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WILLIAMSON COUNTY’S WILD MASK MANDATE MEETING

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A WILD NIGHT IN WILLIAMSON

Last night Williamson County became the 4th Tennessee county to pass some version of a mask mandate since Speaker Sexton’s threat to call a special session if they did, joining Shelby, Davidson, and Hancock County in East TN.

It was a wild meeting, with large groups attending on both sides of the issue. Anti-maskers showed up in force, chanting “No More Masks!” all night long and carrying lots of signs about “freedom” and “choice” – an interesting word for them to be using considering their stance on women’s reproductive rights, but we digress.

Pro-mask parents had shown up around 2PM for the 6PM meeting to secure the majority of places in line to be among the 30 who were allowed to give 1 minute public comments, many of which they ceded to doctors and nurses who showed up to lend their voices to the cause.

Early on it began to feel inevitable that the vote would end with some sort of masking requirement for elementary school-aged children. The justification given for the focus on younger kids was best articulated by Board Member Sheila Cleveland, who made the point that kids above 12 years old had the option to vaccinate, wear a mask, or learn remotely, but younger kids are not yet eligible for the vaccine, and remote learning is not an option for them. She summed up her decision: “What I feel is more damaging (mentally) than wearing a mask is when kids were sent home when schools closed.”

Superintendent Jason Golden was on hand to provide a recommendation to adopt the mandate for elementary school kids, but adding: “There is no clear answer. And if you disagree we respect that. Schools can’t solve COVID or end the pandemic… what we can do is mitigate.”

Jay Galbreath offered a few amendments to make the inevitable mandate slightly more palatable for the anti-maskers, in particular adding an end date for the temporary mandate of September 22nd, two days after the next board meeting, which would mean just one month of masks, and would give the board time to review Williamson-specific data about the spread of COVID-19. Galbreath says he respects both sides, but pointed out “The only place in the county elementary school age kids would be required to wear masks would be in school.”

The amendments did not appease many of the angry anti-maskers, however. One man dressed in nursing scrubs, who we were told works at St. Thomas in Nashville, had been getting in the faces of pro-mask women before the meeting started – telling them “there is no pandemic”. He was the first to be kicked out by board chair Nancy Garrett for his repeated outbursts. Many followed him out, faces twisted in anger.

Another man who identified as a veteran hurled threats at the board.

At close to 10PM, after 4 hours of respectful deliberation between the board members and deeply disrespectful, childish interruptions from the anti-maskers in the audience – more than a few of which were forced to leave – the eventual vote ended 7-3 in favor of a temporary mask mandate for elementary students in the county.

The most commonly cited reason board members gave for voting in support was that they felt better about living with the consequences of imposing a simple mitigation tool than they would about the consequences of not doing so and allowing the disease to spread.

Jennifer Aprea pointed out that she believes in “choice”, but that the choice must stop when that choice can impact the health of others around you, using the example of parents not sending nut-based products to class when other students have a debilitating nut allergy: “Sometimes we have to make a decision for the good of the whole.”

Despite Speaker Sexton’s warnings, there are no signs at this point that Governor Lee plans to call for a special session to ban such mandates. In a press gathering this week Lee said he believes parents should have the choice about masking their kids, but ultimately agreed that school districts DO have the legal authority to impose a mask mandate – something which many anti-maskers disagreed with (although most did not appear to be lawyers).

Many of the anti-masker parents could be heard yelling “DO NOT COMPLY!” after the decision was handed down. (Fascinating to hear that refrain from the same people who tell unarmed black people all they need to do to stay safe is obey police orders)

September 20th will be the next battle in Williamson County. Below are some video highlights from the raucous event.

DR. LEWIS: “Knee-Jerk Reactions Will Harm Tennessee’s Children”

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“Knee-Jerk Reactions Will Harm Tennessee’s Children”

An Op-Ed from Dr. Terri Lewis of Tennessee

In recent days, the contingent of state legislative anti-vaxxers successfully browbeat the Tennessee Department of Health into cancelling childhood vaccine outreach programs – not just for COVID19, but for all routine childhood immunization programs.

On face, it appears that the TN Dept of Health, responsible for public health in 89 of Tennessee’s 95 counties excluding major metropolitan areas where local agencies wield more authority, will no longer conduct public outreach for any preventable childhood communicable disease.

‘Don’t ask, don’t tell’ seems to be the new public health strategy.

Tennessee lags behind the nation in all measures of disease prevention through vaccination. As of July 13, the number of fully vaccinated Tennesseans for COVID settled at 2,599,234 or 38.06% of the population. Overall, Tennessee ranks 33rd among the 50 states with a childhood vaccination rate of 79.9% against a population of 6,944,260. Tennessee currently meets HP2030 targets for 2 out of 3 vaccination-related measures for 24-month old children.

But there are significant gaps.

Many of Tennessee’s children have not completed the entire series of vaccines for preventable illnesses in the last decade. Minority children are less likely to be fully immunized. Some parents refused any and all routine immunizations.

Progress toward meeting vaccination rates for children up to the age of 24 months is located on theTNDOH website [1].

As concerning is the announcement by Dr. Tim Jones, Chief Medical Officer, that henceforth, no vaccination efforts will be conducted for routine childhood vaccines, with the HPV vaccine particularly singled out.

No outreach includes “pre-planning” for flu shots events at schools and back to school vaccines, and by inference, routine immunizations for infants, toddlers, teens and college students. Responsibility for back to school vaccines will become the responsibility of the Tennessee Dept of Education, not the TNDOH.

