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Home My WebLink Aboutagenda.council.worksession.20110315 SPECIAL MEETING CALLED FOR EXECUTIVE SESSION Date March 15, 2011 Call to order at: / 1 m. 1. Councilmembers present: Councilmembers not present: ® Mick Ireland n Mick Ireland n Steve Skadron Steve Skadron Ruth Kruger n Ruth Kruger Torre n Torre Derek Johnson � ❑ Derek Johnson II. Motion to go into executive session by -�V n �D�',� 1 ; seconded by I� e Other persons present: AGAINST: FOR: Mick Ireland ❑ Mick Ireland n Steve Skadron kit ❑ Steve Skadron .Ruth Kruger ❑ Ruth Kruger ® Torre n Torre [Derek Johnson Jon kr 4: is p.a.... ❑ Derek Johnson 111. MOTION TO CONVENE EXECUTIVE SESSION FOR THE PURPOSE OF DISCUSSION OF: C.R.S. 24 -6- 402(4) (a) The purchase, acquisition, lease, transfer, or sale of any real, personal, or other property interest it Conferences with an attorney for the local public body for the purposes of receiving legal advice on specific legal que ns. (c) Matters required to be kept confidential by federal or state law or rules and regulations. (d) Specialized details of security arrangements or investigations, including defenses against terrorism, both domestic and foreign, and including where disclosure of the matters discussed might reveal information that could be used for the purpose of committing, or avoiding prosecution for, a violation of the law; (e Determining positions relative to matters that may be subject to negotiations; developing strategy for negotiations; and ' tructing negotiators; U (0 (I) Personnel matters except if the employee who is the subject of the session has requested an open meeting, or if the personnel matter involves more than one employee, all of the employees have requested an open meeting. IV. ATTESTATION: The undersigned attorney, representing the Council and being present at the executive session, attests that the subject of the unrecorded portions of the session constituted confidential attorney- client c• - ,. ica ion: ' i/ � _ re- _ The undersigned chair of the executive session attests that the discussions in this execu • session were limited to the topic(s) described in Section III, above. �-. 7, ../. .4;77 Adjourned at: s' (? M j MEMORANDUM TO: Aspen Board of Health FROM: Lee Cassin, Jannette Whitcomb, CJ Oliver, and Ashley Cantrell Environmental Health Department /Local Public Health Agency DATE OF MEMO: March 4, 2011 MEETING DATE: March 15, 2011 RE: Quarterly Board of Health Meeting REQUEST OF BOARD OF HEALTH: No action is required. This is the quarterly Board of Health update. We have included information about the new fluoride recommendations with a suggestion that this matter be discussed further at a future meeting. BACKGROUND: The Colorado Public Health Act of 2008 requires municipalities to either form their own Board of Health and Public Health Agency or put their environmental programs under a County Board of Health. The City of Aspen formed its own board to allow the City to continue to set its own policies and priorities, and to administer its programs in the areas of air quality, water quality, recycling, nuisances, food service, global warming, and others, rather than ceding that authority to a County or regional Board of Health. Dr. Morris Cohen serves as the City's Medical Officer, as he has for many years, providing medical expertise and advice. Aspen and Pitkin County are unique in the state in that our "public health" services, i.e. nursing, vaccinations, etc. are provided by the non - profit Community Health Services. That agency is funded by the Healthy Communities Fund. The fund is managed by the County since it is a county-wide tax, but the largest contributors to that fund are City of Aspen residents, because the fund is a property tax based fund. DISCUSSION: New Federal Recommendations on Fluoride Levels in Water The EPA and Department of Health and Human Services announced new recommendations for drinking water fluoridation to prevent excessive exposure. Excerpts are included here: HHS is proposing that the recommended level offluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating review of the maximum amount of fluoride allowed in drinking water. J en There are several reasons for the changes seen over time, including that Americans have access to more sources offluoride than they did when water fluoridation was first introduced in the United 0 u_ Page 1 of 9 0 0 ti States in