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Case Name John B. v. Goetz CW-TN-0002
Docket / Court 3:98-cv-00168 ( M.D. Tenn. )
State/Territory Tennessee
Case Type(s) Child Welfare
Public Benefits / Government Services
Special Collection Olmstead Cases
Attorney Organization Bazelon Center
Case Summary
On February 25, 1998, plaintiffs, consisting of over 500,000 Tennessee residents under the age of 21 who rely on the state's Medicaid Program ("TennCare") for essential medical and mental health services, brought this class action claim against Tennessee State officials in the United States ... read more >
On February 25, 1998, plaintiffs, consisting of over 500,000 Tennessee residents under the age of 21 who rely on the state's Medicaid Program ("TennCare") for essential medical and mental health services, brought this class action claim against Tennessee State officials in the United States District Court for the Middle District of Tennessee, Nashville Division. The plaintiffs claimed "unlawful deprivation of medically necessary care results in the needless infliction of pain, the endangerment of young lives, and the stunting of children's chances to achieve their full potential" in violation of Title XIX of the Social Security Act, 42 U.S.C. §§1396, the terms and conditions of Tennessee's conditions of risk agreements between the State of Tennessee, TennCare, managed care organizations (MCOs) and behavioral health organizations (BHOs). Plaintiffs seek declaratory and injunctive relief.

Tennessee participated in Medicaid from the 1960s until it received a five year waiver under Section 1115 of the Social Security Act, 42 U.S.C. §1315, to implement a demonstration program called TennCare. TennCare has two major distinguishing features from the standard Medicaid program. First, TennCare beneficiaries were assigned to one of 11 managed care organizations (MCOs) who assigned primary care providers to serve as gatekeepers to medical services. Second, TennCare added coverage for state residents who lacked access to group health insurance and those who were "uninsurable" because of preexisting conditions.

In July, 1996, a major amendment added behavioral health services to those provided through TennCare, funded with state and federal block grant money. These funds were disbursed to a new set of behavioral health organizations (BHOs), along with the existing budget for behavioral health services. TennCare's managed care organizations ceased to have any responsibility for behavioral health care, and the BHOs assumed responsibility for providing such services to TennCare's entire enrollment.

Approximately 6,000 severely emotionally disturbed ("SED") TennCare children were considered members of the priority population. The program originally paid BHOs a single capitation rate for all TennCare children, regardless of whether they were members of the priority population classified as SED. However, after the implementation of the Partners Program, non-SED children were only entitled to inpatient psychiatric hospitalization and a limited number of outpatient mental health visits; while SED children were eligible for an "enhanced benefits package" of mental health services as needed. The definition of SED encompassed only children who scored up to fifty on the "Global Assessment Functioning" (GAF) test.

Although the waiver amendment approved by the Health Care Financing Administration (HCFA), and the contracts signed by the BHOs contained language that the behavioral health plans were to provide children all services required by the federal EPSDT mandate, the program did not emphasize the SED or non-SED distinctions to BHOs and the public. BHOs and providers have treated the designation as determinative of a child's access to services. Consequently, many medically necessary behavioral health services have been unavailable to children who did not meet the GAF score criteria for SED designation.

In 1997, HCFA criticized the Partners Program's failure to adequately serve the needs of SED children, sparking the restructuring of the capitation payments for BHOs by TennCare so that SED enrollees now earn the BHOs markedly higher capitation payments than non-SED children. This reinforced the BHOs' perception that they did not need to provide the full array of mental health services a severely disturbed child needs unless the child has the required GAF score.

In July 1996, Tennessee created the Department of Children's Services as the agency responsible for all children in state custody. TennCare allocated $129 million to the Department of Children's Services for EPSDT services for children in state custody, or at risk of becoming in state custody. While TennCare's MCOs were supposed to meet the medical/surgical needs of these children, DCS shared responsibility with the TennCare BHOs for the funding and management of behavioral health services for children in custody. DCS claimed to use this EPSDT allocation to pay for a range of "therapeutic interventions" that complement the health and behavioral health services covered by the managed care plans. The department administered the funds outside of the TennCare MCO/BHO care delivery system.