The elements of a successful outreach effort are well documented.

First, parental and community education and messaging around the safety, efficacy, and importance of childhood immunization is essential to ensure that children receive the full complement of preventive vaccines. With the gap in health insurance coverage for children this is an important function of the TNDOH at the county level across the state.

Second, there must be ready access to immunizations at every opportunity. The percent of children without health insurance increased from 5.2% in 2018 to 5.7% in 2019, with Hispanic children most represented in the childhood insurance coverage gap [2]. By fall of 2020, 9% of Tennessee children were uninsured, more than twice the level at the same time in 2019, according to the Vanderbilt Center for Child Health Policy[3]. Brief periods of being uninsured can have long-term effects on the health of children and their achievement in school… children who lose their insurance miss important immunizations and go months with major unaddressed problems…” [J. Zickafoose, MD, MS, Monroe Carrell Children’s Hospital at Vanderbilt]. Children who fall into the coverage gap are least likely to receive preventive care.

Third, reliable and readily accessible immunization records that provide a non-duplicated reflection of on-time immunizations are important for ensuring an accurate personal history for personal health management. This responsibility lies with health providers, not the Tennessee Department of Education. Lack of health coverage will magnify the negative impact of the childhood coverage gap where the health system fails to conduct routine outreach.

Finally, preventable childhood diseases are on the rise with the reduction in vaccination rates. Uninsured children are particularly vulnerable. When compared with privately insured children, uninsured children have more health disadvantages including need for medical or dental care; greater severity of illness, more hospitalizations and higher mortality rates; more vaccine-preventable disease; and higher rates of chronic illness such as asthma and diabetes [4].

The announced actions that resulted decisions to termination vaccine program leadership and cease immunization program outreach will have harmful effects resulting in tangible, measurable harms to Tennessee’s children and youth.

I strongly encourage the re-examination of these knee-jerk reactions to pressures exercised from certain sectors of the population.

[1] https://www.tn.gov/content/dam/tn/health/documents/cedep-weeklyreports/2020-24-Month-Old-Survey.pdf

[2] https://www.aappublications.org/news/2020/12/01/researchupdate120120

[3] https://www.vumc.org/health-policy/tennessee-poll-uninsured-kids-covid19-2020

[4] https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/Uninsured_children/state/TN

Dr. Terri Lewis

Silver Point, TN

Global Immunization Action Network Team

https://www.giant-int.org/

 

 

 

@TheTNHoller

DR. FISCUS RESPONDS, WITH RECEIPTS

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Yesterday, the Tennessee Department of Health released a letter they claim was written by Chief Medical Officer Dr. Tim Jones on July 9th outlining their reasons for firing Dr. Fiscus, Tennessee’s top vaccine expert. For some reason this letter was not mentioned when the story of the Fiscus firing initially broke, and quickly became national news – and, according to Dr. Fiscus, was not shared with her at the time of her firing.

The Jones letter attacks the leadership and management abilities of Dr. Fiscus, and even goes so far as to accuse her of attempting to self-deal by steering Department resources to an organization she stood to gain from, without evidence. We posted a link in which Dr. Fiscus addresses those baseless accusations. We have also reached out to Dr. Jones and Commissioner Piercey for interviews about it, but have not heard back.

Dr. Fiscus has also gone ahead and addressed the letter point by point in a scathing takedown of the Jones letter. We have posted it below in its entirety.

-She says she’s “disappointed in people I considered friends and mentors,” describing how CMO Tim Jones and John Dunn (who wrote glowing reports) supported her… until they didn’t.

-She addresses CMO Tim Jones’ attacking her leadership and character by pointing to and including excerpts from her glowing performance reviews, with receipts.

–Jones attempted to use a meeting with another physician against Dr. Fiscus — who counters with a text from that physician calling her “the greatest treasure the department had” and referring to her firing as “complete and utter bullshit”.

-In the dirtiest part of the Jones letter, he implies Dr. Fiscus is self-dealing. Her performance reviews show they not only knew about Immunize TN (the org she convened), they call it “very successful” in her performance reviews.

–Jones accuses Dr. Fiscus of sharing “her own interpretation” of the mature minor doctrine without running it by counsel. Sooo… she includes an email from TDH counsel saying the summary has been blessed by Governor Lee’s office and is ok to forward” — oops.

-Lastly, Dr. Fiscus takes on Governor Lee’s office “dodging the question” and “twisting the narrative away from the subject” of how they’ve changed the vaccine program for children in Tennessee. (which their own anti-vaccine supporters have bragged that they have).

Bottom Line: This Dr. Fiscus rebuttal makes it clear The Tennessee Department of Health and Governor Lee not only were willing to scapegoat TN’s top vaccine expert for political reasons… they’re also very comfortable making things up to assassinate her character as well.

Good luck with recruitment.

 

For Immediate Release

July 15, 2021

Michelle Fiscus, MD FAAP Response to Tennessee Department of Health’s Justification of Termination

I apologize in advance for the length of this response, but there is much to say in response to TDH’s recently released letter attempting to justify my termination. I became aware of the existence of the document today when it was shared with my husband by a member of the media.

