Tennessee made national headlines this week for firing the top vaccination official at the Department of Health . The state has has been mum about the reasons for Michelle Fiscus’ termination, but she has alleged being made a scapegoat for GOP lawmaker anger over a state policy urging teens to get vaccinated against COVID-19.

Now the state is releasing a memo written by Tim Jones, the chief medical officer at the Health Department, to Commissioner Lisa Piercey claiming Fiscus didn’t work well with others and didn’t seek permission and guidance about the content of a letter “regarding her own interpretation” of state law regarding the authority of minors to get vaccines without their parents’ permission. Fiscus says the letter was drafted by an agency lawyer and “blessed” by Gov. Bill Lee’s office.

UPDATE: The Fiscus camp denies misdeeds, pointing to her glowing performance review as recently as last year.

Here’s the full text of the letter:

To: Lisa Piercey, MD, MBA, FAAP, Commissioner

From: Tim Jones, MD

July 9, 2021

Re: Expiration of service of Michelle (Shelley) Fiscus, MD

Based on program management deficiencies and failure to follow appropriate processes and procedures, please accept this recommendation to expire the executive service of Dr. Michelle Fiscus, Director, Vaccine Preventable Diseases and Immunization Program (VPDIP), Tennessee Department of Health.

This recommendation is based on Dr. Fiscus’s failure to maintain good working relationships with members of her team, her lack of effective leadership, her lack of appropriate management, and unwillingness to consult with superiors and other internal stakeholders on VPDIP projects.

On multiple occasions during the 2020-2021 COVID response, Dr. Fiscus has failed to maintain satisfactory and harmonious relationships among her team. In February 2021, CEDEP leadership and TDH Human Resources received multiple complaints from program staff regarding her management style, treatment of employees, and poor program morale. Dr. Dunn met with five senior team members who expressed consistent complaints related to management of the program by Dr. Fiscus during the COVID response. He had several coaching sessions with Dr. Fiscus, with minimal improvement in the situation noted. Two of her most senior leaders have subsequently resigned.

On March 7, 2021, Dr. Dunn and I met with Dr. Fiscus and another departmental physician to mediate complaints against Dr. Fiscus of disrespectful treatment and ineffective management. The meeting terminated with a refusal of both parties to communicate constructively, and with a refusal by the other physician to work further on the VPDIP team. Dr. Fiscus was coached on professionalism and teamwork.

Dating back to December 2020, the vaccine planning team required intervention by CEDEP leadership to address inefficient use of team resources, including poor inter-program communication regarding vaccine distribution. Repeated failures by Dr. Fiscus to appropriately delegate to others resulted in repetitive, long, and inefficient meetings. These meetings took already busy colleagues away from other tasks.

Over the past three months Dr. Fiscus requested to give a new non-profit organization TDH funding to support VPDIP activities. This organization was founded and led by Dr. Fiscus, had no Executive Director or other employees, and had no other substantive source of funding. Providing funds to such an entity would be poor judgement and a substantial conflict of interest.

In June, 2021, Dr. Fiscus communicated directly with a state university regarding the department producing COVID-vaccine reports for the institution. She did not notify or consult with supervisors, and the situation only became evident when departmental legal counsel received formal documents directly from the university memorializing the arrangement. The requested reports were not produced by the department.

In May, 2021, Dr. Fiscus broadly shared a letter regarding her own interpretation of state and federal law with external partners with respect to vaccinations and other medical treatment of minors. The letter should have been reviewed by both leadership and departmental legal counsel. However, Dr. Fiscus did not share the letter nor otherwise include any of these parties in the drafting process prior to sending it out. This action resulted in confusion of both law and policy for private providers, parents, and legislators.

These examples clearly demonstrate that Dr. Fiscus’s performance in this role has led to strained relationships with internal and external stakeholders at multiple levels, and to an ineffective and non- cohesive workplace. Her leadership and management of her team does not foster the culture or environment expected at the Tennessee Department of Health.