "all health care providers (including but not limited to [add Club orthopedist and medical internist], other physicians, laboratories, clinics and Club trainers) with whom I have consulted pursuant to my Uniform Player's Contract or the Basic Agreement."

Ramirez and his representatives were prepared to appeal the synthetic testosterone results, intending to argue he had taken a steroid precursor known as DHEA, according to two sources. The drug is akin to the now-banned substance famously known as Andro, but it is not on baseball's banned list.

Baseball had geared up to dispute the argument, and a Ramirez appeal was scheduled for last Wednesday. MLB's legal team intended to use expert testimony to cite evidence it believed showed DHEA could not have been the cause of the synthetic testosterone.

However, in the days before the hearing, the union turned over Ramirez's medical records -- and they turned out to be a boon for MLB.

Within the records was a prescription written for the drug human chorionic gonadotropin (hCG) -- No. 55 on the list of banned performance-enhancing substances in the policy. The drug is mainly used for female fertility issues, but it is best known among male steroid users as a substance that can help kick-start the body's production of natural testosterone, which is stymied when using synthetic testosterone (aka steroids).

The synthetic testosterone in Ramirez's body could not have come from the hCG, according to doping experts, and so suddenly Ramirez had two drugs to answer for. Worse still for the ballplayer, MLB now had a document showing he had been prescribed a banned substance. This was ironclad evidence that could secure a 50-game suspension.

And so, in the hours before the appeal was scheduled to proceed, Ramirez notified MLB that he would accept the 50 games and drop his planned legal fight.

Soon thereafter, he issued his statement that his suspension had resulted from taking a medication -- not a steroid -- that was prescribed to him by a physician. Technically, that was true, but it was hardly the complete story.

Mark Fainaru-Wada and T.J. Quinn are investigative reporters with ESPN's enterprise unit. Fainaru-Wada can be reached at markfwespn@gmail.com. Quinn can be reached at tjquinn31@yahoo.com.