Three things about this. One, medical decisions are hard. Each one is different, each player heals differently, and each diagnose is, at times and especially early, imprecise. I've told the story before about how Kyle Lohse had trouble pitching and getting a feel for his pitches, but MRI after MRI and exam after exam showed nothing wrong with his forearm. So what gives? Dr. George Paletta talked to Lohse about the issue and the righthander explained that it intensified as he pitched. So Paletta came up with the idea of having him simulate throwing and then have the arm examined. Voila! They realized how the inflammation in the forearm was caused by activity, and a treatment was set up.
Two, in the past 20 years the Cardinals have gone through medical staffs and training staffs multiple times. Paletta has even come and gone and then been asked back by the team to be in charge of the medical treatment. You'll recall the team entered into a partnership with Mercy that was lucrative for them and that was part of the treatment. So, yeah, there's accountability. Trainers know it. Doctors know it.
Three, let's get the facts out there on Mikolas, so that if you have an opinion on his treatment it can be based on the correct information. Mikolas pitched through the soreness last season, and at the end of the season he was given an exam and a scan to determine some of the causes for his discomfort. He was prescribed a platelet rich plasma injection at the end of the season. Rest was prescribed after that so that he could have a normal throwing program. Normal throwing program in the offseason does not involve high-intensity bullpen work, and it's not unusual for pitchers to take the mound in the early days of spring and have some flexor soreness because it's the first time they're throwing sliders or harder breaking pitches with intent. The tendon gets tested in a way it hasn't been during the winter, and sometimes it gets angry. That's where Mikolas is.
And, yes, the Cardinals are concerned too that it has not improved. This has their attention. But any time Mikolas tested it during his normal throwing program he had positive results. It wasn't until intensity increased that there was an issue.