NASHVILLE (AP) — Before a top Tennessee health official recommended firing the state's former vaccine director over claims that include shortcomings in her leadership, her supervisor had praised her "strong leadership" as recently as last month while her program faced "very intense scrutiny and performance expectations," according to a state job performance evaluation circulated publicly on her behalf.

The interim performance review sheds additional light on the circumstances leading up to the July 12 termination of Dr. Michelle Fiscus, who has spent the last week speaking nationally in rebuttal to a firing she argues was political appeasement for Republican lawmakers who were fuming over the department's COVID-19 vaccine outreach efforts for eligible minors.

In a July 9 letter, Tennessee's chief medical officer, Tim Jones, said Michelle Fiscus should be removed due to complaints about her leadership approach and her handling of a letter explaining vaccination rights of minors for COVID-19 shots, which helped prompt the backlash from lawmakers. The Department of Health released her personnel file, including the firing recommendation letter, in response to public records requests from news outlets.

Tennessee officials didn't include her performance reviews, which are exempted under state public records law, but Fiscus' husband Brad released them in rebuttal. Several years' worth of them show her performance was deemed "outstanding," including for October 2019 through September 2020. Over the weekend, Brad Fiscus said they located two more recent interim evaluations. One followed a legislative meeting last month that put the department in the hot seat over its childhood vaccine messaging efforts.

That meeting is briefly mentioned in the June performance review by Fiscus' supervisor, state epidemiologist John Dunn, who suggests she "work closely with her supervisor during the upcoming month to coordinate and clear all vaccine communications following legislative (Government Operations) hearings focused on (Tennessee Department of Health) immunization priorities and actions."

Neither review directly mentions her much-discussed memo on the Mature Minor Doctrine, which traces back to a 1987 state Supreme Court case and allows children 14 and up to be vaccinated without a parent's consent. The recommendation to fire her claims she sent around "her own interpretation" of the doctrine. Fiscus has said the letter she sent providers was verbatim from documents provided by the department's chief legal counsel. She provided email records to back up the assertion.

Dunn's evaluations praise Fiscus multiple times. The June review says the state's "COVID vaccination planning and program implementation have been excellent" under her.

It also laments that vaccination rates have been "disappointing due in part to Tennessee's population demographics and core beliefs on vaccination." Dunn mentions Fiscus' work to promote the vaccine, but says "the communications approach has been less robust than advocated for from the (Tennessee Department of Health) perspective because of overarching Government Comms team objectives" outside of the department's Communicable and Environmental Diseases and Emergency Preparedness Division.

"I appreciate Dr. Fiscus and her determination," Dunn wrote. "The implementation plan has been very successful in reaching the most at-risk in our population."

In the June review, Dunn notes the loss of some employees and some staff complaints to department leaders and human resources. In both reviews, Dunn frames staff-related concerns within the context of how the unprecedented COVID-19 response has taken a toll on health workers nationwide.

"The toll of COVID has been dramatic," the June review states. "Dr. Fiscus has balanced her responsibilities well and should continue to focus on her team and herself in regards to work-life balance, professional development, and job satisfaction."

Within the April review, Dunn raises concerns over the proposals being floated by lawmakers due to the pandemic. He stressed the importance of communicating with the department's legal counsel and "legislative leads" because "COVID has created much legislation which threatens (the Communicable and Environmental Diseases and Emergency Preparedness Division) and public health program objectives."

Late last week, Fiscus released a point-by-point rebuttal on the claims made in the firing recommendation.

She also responded to the governor's office regarding her claims that the Health Department stopped outreach for vaccinating minors for all diseases, not just COVID-19, which she has backed up through departmental email records, saying she never said the children's vaccines program had been halted. What has been stopped, she said, are "partnerships between local health departments and outside agencies, such as schools, to provide vaccines outside of a local health department" and "any attempts to communicate to parents that their children are in need of critical routine immunizations during this back-to-school season."

Republican Gov. Bill Lee's office and the Health Department have declined to comment directly on Fiscus' firing.

One prominent Tennessee Republican weighed in Friday, though without naming Fiscus or the pause over outreach for childhood vaccines.

Former U.S. Sen. Majority Leader Bill Frist, a surgeon, tweeted that "it is the responsibility of our state's leaders to take sometimes uncomfortable, even unpopular, positions when the health and lives of our people are at stake."

"Tennessee can stand by #science and #savelives, or we can further a dangerous trend that is eroding public health and trust in government," Frist tweeted.