Fired immunization director never saw letter recommending termination

The Department of Health fired its director of the immunization program for several reasons, including failure to consult superiors on the state’s vaccine program, according to a letter placed in her personnel file.

But Dr. Michelle Fiscus, who was terminated Monday, says she didn’t know about the letter written by Dr. Tim Jones on July 9 until notified Thursday by a reporter.

“It’s interesting something was put in my personnel file and not shared with me,” Fiscus said. She noted the letter could have been written and dated after she was fired.

According to the Tennessee Journal, Fiscus said the letter was written by a department attorney and “blessed” by Gov. Bill Lee’s office.

Obtained by Tennessee Lookout in an official open records request through the Tennessee Department of Health, the letter from Jones recommends Fiscus be fired for program management “deficiencies and failure to follow appropriate processes and procedures.”

In addition, the recommendation is based on her failure to maintain good working relationships, lack of effective leadership and appropriate management and “unwillingness” to consult superiors and internal stakeholders on vaccination and immunization projects.

In contrast, her latest evaluation from 2019-20, provided to the Tennessee Lookout, calls Fiscus a “strong leader” for a vaccination team and an “integral piece of the COVID pandemic response. Her leadership and efforts in multiple areas have been critical.” She also received a strong evaluation for her work on a hepatitis A breakout.

Another evaluator said she “exceeded expectations,” was a “key contributor” in the COVID-19 response and did “excellent” work preparing for the COVID-19 vaccine program. Yet another evaluator said she “exceeded expectations” in managing an immunization registry.

However, the letter recommending she be fired points to a memo Fiscus sent to vaccination providers such as drugstores in which she described the state’s Mature Minor Doctrine, a case law allowing teens ages 14 and older to receive medical care, including vaccinations, without parental approval.

Fiscus “broadly shared” the memo with her “own interpretation of state and federal law” on vaccinations and treatment of minors, according to the letter. 

“The action resulted in confusion of both law and policy for private providers, parents and legislators,” the letter states.

Because of the memo and the state’s public service announcements, a handful of conservative lawmakers accused the Department of Health of trying to conduct a mass vaccination of children without parental permission.

Fiscus said Thursday she used language approved by department legal counsel to write the letter and noted that it wasn’t practice to seek approval from senior staff for any memos to vaccine partners.

The letter also describes poor relationships between Fiscus and staff that caused “poor program morale” as well as meetings with senior team members that failed to lead to improvements. Dating to December 2020, the department’s vaccine planning team needed intervention from senior leaders to deal with “inefficient use” of resources such as poor communications about vaccine distribution, according to the letter.

In addition, the letter is critical of Fiscus’ work to set up a nonprofit organization and her requests to provide it with Department of Health funding. 

“Providing funds to such an entity would be poor judgment and a substantial conflict of interest,” the letter states.

Fiscus told Tennessee Lookout she did help organize Immunize Tennessee, which has 501(c)3 status, with the knowledge of the health department, working on it for two years to support the state’s vaccination efforts, as charged by the U.S. Centers for Disease Control. Fiscus, formerly a Williamson County pediatrician, said she does not receive pay or benefits and does not serve on the group’s board but acts in an ex-officio capacity. 

In addition, the letter says Fiscus communicated directly with a state university about the department providing it with COVID-vaccine reports, without notifying supervisors. Fiscus said she was assigned to advise universities across the state during the pandemic but was uncertain about the particular reference.