First, let me say how disappointed I am in people whom I considered friends and mentors in the Department of Health. Dr. Tim Jones, who signed this letter to Commissioner Piercey, recruited me to the position of medical director of the Tennessee Immunization Program in 2018 and has been a trusted friend and colleague. He has confided in me throughout this pandemic response, and first let me know that my employment at TDH was threatened in late June 2021. I asked him at that time, in a meeting with my direct supervisor, Dr. John Dunn, on what grounds I was to be terminated and he replied, “None, as far as I’m concerned” and told me he would continue to “fight” for me to remain at TDH. In the moment, I told Drs. Jones and Dunn that I would resign before I would allow them to terminate me.

Over the next few weeks, both Dr. Dunn and Dr. Jones voiced their continued support for me, with Dr. Dunn telling me repeatedly that I “belonged at TDH” and that he did not want me to leave. I repeatedly shared with Dr. Dunn that I would not remain at TDH, but that I hoped my departure would be on my timeline rather than that of the administration’s. Dr. Dunn went to far as to text state Chief Operating Officer, Brandon Gibson, regarding the injustice he felt over the talks of my termination at the level of Governor’s office. I asked Dr. Dunn if Chief Gibson responded to the text, to which he replied, “She ‘hearted it’”.

On Saturday, July 3rd I received an unexpected call from Dr. Jones on my personal cell phone. Dr. Jones asked if I was at home because he wanted to “drop something by the house.” I assumed it was a letter ending my employment, but Dr. Jones said, rather sheepishly, that he was bring by scones that his wife, Jill, had baked for me. “…and an orchid.” I asked Dr. Jones if he was also bringing a letter with him and he sounded surprised that I asked. He responded, “No. I just want you to know you’re not the only one lying awake at night staring at the ceiling over this.” I told him I was out of town, he said, “good” and we ended the call. On Wednesday, July 7th, when I returned to the office, the plate of scones and the orchid were on my desk (I have since given the orchid to one of my former employees rather than bring it home) as well as the Amazon envelope containing the dog muzzle. I sent Dr. Jones a text thanking him for the scones and the orchid and asked if he also sent the muzzle. He said he did not. This does not seem to be behavior consistent with that of an individual who would write this letter of justification that was dated just two days later.

On July 12th at 0617 Dr. Dunn sent me the following text: “Good morning Shelley. I think all their timelines and decision points are said he [sic] sure you have everything you need and one [sic] today.” I called Dr. Dunn because his text was unclear and he stated that I should connect with Tim (Jones) sometime that day and that I should make sure “you have everything you need”. Shortly after this, Tim Jones called me on my personal cell phone and said, “You will be getting an invite for a meeting today at 3:30pm. I probably won’t be alone. Let me know if you would like to talk before then.” “What would we talk about?”, I asked. Tim replied, “Well, if you want to give me anything.” I replied, “Oh, no. Thanks.”

Just prior to 3:30 I went up to see the Deputy Commissioner, who has been a dear friend in the Department. I found Dr. Jones pacing in the hallway, clearly distressed. His back was to me and I said, “are you pacing???” but did not wait for a reply. As I have previously stated, Dr. Jones met with me and a member of the human resources department at 3:30pm, stated he was sorry to have to have the meeting, and provided me the choice of resignation or the “expiration of my executive service”. Dr. Jones appeared somewhat surprised with my choice to be terminated.

I will address the content of the letter point by point:

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.

My annual reviews from my four years at TDH refute these allegations. From my annual review for the period of 10/1/2019-9/30/2020, written by Dr. John Dunn and approved by Dr. Tim Jones:

“Dr. Fiscus has consistently exceeded expectations during this evaluation period. Her leadership in running the program activities has been exceptional. Many of the program staff have been on AWS yet they are meeting program objectives and deliverables.” End of cycle outcome rating: Outstanding

“Dr. Fiscus has selflessly focused on the needs of her team and not [sic] her own professional development plan. Her attention to team dynamics and staffing have been outstanding during this rating period. She is providing opportunities to her staff to step into leadership roles. Dr. Fiscus has considtently [sic] exceeded expectations in regards to management of HR issues and balancing the additional workload related to C19.” End of cycle outcome rating: Outstanding

From my interim evaluations from 12/01/2020 – 6/30/2021, written by Dr. John Dunn (changes in HR policy no longer required Dr. Tim Jones’ approval):

“The vaccine team and Dr. Fiscus have been under tremendous stress with attrition being noted. Dr. Fiscus is working closely with her team to provide growth and development opportunities while balancing the workload of COVID vaccine.”

The two employees referenced who have resigned have completed exit interviews with senior leaders outside of my program. Their comments were shared with Dr. Dunn and did not indicate that their resignations were due to my leadership. One of the two employees accepted an opportunity with a global health organization, which was their aspiration. Both I consider to be good friends and are still in frequent contact with me.

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.

This has been a pandemic of historic proportions and a COVID-19 vaccine roll-out that required that I, as well as members of my team, work extraordinary hours for months on end. It was stressful and, at times, there were disagreements. The physician referenced above reached out to Dr. Jones because she was concerned about my ability to continue to work at the pace I was working and hoped Dr. Jones might be able to assist me with delegating responsibilities. I was never “coached on professionalism” although I was coached on teamwork and the need to work on my ability to delegate responsibility to others. The physician referenced above sent a text to me on Monday, July 12, after learning of my termination. It read (shared with permission):

“What you may not know from our interactions is that I truly believe you are the greatest treasure TDH had. This is complete and utter [expletive] and I am incredibly proud of you, the work you’ve done, and your response to this situation. Stay strong and keep up the good fight!”

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.