The Department of Children Services was required to provide a basic benefits package to all children in custody, whether they met the SED qualification or not. However, the behavioral health plans had no obligation to provide enhanced services for SED children when those children entered state custody, at which point DCS became responsible.

Aside from Tennessee's participation in Medicaid, Tennessee accepted federal funds under the Adoption Assistance Act. Federal statutory conditions relating to the state's administration of services for children in custody, or at risk of coming into custody, were attached to the receipt of the funds. Most of these conditions governed the provision of social and custodial services to such children, or were designed to achieve permanent placements for them, and were not at issue in this case.

The Adoption Assistant Act's requirement of provision of necessary health services for children in custody, or at risk of coming into state custody, was at issue in these proceedings. The Act also required that health services for a child in custody, or at risk of entering custody, be coordinated with the other educational, social and custodial services which the child needs.

The plaintiffs relied on the defendants for provision of critical EPSDT and services necessary to address children's health needs. Members of this class claimed to be subject to systemic deficiencies in TennCare that impaired their access to such services.

On March 11, 1998, the parties entered a consent decree. The United States District Court for the Middle District of Tennessee at Nashville (Judge William Haynes Jr.) certified the class and a subclass of consisting of children in custody or at risk of coming into custody of DCS.

In the Consent Decree, the state agreed to achieve full compliance with EPSDT, related laws, and the substantive provisions of the agreed order within five years. It also agreed to immediately begin providing partial, and steadily increasing, benefits from the remedial plan as the totality of the terms were implemented.

On December 19, 2001, Judge John Nixon found that, although the Defendants were well-intentioned in complying with the Court's 1998 Consent Decree, ultimately, they were not in compliance. John B. v. Menke, 176 F. Supp. 2d 786 (M.D. Tenn. 2001). The court appointed a special master to mediate and submit to the court an EPSDT-compliance plan. The defendants were again found to be non-compliant in 2004.

In an order dated September 18, 2009, Judge Nixon denied the Defendants' motion to vacate the Consent Decree. F. Supp.2d 871 (M.D. Tenn. 2009). The Defendants appealed and in December 2010, the Sixth Circuit of the United States Court of Appeals (Judge Julia Gibbons) vacated part of the Consent Decree. John B. v. Goetz, 2010 U.S. App. LEXIS 25589. The defendants argued that Medicaid 42 U.S.C. §1396(a)(30) was not privately enforceable. The Sixth Circuit vacated the consent decree's requirement that the Defendants ensure the availability of services was geographically comparable and any other provisions based on §1396a(a)(30). Because of concerns that the district court had developed a skewed view of the case, the Sixth Circuit also ordered that the case be reassigned to a new district judge, Thomas A. Wiseman.

In March 2011, Judge Wiseman made preliminary findings that multiple paragraphs of the Consent Decree were subject to vacatur because they were based on statutory provisions or regulations that were themselves not enforceable under § 1983. John B. V. Emkes, 2011 U.S. Dist. LEXIS 20399. (Motion to Vacate Granted in Part.) The Court vacated those paragraphs, but held that the decree as a whole was still enforceable.

The state then filed a second motion to vacate the decree, this time on the grounds that it was in substantial compliance with the terms of the Decree. On February 14, 2012, the District Court concluded that the state was indeed in substantial compliance and granted the Defendant's motion to vacate both the Consent Decree and all injunctive relief that had been ordered in the case. Specifically, the court noted major improvements in the state's outreach to parents and families, communication efforts, screening processes, diagnostic and treatment processes, and compliance monitoring. The Court subsequently dismissed the case, but retained jurisdiction for the consideration of attorney's fees.

