The Indians placed Miller on the DL with a strain of the tendon in his right elbow and called up left-hander Rafael Perez from Double-A Akron to replace him on the active roster. Miller flew to Cleveland on Thursday morning for an MRI that will give the club a better idea of how long he can expect to be out, or if surgery is necessary.
Miller suffered a similar injury last year and missed virtually the entire second half of the season. He was able to rest and rehab the injury without going under the knife.
"We'll wait and see how it eventually plays out," head athletic trainer Lonnie Soloff said. "In the next five to seven days, we'll come up with a game plan."
Soloff was still awaiting word on Betancourt's MRI before Thursday's game. Betancourt injured a muscle on his upper back while throwing a curveball to Ramon Hernandez.
"He was more sore [Thursday] morning than he was [Wednesday] night," Soloff said.
The two injuries, which happened within less than 10 pitches of each other, have put the Indians in a jam where their bullpen is concerned.
Perez was called up over several more statistically qualified prospects because he was the most prepared to give the Indians length out of the bullpen for Thursday's game.
The 23-year-old Perez became the second left-hander in the Tribe's 'pen, joining Scott Sauerbeck. Acquired by the Indians as a non-drafted free agent before the 2002 season, Perez was impressive in an '05 season split between Class A Kinston, where he went 8-5 with a 3.36 ERA in 14 starts, and Akron, where he went 4-3 with a 1.76 ERA in 15 appearances, including eight starts.
This season, Perez has gone 1-2 with a 7.02 ERA in three starts for the Aeros. His last start was Sunday, so he reported to Camden Yards prepared to pitch, if need be.
"He can give us 80 to 85 pitches, if we need," manager Eric Wedge said. "We like what we saw from him in Spring Training."
Perez most likely won't be with the club for long.
Right-handers Jeremy Guthrie (1-0, 0.00 ERA in two starts), Andrew Brown (2-0, 1.08 ERA in five appearances) and Brian Slocum (0-0, 1.23 ERA in four appearances) have all put up good numbers thus far at Triple-A Buffalo. Unfortunately, they've all also pitched in the last couple days, which is why the Tribe couldn't turn to them Thursday.
Veteran left-hander Felix Heredia (0-0, 10.12 ERA in two appearances) and right-hander Steve Karsay, recently added to the Buffalo roster after a stint in extended Spring Training, are also in the mix, but Shapiro said both need to get more innings under their belt before the Indians would call them up.
The bullpen was the Tribe's greatest concern coming into this season, and so far those concerns have been justified. Through 15 games, the 'pen has gone 1-2 with a 5.76 ERA and one blown save in four opportunities.
In addition to the injuries to Miller and Betancourt, the Indians also saw command troubles from youngster Fernando Cabrera, who was placed on the DL on April 15 with a bruised right heel. He began his rehab two days later, but won't be available to come off the DL until April 29.
The good news is that back-end relievers Guillermo Mota and Bob Wickman have been consistent.
"You hope the back end is solid," Shapiro said. "The middle will have fluctuations. It's going to have some fluctuation over the next two to three days to get settled."