Again, annual reviews refute these allegations. The statewide roll-out of multiple new vaccines using new means and methods developed by the federal government that must be adapted to a local environment is complex and extremely challenging. It did take time to determine the most efficient and effective means for accomplishing this goal, which I accomplished with excellence.

From my annual review for the period of 10/1/2019-9/30/2020, written by Dr. John Dunn and approved by Dr. Tim Jones:

“Dr. Fiscus has been a strong leader for the VPD team and has been an integral piece of the COVID pandemic response. Her leadership and efforts in multiple areas have been critical.”

“Dr. Fiscus has exceeded expectations for this work outcome [Ensure that reports of vaccine preventable diseases are responded to rapidly and thoroughly]. Her efforts to maintain programmatic [sic] activities have been notable. She has been a key contributor and leader for the C19 response. Her work in balancing the upcoming flu and C19 vaccine planning has been excellent. End of cycle outcome rating: Advanced

“Dr. Fiscus has done an outstanding job representing TDH and CEDEP. Her work has far exceeded expectations in regards to outbreach [sic] to stakeholder groups and collaborators in the C19 response…. I greatly appreciate her leadership and teamwork. End of cycle outcome rating: Outstanding

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.

When I joined the Immunization Program I looked to see what the state’s immunization coalition had been doing and found Tennessee was one of only two states in the southeast that did not have a statewide coalition.

As evidenced by my 2019 job plan:

“VERY SUCCESSFUL”

As you can see, leadership at TDH was well aware of my work to convene ImmunizeTN and celebrated those efforts. I convened stakeholders who went on to incorporate as a 501(c)3 non-profit organization. I am not on the board of directors, I am not on the payroll, and I serve in only an ex-officio advisory capacity to the board. The coalition has funding from the American Academy of Pediatrics and it is true that I was going to use CDC funding to support the work of the coalition to promote immunizations and provide education to healthcare providers and to the public. ImmunizeTN also has a social media presence which is used to spread pro-vaccine messaging and refute anti-vaccine mis- and disinformation. The CDC provides funding to state immunization programs to support this work and encourages states to provide financial support to their immunization coalitions. There is no conflict of interest as I do not benefit materially from the coalition. I would argue that the refusal of TDH to allow the use of CDC funds to support the work of this coalition further obstructs our ability to combat vaccine misinformation and overcome vaccine hesitancy.

I have released my annual evaluation, in their entirety, to the media, except for the 2018-2019 document, which is not in my possession. I have requested a copy of that document from TDH Human Resources without response. I request that this document be released immediately as it, too, supports my record as an exemplary employee of TDH.

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.

As I do not have access to my state email account, I cannot be certain of the details of this situation. As the state-appointed liaison to all levels of education in Tennessee as it pertained to the COVID-19 response, I was the point contact for all colleges and universities in the state. To my recollection, the University of Tennessee asked if TDH would be able to provide data regarding the COVID-19 immunization coverage rate of UTK students and staff using data from the immunization registry. UTK provided a draft data use agreement which I forwarded to the TDH Office of General Counsel for their review and thoughts, but I do not recall receiving a response. There was no consultation with supervisors because I did not completely understand what was being requested by UTK and my first inquiry was to OGC for the review of the document.

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.

The details of the Mature Minor Doctrine memo of May 10th have been shared broadly, as have the emails that led up to the release of that document. The memo is in the public record. There is no personal interpretation of the doctrine included in that memo—the language, with the exception of the introductory paragraph and the final line, “There is no federal, legal requirement for parent or caregiver consent for COVID-19, or any other, vaccine”, was taken verbatim from the document provided to me by Grant Mullins, TDH chief legal counsel. It was not customary for my communications with medical providers regarding the logistics and administration of COVID-19 vaccines to be reviewed, and several memos preceded this one without any discussion of the need for internal review. To state that I did not include legal counsel in the drafting process is clearly untrue, given Mr. Mullin’s email to me below which states, “this is forward facing so feel free to distribute to anyone.”

Additionally, I would like to respond to statements released by the Governor’s office.

Governor Lee’s press secretary, Casey Black, stated the following in an email to the media on July 14, 2021:

Despite misleading reporting, the Department of Health has not halted the Vaccines for Children Program that provides information and vaccine access to Tennessee parents. This program covers immunizations including DTap, MMR, Polio, Chicken Pox and Hepatitis B and will continue to be successfully administered:

• Tennessee ranked among the top 10 states for MMR vaccination coverage among kindergartners during the 2019-2020 school year • 95.3 percent of 2020-2021 kindergarten students in TN were fully immunized

• For more than a decade Tennessee has above 90 percent coverage of kindergarten students receiving childhood immunizations including DTap, MMR, Polio, Chicken Pox, Hepatitis B.

The department is mindful of ensuring parents, not kids, are the intended audience for any outreach efforts regarding medical decisions for children and has simply re-evaluated some tactics like reminder postcards and follow-up communications. While childhood immunization rates temporarily dropped during the COVID-19 pandemic, we are already seeing vaccination rates rebound to pre-pandemic levels and will continue supporting parents who are working to get their families back on track.

I know a lot of misleading info is being shared, so don’t hesitate to give me a call if you have any questions.

I’ve also copied Sarah Tanksley from the Dept. of Health here in case any follow up is needed on her end.