In April of 2012, the Plaintiffs filed for and were granted leave to file a Sealed Notice of Appeal. Plaintiffs argued that the District Court had abused its discretion in vacating the Decree, and that the paragraphs the District Court had held were unenforceable were in fact enforceable. In March 2013, a panel of Sixth Circuit judges affirmed the judgment of the District Court. The Circuit Court found that that the District Court was correct that certain paragraphs of the Decree were unenforceable, and that it had used proper discretion in finding that the state was in substantial compliance with the remaining terms of the decree. The Circuit Court declined to award Plaintiffs attorneys' fees.

The case is now closed.

Joshua Arocho - 06/20/2012
Lauren Latterell Powell - 10/27/2017

compress summary

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Issues and Causes of Action
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Benefit Source
Constitutional Clause
Due Process
Content of Injunction
Goals and Timekeeping
Mental impairment
Government Services (specify)
Payment for care
Public benefits (includes, e.g., in-state tuition, govt. jobs)
Medical/Mental Health
Medical care, general
Mental health care, general
Mental Disability
Developmental disability without intellectual disability
Mental Illness, Unspecified
Plaintiff Type
Private Plaintiff
Causes of Action 42 U.S.C. § 1983
Adoption Assistance and Child Welfare Act of 1980 (AACWA), 42 U.S.C. § 620 et seq.
State law
Title XIX of the Social Security (Medicaid) Act, 42 U.S.C §1396
Defendant(s) Assistant Commissioner
Plaintiff Description 500,000 children enrolled in the TennCare Program for mental and medical services
Indexed Lawyer Organizations Bazelon Center
Class action status sought Yes
Class action status granted Yes
Filed Pro Se No
Prevailing Party Plaintiff
Public Int. Lawyer Yes
Nature of Relief Injunction / Injunctive-like Settlement
Source of Relief Settlement
Form of Settlement Court Approved Settlement or Consent Decree
Order Duration 1998 - 2012
Filing Year 1998
Case Closing Year 2013
Case Ongoing No
Additional Resources
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  Legal Accountability in the Service-Based Welfare State: Lessons from Child Welfare Reform
Date: Summer 2009
By: Kathleen G. Noonan, Charles F. Sabel, William H. Simon (Center for High Impact Philanthropy , Columbia Law School and Stanford Law School Faculty)
Citation: 34 Law & Soc. Inquiry 523 (Summer 2009)
[ Detail ] [ External Link ]

3:98-cv-00168 (M.D. Tenn.)
CW-TN-0002-9000.pdf | Detail
Date: 04/10/2013
Source: PACER [Public Access to Court Electronic Records]
General Documents
CW-TN-0002-0002.pdf | External Link | Detail
Date: 02/25/1998
Consent Decree
CW-TN-0002-0003.pdf | External Link | Detail
Date: 03/11/1998
Opinion (Finding Non-Compliance with Consent Decree) (176 F.Supp.2d 786) (M.D. Tenn.)
CW-TN-0002-0015.pdf | WESTLAW| LEXIS | Detail
Date: 12/19/2001
Source: Google Scholar
Defendants' Motion to Reconsider [ECF# 609]
CW-TN-0002-0010.pdf | Detail
Date: 02/27/2006
Source: PACER [Public Access to Court Electronic Records]
Memorandum in Support of Defendants' Motion to Vacate the Consent Decree and Dismiss the Case [ECF# 739]
CW-TN-0002-0011.pdf | Detail
Date: 11/20/2006
Source: PACER [Public Access to Court Electronic Records]
Opinion (Denying Petition for Writ of Certiorari) (549 U.S. 1279)
CW-TN-0002-0018.pdf | WESTLAW| LEXIS | Detail
Date: 03/19/2007
Source: LexisNexis
Opinion (Compelling Discovery) (2007 U.S.Dist.LEXIS 75457) (M.D. Tenn.)
CW-TN-0002-0021.pdf | LEXIS | Detail
Date: 10/10/2007
Source: LexisNexis
Opinion (Re: various motions for clarification of discovery order) (2007 U.S.Dist.LEXIS 84557) (M.D. Tenn.)
CW-TN-0002-0019.pdf | LEXIS | Detail
Date: 11/15/2007
Source: LexisNexis
Opinion (Denying Defendants' motion for stay pending appeal) (2007 U.S.Dist.LEXIS 86782) (M.D. Tenn.)
CW-TN-0002-0020.pdf | LEXIS | Detail
Date: 11/26/2007
Source: LexisNexis
Order (6th Cir. Granting Defendants' Petition for Writ of Mandamus) (531 F.3d 448)
CW-TN-0002-0014.pdf | WESTLAW| LEXIS | Detail
Date: 06/28/2008
Source: Google Scholar
Order (denying Defendants' Motion to Vacate Consent Decree) (661 F.Supp.2d 871) (M.D. Tenn.)
CW-TN-0002-0013.pdf | WESTLAW| LEXIS | Detail
Date: 09/18/2009
Source: Google Scholar
Opinion (Granting Plaintiffs' Motion to Compel) (2010 U.S.Dist.LEXIS 8821) (M.D. Tenn.)
CW-TN-0002-0017.pdf | LEXIS | Detail
Date: 01/28/2010
Source: LexisNexis
Opinion (Sixth Circuit) (vacating portion of Consent Decree and remanding) [Ct. of App. ECF# 1419] (626 F.3d 356)
CW-TN-0002-0001.pdf | WESTLAW| LEXIS | Detail
Date: 11/30/2010
Source: PACER [Public Access to Court Electronic Records]
Amended Opinion [Ct. of App. ECF# 1420]
CW-TN-0002-0012.pdf | Detail
Date: 12/16/2010
Source: PACER [Public Access to Court Electronic Records]
Opinion (Preliminary Finding re: vacating portions of Consent Decree on remand) (2011 WL 795019 / 2011 U.S.Dist.LEXIS 20399) (M.D. Tenn.)
CW-TN-0002-0016.pdf | WESTLAW| LEXIS | Detail
Date: 03/01/2011
Source: LexisNexis
Agreed Pretrial Order [ECF# 1532] (M.D. Tenn.)
CW-TN-0002-0005.pdf | Detail
Date: 11/01/2011
Source: PACER [Public Access to Court Electronic Records]
Memorandum Opinion and Order [ECF# 1572] (852 F.Supp.2d 944) (M.D. Tenn.)
CW-TN-0002-0006.pdf | WESTLAW| LEXIS | Detail
Date: 02/14/2012
Source: PACER [Public Access to Court Electronic Records]
Memorandum Opinion [ECF# 1573] (852 F.Supp.2d 957) (M.D. Tenn.)
CW-TN-0002-0007.pdf | WESTLAW| LEXIS | Detail
Date: 02/14/2012
Source: PACER [Public Access to Court Electronic Records]
Order [ECF# 1574] (M.D. Tenn.)
CW-TN-0002-0008.pdf | Detail
Date: 02/14/2012
Source: PACER [Public Access to Court Electronic Records]