Thanks again,

Casey Black Press Secretary | Office of the Governor

What is stated above is, indeed, factual; however, it is not relevant to the concern regarding TDH’s moratorium on childhood vaccination events in schools, outreach to adolescents or their parents regarding COVID-19 vaccinations, or the directive to not publicize National Immunization Awareness Month in August. I have never stated that the Vaccines for Children Program had been halted. The VFC Program is an entitlement program that provides vaccines to children who are insured through TennCare or who are uninsured, and I would certainly hope that the work of that program has been unhindered. What has been halted is the partnerships between local health departments and outside agencies, such as schools, to provide vaccines outside of a local health department. What has been halted is any attempts to communicate to parents that their children are in need of critical routine immunizations during this back-to-school season. That is a significant change from the standard operations of the Department of Health and this decision creates barriers to immunization and will result in decreased vaccination coverage rates, especially among poor and minority populations. It is interesting that the talking points provided discuss the past accomplishments of the program, all of which were under the direction of myself and my immediate predecessor and have absolutely nothing to do with the current concerns regarding the actions taken by Dr. Piercey to appease a handful of outraged and uninformed legislators. The information I have shared is not “misleading”, it is the response from the Governor’s office that both dodges the questions posed and twists the narrative away from the subject at hand.

 

 

TN HEALTH DEPT. HIGHER-UPS ATTACK DR. FISCUS’ CHARACTER

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Earlier today the Tennessee Department of health released a letter from Chief Medical Officer Dr. Tim Jones to Department Commissioner Dr. Lisa Piercey (supposedly from July 9th) outlining the justification for firing Dr. Michelle Fiscus, the state’s top vaccine expert. This comes after a tremendous amount of blowback on a national scale, and reeks of a cleanup effort on the part of Governor Lee’s administration.

The letter disparages Dr. Fiscus in many ways, questioning her character, leadership abilities, and relationships, which doesn’t seem to jive with her glowing performance reviews – but it also goes the extra mile and alludes to outright corruption, implying Dr. Fiscus was steering resources to a foundation for her own benefit, calling it a “conflict of interest”.

Dr. Tim Jones says:

“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.”

We spoke with Dr. Fiscus about this. She says she helped convene Immunize TN, a 501(c)(3) organization, to raise awareness about immunizations and refute anti-vaccine propaganda and get more Tennesseans vaccinated. “We’re asked by the CDC to put together pro-vaccination coalitions, and they give a grant to the state to support your state’s immunization coalition,” Dr. Fiscus told us. “Tennessee didn’t have one, so we got one together to make one. Immunize TN was going to do some of the work we were asked to do, which is standard operating procedure.”

Dr. Fiscus says she doesn’t receive pay from Immunize TN and is not on the board, saying she helped bring it together and was trying to steer resources to it to help it grow and become effective, part of her job as the state’s top vaccine expert. “They’re making it seem like I was trying to feather my best, which is completely false. The letter from Tim Jones alleges there was no board of directors, which is untrue. It has been in the works for 2 years and is part of my work plan.”

She says requests for funding for Immunize TN were made by Doctor Dorothy Sinard, who is on the board and is one of the other doctors involved. Dr. Sinard could not yet be reached for comment.

“Why wouldn’t that letter have been shared with me at the time of my termination?” Dr. Fiscus wonders.

A fair question.

REP. CLEMMONS ON THE FISCUS FIRING: “I’M INFURIATED”

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Rep. John Ray Clemmons shared his feelings on Governor Lee firing Dr. Fiscus for doing her job and trying to keep Tennesseans safe, saying all Tennesseans should be “infuriated” at Lee for caving to the extreme science-denying right. Clemmons also expresses disappointment with TN Dept. of Health commish Dr. Lisa Piercey for not standing up for Dr. Fiscus.

DR. FISCUS CALLS GOV. LEE “TOXIC TO WORK UNDER”

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Today Tennessee’s top immunizations expert Dr. Michelle Fiscus is making the rounds on national shows talking about her firing at the hands of Governor Lee for doing her job and trying to keep Tennessee safe. She isn’t holding back. Below are some clips.

HEALTH DEPT’S FISCUS FIRED FOR DOING HER JOB

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Today, Dr. Michelle D Fiscus, who serves as the Medical Director of Tennessee’s Vaccine Preventable Diseases and Immunization program, has been fired from her role by Governor Lee’s administration.

This comes in the wake of public pressure from elected Republicans, who have threatened to dissolve the department because of what they perceive to be a push to encourage young Tennesseans to get vaccinated, which might be reasonably considered to be part of her job.

Last month in a government ops committee meeting things got heated when Republicans learned the Tennessee Department of Health had been allowing young Tennesseans over 14 to get the COVID-19 vaccine if they so chose even without their parents signing off on it.

The Health Department did this because the law allows them to, and because the data shows the vaccine is protecting people – almost every single Tennessean to die of the disease in recent months has been unvaccinated – but that didn’t stop Rep. Scott Cepicky and others from attacking the department and threatening dissolution.

The number of younger Tennesseans to get the vaccine without parental approval was exactly eight, three of which were TN Dept of Health commissioner Dr. Lisa Piercey’s own children.

The Fiscus firing is pretty clearly Governor Lee’s way of sacrificing her to the extreme right in an effort to alleviate some of the pressure.

In essence, Dr. Fiscus is being fired for doing her job as she tries to get Tennesseans vaccinated.

We are currently towards the very bottom in terms of vaccine intake, in no small part because of a lack of leadership at the top, not only from Rep. Cepicky, but also from TN House GOP caucus chair Jeremy Faison, who has actively been trying to dissuade Tennesseans from getting the vaccine.