Plaintiff's Motion for Leave to File Under Seal (so ordered) [ECF# 1593] (M.D. Tenn.)
CW-TN-0002-0009.pdf | Detail
Date: 04/13/2012
Source: PACER [Public Access to Court Electronic Records]
Opinion (517 Fed.Appx. 409)
CW-TN-0002-0025.pdf | WESTLAW| LEXIS | Detail
Date: 03/13/2013
Source: Westlaw
Opinion (710 F.3d 394)
CW-TN-0002-0023.pdf | WESTLAW| LEXIS | Detail
Date: 03/14/2013
Source: Westlaw
Judges Alito, Samuel A. Jr. (Third Circuit, SCOTUS)
Breyer, Stephen Gerald (First Circuit, SCOTUS)
Gibbons, Julia Smith (W.D. Tenn., Sixth Circuit)
CW-TN-0002-0001 | CW-TN-0002-0012 | CW-TN-0002-0014
Ginsburg, Ruth Bader (D.C. Circuit, SCOTUS)
Haynes, William Joseph Jr. (M.D. Tenn.)
CW-TN-0002-0003 | CW-TN-0002-0013 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-0021
Kennedy, Anthony McLeod (Ninth Circuit, SCOTUS)
Kethledge, Raymond M. (Sixth Circuit)
CW-TN-0002-0001 | CW-TN-0002-0012 | CW-TN-0002-0023 | CW-TN-0002-0025
Nixon, John Trice (M.D. Tenn.)
Roberts, John Glover Jr. (D.C. Circuit, SCOTUS)
Rogers, John M. (Sixth Circuit)
CW-TN-0002-0001 | CW-TN-0002-0012 | CW-TN-0002-0014
Scalia, Antonin (D.C. Circuit, SCOTUS)
Souter, David Hackett (First Circuit, SCOTUS)
Stevens, John Paul (Seventh Circuit, SCOTUS)
Thomas, Clarence (D.C. Circuit, SCOTUS)
Wiseman, Thomas Anderton Jr. (M.D. Tenn.)
CW-TN-0002-0005 | CW-TN-0002-0006 | CW-TN-0002-0007 | CW-TN-0002-0008 | CW-TN-0002-0009 | CW-TN-0002-0016 | CW-TN-0002-9000
Plaintiff's Lawyers Anderson, Mary B. (Illinois)
Anderson, Leanna Marie (California)
Barrett, George E. (Tennessee)
Bonnyman, George G. Jr. (Tennessee)
CW-TN-0002-0002 | CW-TN-0002-0003 | CW-TN-0002-0005 | CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-9000
Bowden, Ellen M. (Alabama)
CW-TN-0002-0002 | CW-TN-0002-9000
Bristol, Marjorie A. (Tennessee)
Burnim, Ira Abraham (District of Columbia)
Caster, Shawn L. (Tennessee)
Chang, William S.W. (New York)
Choy, Jason Francis (New York)
Cohen, J. Richard (Alabama)
CW-TN-0002-0002 | CW-TN-0002-9000
Coleman, Christopher E. (Tennessee)
Croce, Lenny L. (Tennessee)
D'Souza, Lisa J. (Tennessee)
Doffermyre, Everette L. (Georgia)
Dunlap, Andrew R. (New York)
CW-TN-0002-0001 | CW-TN-0002-0016
Evans, Katherine (California)
Giliberti, Mary (District of Columbia)
Goldman, Jeffrey S. (Illinois)
CW-TN-0002-0013 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020
Gunn, Patricia C. (Tennessee)
CW-TN-0002-0020 | CW-TN-0002-9000
Heyman, Gregory Todd (New York)
CW-TN-0002-0019 | CW-TN-0002-0020
Hutto, Elizabeth Banston (Tennessee)
CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017
Johnson, Kimberly Jean (Georgia)
Johnson, Mark P. (Missouri)
Johnson, Michele M. (Tennessee)
CW-TN-0002-0001 | CW-TN-0002-0002 | CW-TN-0002-0003 | CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Jones, Ronald Cantrell (Illinois)
Joseph, Robert Thomas (Illinois)
Kass, Albert Howard (New York)
CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Khalil, Junaid (New York)
Knowles, Ralph I. Jr. (Georgia)
CW-TN-0002-0013 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Kozlowski, David Arthur (Tennessee)
McDaniel, Katherine L. (New York)
CW-TN-0002-0001 | CW-TN-0002-0016
Overby, Russell J. (Tennessee)
Reed, Michael H. (New York)
Reznik, Victoria (New York)
Richardson, Tony L. (California)
Rivera, David (Tennessee)
Schlaff, Shira Judith (New York)
Seltzer, Tamara Lynn (District of Columbia)
Singh, Vanessa C. (New York)
Tsou, Sarah Kao-Yen (New York)
Weissman, Barry Leigh (California)
CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-9000
Yerian, Christina M. (Tennessee)
Defendant's Lawyers Aemisegger, Nicholas G. Jr. (Montana)
Brown, Katherine Ann (Tennessee)
Cooper, Robert E. Jr. (Tennessee)
CW-TN-0002-0001 | CW-TN-0002-0011
Cooper, Charles Justin (District of Columbia)
CW-TN-0002-0001 | CW-TN-0002-0010 | CW-TN-0002-0011 | CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-9000
Hann, Jennifer Helton (Tennessee)
Harris, Ronald G. (Tennessee)
CW-TN-0002-0010 | CW-TN-0002-0011 | CW-TN-0002-9000
Harwell, Aubrey B. Jr. (Tennessee)
CW-TN-0002-0010 | CW-TN-0002-0011 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Hinson, Leesa Ann (Tennessee)
Hume, Hamish P.M. (District of Columbia)
Irwin, Philip D. (Tennessee)
CW-TN-0002-0011 | CW-TN-0002-9000
Kirk, Michael W. (District of Columbia)
CW-TN-0002-0001 | CW-TN-0002-0010 | CW-TN-0002-0011 | CW-TN-0002-0013 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Kleinfelter, Janet M. (Tennessee)
CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Koukoutchos, Brian Stuart (District of Columbia)
CW-TN-0002-0001 | CW-TN-0002-0013 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Miller, Charles A. (District of Columbia)
CW-TN-0002-0013 | CW-TN-0002-0017 | CW-TN-0002-0020 | CW-TN-0002-9000
Minkoff, Elizabeth B. (Tennessee)
Moss, Nicole J. (District of Columbia)
CW-TN-0002-0010 | CW-TN-0002-0011 | CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-0020 | CW-TN-0002-9000
Ney, Paul C. Jr. (Tennessee)
Reed, Carolyn E. (Tennessee)
Ross, Linda A. (Tennessee)
CW-TN-0002-0001 | CW-TN-0002-0010 | CW-TN-0002-0011 | CW-TN-0002-0013 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Sauer, Dean John (District of Columbia)
CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-0019 | CW-TN-0002-0020 | CW-TN-0002-9000
Shaffer, Derek L. (District of Columbia)
CW-TN-0002-0001 | CW-TN-0002-0013 | CW-TN-0002-0016 | CW-TN-0002-0017 | CW-TN-0002-9000
Stephenson, Kathryn A. (Tennessee)
Summers, Paul G. (Tennessee)
Walkup, John Knox (Tennessee)
Weitzner, Michael (District of Columbia)
Wheelbarger, Kathryn L. (District of Columbia)
Other Lawyers Bailey, Martin B (Tennessee)
Biller, Stephen H. (Tennessee)
Boulware, Leilani (Tennessee)
Carey, Edmund L. Jr. (Tennessee)
Carter, Richard A. (Tennessee)
Cates, Taylor A. (Tennessee)
Davidson, Paul (Tennessee)
CW-TN-0002-0019 | CW-TN-0002-9000
Dietz, Wallace Wordsworth (Tennessee)
Domenick, Beth L. (Pennsylvania)
Hickman, Scott (Tennessee)
Hicks, John S. (Tennessee)
Hornback, Michael D (Tennessee)
Hubbard, William B. (Tennessee)
Jenkins, Marc R (Tennessee)
Kay, Susan Laurie (Tennessee)
Lewis, George Tolbert III (Tennessee)
Lillard, David H (Tennessee)
Martin, Jerry E. (Tennessee)
Miller, John L. (Tennessee)
Passino, Michael James (Tennessee)
Safar, Joseph C (Pennsylvania)
Shockley, Gary C (Tennessee)
Smith, Thomas J. (Pennsylvania)
Vernick, Scott L. (Pennsylvania)
Walker, Kathryn Hannen (Tennessee)
Webb, Christopher Corum (Tennessee)
Welch, Charles B Jr. (Tennessee)
Wright, Sonya Smith (Tennessee)

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