Tennessee Republicans have also gotten plenty of help from Fox News and other conservative sites, who have been repeatedly and constantly disparaging the vaccine even though they themselves have been vaccinated, including Fox chief Rupert Murdoch.

The cynicism is breathtaking.

STATEMENT FROM DR. FISCUS:

July 12, 2021

Today I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic. That’s nearly 40% of us. And along with our resignations or retirements or, as in my case, push from office, goes the institutional knowledge and leadership of our respective COVID-19 vaccine responses.  I will not sit quietly by while our public health infrastructure is eroded in the midst of a pandemic.

We are a group of dedicated public health professionals who have worked endless hours to make COVID-19 vaccines, the ONE tool we have to effectively end the scourge of the COVID-19 pandemic, available to every person in our jurisdictions.  Along the way we have been disparaged, demeaned, accused, and sometimes vilified by a public who chooses not to believe in science, and elected and appointed officials who have put their own self-interest above the people they were chosen to represent and protect.

On May 6, 2021, in advance of the approval of the Pfizer COVID-19 vaccine for 12-15 year olds and in response to multiple questions I had received regarding the rules around vaccinating minors, I reached out to Tennessee Department of Health’s general counsel to request a statement regarding Tennessee’s Mature Minor Doctrine that resulted from a Tennessee Supreme Court Ruling in Cardwell v Bechtol in 1987. In response, I received a document attached to an email stating, “Sure—Attached is the new summary of the doctrine that has just recently been posted to the website and is blessed by the Governor’s office on the subject. This is forward facing so feel free to distribute to anyone.” On May 10, 2021, I copied and pasted the language provided to me into a memo that was distributed only to providers who were administering COVID-19 vaccines. A recipient of that memo was upset that, according to Tennessee Supreme Court case law, minors ages 14-17 years are able to receive medical care in Tennessee without parental consent and posted the memo to social media. Within days, legislators were contacting TDH asking questions about the memo with some interpreting it as an attempt to undermine parental authority. Let me be clear: this was an informational memo containing language approved by the TDH Office of General Counsel which was sent to medical providers by the medical director of the state’s immunization program regarding the guardrails set 34 years ago by the Tennessee Supreme Court around providing care to minors.

What has occurred in the time between the release of this memo and today, when I was terminated from my position as medical director of the vaccine-preventable diseases and immunization program at the Tennessee Department of Health, can only be described as bizarre. On May 19th TDH was asked to appear before the Government Operations Committee due to the concern that the memo was “a bit of a prodding or encouraging to vaccinate children without parental consent”.  This was followed by a series of requests from members of the Committee for data around the impact of COVID-19 on children and a request to appear before the Committee again on June 16. It was at that June 16th meeting that the Department was accused of “targeting” youth through Facebook messaging and its actions were described as “reprehensible” by one Committee member. That member went on to call for the “dissolving and reconstitution” of the Department of Health in the midst of a pandemic where one out of every 542 Tennesseans has died from COVID-19 on their watch and less than 38% of Tennesseans have been vaccinated. It is the mission of the Tennessee Department of Health to “protect, promote and improve the health and prosperity of the people of Tennessee” and protecting them against the deadliest infectious disease event in more than 100 years IS our job. It’s the most important job we’ve had in recent history. Specifically, it was MY job to provide evidence-basededucation and vaccine access so that Tennesseans could protect themselves against COVID-19. I have now been terminated for doing exactly that. Each of us should be waking up every morning with one question on our minds: “What can I do to protect the people of Tennessee against COVID-19?”. Instead, our leaders are putting barriers in place to ensure the people of Tennessee remain at-risk, even with the delta variant bearing down upon us.

What’s more is that the leadership of the Tennessee Department of Health has reacted to the sabre rattling from the Government Operations Committee by halting ALL vaccination outreach for children.  Not just COVID-19 vaccine outreach for teens, but ALL communications around vaccines of any kind. No back-to-school messaging to the more than 30,000 parents who did not get their children measles vaccines last year due to the pandemic.  No messaging around human papilloma virus vaccine to the residents of the state with one of the highest HPV cancer rates in the country. No observation of National Immunization Awareness Month in August. No reminders to the parents of teens who are late in receiving their second COVID-19 vaccine. THIS is a failure of public health to protect the people of Tennessee and THAT is what is “reprehensible”. When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives.

I was told that I should have been more “politically aware” and that I “poked the bear” when I sent a memo to medical providers clarifying a 34 year old Tennessee Supreme Court ruling. I am not a political operative, I am a physician who was, until today, charged with protecting the people of Tennessee, including its children, against preventable diseases like COVID-19. I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts. They believe what they choose to believe rather than what is factual and evidence-based. And it is the people of Tennessee who will suffer the consequences of the actions of the very people they put into power. The public health professionals at the Tennessee Department of Health have worked themselves to exhaustion to protect Tennesseans from this virus. They are heroes. They have prevented suffering and saved countless lives. They are to be honored and commended, not cursed and vilified. And the “leaders” of this state who have put their heads in the sand and denied the existence of COVID-19 or who thought they knew better than the scientists who have spent their lives working to prevent disease… who have ignored the dead and dying surrounding them—even when their own colleagues have fought for their lives—they are what is “reprehensible”. I am ashamed of them. I am afraid for my state. I am angry for the amazing people of the Tennessee Department of Health who have been mistreated by an uneducated public and leaders who have only their own interests in mind. And I am deeply saddened for the people of Tennessee, who will continue to become sick and die from this vaccine-preventable disease because they choose to listen to the nonsense spread by ignorant people. At this point, you are going to get vaccinated or you are going to get sick. Yes, not getting the vaccine is a personal choice.  It’s true that you are likely to survive COVID-19.  It’s the 1 out of every 542 people surrounding you that will suffer the consequences of an unfortunate decision to remain vulnerable to this horrible disease.

May God bless the people of Tennessee.

Michelle D. Fiscus, MD FAAP

NYT’s “THE DAILY” Podcast On GREENEVILLE, TN’s Vaccine Hesitancy

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Today’s episode of the New York Times “The Daily” podcast is called “Rural Tennessee’s Vaccine Hesitators”, and it’s all about vaccine hesitancy in GREENEVILLE, Tennessee – a community hard-hit by COVID where vaccine intake is exceptionally low compared to nationwide standards.

In general, Tennessee is at the bottom when it comes to vaccine intake, in large part thanks to a lack of leadership by Governor Lee, who made little fanfare of getting the vaccine himself, and has promised a marketing campaign to encourage folks to get the vaccine that has never materialized.

The Daily episode talks to doctor Daniel Lewis, a much-respected Greeneville doctor who nearly died of COVID, and has been doing his best to encourage folks in the area to get the shots.

VIDEO: GOVERNOR LEE GRILLED ??ON REFUSAL TO EXPAND MEDICAID

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At his first Virus update presser of the week yesterday, Governor Lee was grilled repeatedly, first by Alex Apple of Fox Nashville, then by Phil Williams of News Channel 5, about his refusal to expand Medicaid in Tennessee.

Expanding Medicaid would bring $1 BILLION of our own tax dollars back to our state each year. Instead Lee is touting a new $10 MILLION grant to rural hospitals. Meanwhile we’re #1 in rural hospital closures per capita and medical bankruptcies.

Not expanding literally is policy murder.

Lee says he’s only concerned about virus victims right now, but the truth is there’s no moral reason to be less concerned about those suffering from other diseases who have just recently become unemployed through no fault of their own, and who now find themselves without insurance. There are only political reasons.

Read this new STUDY that lays out what a huge mistake Lee and the Tennessee GOP supermajority are making, and watch the video below:

“IT’S A CLUSTER. GET YOUR CRAP TOGETHER.” – A Ballad Health Hospitalist Speaks Out

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Governor Lee has spent the past few weeks telling us “the storm is passing”, but the virus doesn’t appear to be listening. It continues to spread at a rapid pace, including here in Tennessee. Even our rural communities are far from immune, with massive outbreaks in Sumner County and then just two days ago at a nursing home in Cookeville.

After 10+ days of urging from thousands of Tennessee doctors and nurses Lee finally issued a stay-at-home mandate Thursday, citing traffic data from Unacast showing movements in Tennessee starting to tick up again as his reason, particularly in rural Tennessee. (Unacast gives TN a “D-” for social distancing and an “F” to over half our counties)

Lee believes the Unacast data means rural TN is still not taking the threat of the virus seriously enough. The data does show an uptick recently, but it’s not the first uptick in recent days, so it seems a convenient reason to justify doing something he really didn’t want to do.

He was the 40th governor to issue a stay-at-home mandate.

Waiting nearly 2 weeks to do what he should’ve done a long time ago likely means many more will be infected, particularly because this disease is largely spread by folks who don’t show any symptoms, and who don’t even know they have it. This is why it’s still of utmost importance to have people of all ages and health conditions to look at pages such as https://www.sciquip.co.uk/products/ppe.html and others so they’re able to purchase suitable personal protective equipment to protect themselves and others against the spread of the virus.

The people most at risk are our frontline health care workers. They’ve been getting standing ovations from their neighbors all around the world for good reason, and they deserve to be the “TIME MAGAZINE PERSON OF THE YEAR” this year with no close second.

The problem is, despite Governor Lee’s assurances, we’re not properly protecting them. While health care workers in China appear to have Hazmat suits to go to battle with, our health care workers here in America are being given sports ponchos and garbage bags, and even being told to strap diapers on their faces in Tennessee – despite Governor Lee telling us otherwise.

As recently as yesterday Lee said “we’re staying ahead of the need” here, but those whose lives are on the line tell a different story. We spoke to a hospitalist in the Northeast Tennessee Ballad Health Care system about the lack of preparedness and communication there.

She spoke to us on a condition of anonymity to express her concern about the way things are being handled at Ballad hospitals – and it seems fair to wonder if this isn’t how it is in many hospitals around our state. (The anonymity comes because she’s certain Ballad would fire her if her identity got out. Not only are our health care workers not being protected throughout the country, they’re also being pressured to stay silent)

For context, Ballad is a state-sanctioned health care monopoly in Northeast Tennessee with over a dozen hospitals. They have come under fire recently for suing thousands of poor folks for not being able to pay their hospitals bills. Those who are struggling to cover the cost of their healthcare and are looking for help with this may want to consider using a crowdfunding platform online – check this site – in order to generate the necessary funds.

They were also the target of over 200 days of protest in Kingsport, and CEO Alan Levine was the mouthpiece for a company that was found guilty of Medicare fraud and forced to pay $260 MILLION in fines. (He was also recently tapped by Governor Lee for his statewide charter school approval board, which is in place to override local rulings on charter schools, and he has been known to insult people on twitter from time to time.)

But Levine’s transgressions aside, the Ballad Hospitalist tells us the reaction by Ballad has been “A CLUSTER”, citing a lack of protective equipment and testing and poor communication and education of frontline health care workers.

To be fair, these don’t seem to be entirely uncommon issues throughout the country, but the picture she paints is much different from the rosier one Governor Lee is painting for us at his press conferences, which still seem to lack the needed wartime urgency.

The Ballad Hospitalist started out by talking about masks, saying frontline health care workers at Ballad Health weren’t even wearing PPE like surgical masks throughout the day until recently:

“We didn’t even get surgical masks until 3 days ago (March 31st). Even when we knew it could be present. I had started wearing a surgical mask because it’s all I could get. It was frowned upon, but I didn’t care. I couldn’t find an N-95, but I do wear a surgical mask. We get ONE for the entire day, that’s it.”

She said nurses whose masks break or get misplaced are afraid to go ask for another one, and tells a story of having to go to bat for a nurse who couldn’t find theirs. It’s understandable that supplies will run low with many people needing new masks frequently, however, there should be no reason as to why they can’t try and stock up on as much PPE as possible. Protective masks are being produced and provided in many different places now, for example, you can find some here or other places online. There should be no reason for such low supplies.
About the fact that supplies are so short, she has no patience for it:

“We don’t have enough supplies? GET THEM. This is your people. This is going to kill people. Maybe they didn’t think it was going to come to podunk Tennessee. But it’s here. At least 20 cases at Ballad that I know of. We’ve had 3 deaths, and at least 3 health care workers are now sick.

Governor Lee and the Tennessee Department of Health continue to brag about how many people Tennessee is testing as a way to deflect criticism being leveled at them in comparison to neighboring states like Kentucky, which took stronger, quicker action against the spread, has seen its numbers climb far more slowly, and recently told their citizens not to travel to Tennessee.

But despite the claim that there are no-to-few barriers to testing in Tennessee, tests are taking up to 10 days to turn around, and many are still being denied tests throughout the state and country. Some sites in TN are even charging up to $200 per test, which destroys the idea that “whoever wants a test can get one”.

The Ballad Hospitalist still has serious concerns:

“We really weren’t even testing for it. Nobody really knows who’s supposed to be testing or what the hell they’re doing. The Director of the ER has been complaining how the testing works, do we or don’t we? They don’t want to test in the ER. We just now got the rapid testing which can be turned around in 6 hours. Here in the USA we should be testing everybody.”

One of her biggest concerns at Ballad was communication, which she said is all over the place, and has led to a lot of confusion among health care workers that interact with sick patients on a daily basis:

“They’re just not communicating well. Nobody really knows what to do. Education is lacking. I watch these nurses, they have no idea how to put on or take off protective equipment. The nurse has a Covid patient, then has a full patient load and has to go deal with other patients. They’ve been putting nurses at the door to take our temperature as we come in, but I’ve been having to tell nurses to take my temperature. They just ask “you don’t have a temperature do you”?

I do think there’s going to be a huge surge of problems.”

As for what happens when a health care worker is concerned they might have been exposed or feel symptoms, she says nurses are being forced to use their paid time off, and they’ve started laying off staff – something many hospitals have been doing now that elective procedures, which are reimbursed by insurance companies at a higher rate, have stopped – the perils of an entirely for-profit health care system.

As for her message to Ballad, it’s simple really: “Get your crap together.”

“Ballad needs to GET THEIR CRAP TOGETHER. I think Ballad historically does a good job with things. A lot of people have complained since Ballad combined two systems into one, and some jobs were cut and pay was reduced – but when it comes to health care I think they’ve done a pretty good job. BUT THIS HAS BEEN A CLUSTER.

It’s sad to me because I see such a mix of people that still don’t think it’s a big deal. Even doctors I’ve heard say this is being blown out of proportion. Sadly I think that’s because they live here. READ THE NEWS. Look what’s going on in other places. They say it’s because the numbers are skewed. No. This is real.”

As for what made her start to take it seriously, she points to a Washington hospitalist who spoke her language about what patients are going through.

“A hospitalist in Washington speaking about a patient’s progression is what really spoke to me. I was like – okay, this is a big deal. This thing is ugly. She was talking about her co-workers dropping like flies, speaking about it in a medical language that I could understand, from medical people that have seen it. Not news speak. “
Unfortunately, The Ballad Hospitalist has to stay anonymous because she says it’s clear that if you speak out Ballad will fire you – their emails say “CONFIDENTIAL NOT TO BE SHARED WITH MEDIA” – and they’re really the only employer in the area for what she does.
We appreciate her, and that she was willing to talk to us. Frontline health care workers are heroes, and they deserve to be protected.

The bottom line is in the richest country in the world we’ve lacked a uniform, comprehensive reaction to this problem, and we have been caught unprepared in large part because of a reluctance by Trump (and Fox News) to take the problem seriously until it was too late. (also, cutting the CDC budget and firing the Pandemic response team didn’t help)

Our numbers have skyrocketed. Our outbreak is the worst in the world. Our for-profit health care system system has been exposed on many levels, and we can only hope now our state doesn’t suffer even more because of a slow response and lack of seriousness by our local officials, state government, and hospital management here at home.

If you want to tell Governor Lee to hurry up and get the needed testing and gear for workers like her, holler at him HERE.