the 1940s. Water is now one of several sources offluoride. Other common sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals. Water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the U.S. over the past several decades. NHS' proposed recommendation of 0.7 milligrams offluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams. This updated recommendation is based on recent EPA and HHS scientific assessments to balance the benefits of preventing tooth decay while limiting any unwanted health effects. These scientific assessments will also guide EPA in making a determination of whether to lower the maximum amount offluoride allowed in drinking water, which is set to prevent adverse health effects. The new EPA assessments offluoride were undertaken in response to findings of the National Academies of Science (NAS). At EPA's request, NAS reviewed new data onfluoride in 2006 and issued a report recommending that EPA update its health and exposure assessments to take into account bone and dental effects and to consider all sources offluoride. In addition to EPA's new assessments and the NAS report, HHS also considered current levels of tooth decay and dental fluorosis and fluid consumption across the United States. Aspen's Drinking water sources, Castle & Maroon Creeks, contain natural occurring levels of fluoride. The gap between these natural levels and what would be artificially added to meet the new lower standard is much less than it used to be. Several other factors are relevant to whether it is wise to continue additional fluoridation to Aspen's water. These include recent studies showing a link to increased rates of hip fractures in women, and concerns of purity, occupational - safety risks of adding fluoride, and the amounts of fluoride ingested in a multitude of foods and drinks. Since Aspen's source water contains fluoride and the new research advocates lowering artificial levels, Aspen's Board of Health should discuss the appropriate response to the new emerging Health Data. Ozone update: The primary goal for the City of Aspen's ozone monitoring program is to determine whether ground level ozone is impacting the health of the community. Currently, the National Ambient Air Quality Standard (NAAQS) for ozone is an 8 -hour average of 75 ppb over a three year period. EPA has proposed reducing the "primary" (health - protective) standard from 75 ppb to a value in the range of 60 ppb to 70 ppb. Breathing ozone can trigger a variety of health problems including chest pain, coughing, throat irritation, 'and congestion. It can worsen bronchitis, emphysema, and asthma. Aspen has had ten days beginning on March 6, 2010 where the 8 -hour average for ozone was at or above 60 ppb. To date our highest 8 -hour average is 66 ppb recorded on June 22, 2010. Staff has not observed any additional days above 60ppb since June 2010. Another concern with ozone is the potential impact it could have on our environment, specifically our forests. Ozone damages leaves of trees and other plants, and interferes with the ability of plants to produce and store food, which makes them more susceptible to disease, insects, other pollutants, and harsh weather. 1 m Staff are currently working on a webpage that will have real -time (updated hourly) ozone readings. The design will be similar to the Garfield County's webpage http: / /www.garfieldcountyaq.net/ Attachment A gives you a rough idea of the concept. Page 2 of 9 r� 0 0 (V 3arfield County Air Quality http: / /www.garfieldcountyaq.net/ HOME AIR QUALI TY AIR MONITORING EMISSIONS SP ECIAL PROJECTS EDUCATION OTHER LINKS GARF I ELD (0'LNiY P ^ANAGEMENT REPORTS INVENTORIES AND OUTREACH 0 RIFLE, COLORADO: REAL -TIME AIR QUALITY INFORMATION 03M/201112:00 PM 42F Program Announcements Air Quality Management Planning es. 6 mph Air Quality Advisories State Air Quality Advisories ..^ NNW Interagency Incident Information System (InciWebl q � 0.0 in 3/4/2011 12:30:00 PM MST Ideal Image Ozone 03 1 Four Average 48 ppb 44 8 Hour Rolling Average 46 ppb Air Quality Standards 3/4/2011 12:00:00 PM Pollutant Average Time U.S. EPA Particulate Matter PM2.5 Standard Data Disclaimer Ozone 8 - Hour 0.075 ppm Current Average 4 ug /m (75 ppb) Pis quality and meteorology data are displayed on this Web page typically within one to three hours of their collection. 3 ollewion. Aa a result, data posted PM2.5 24 - hour 35 Ug /m are raw t have not been validated by human human reviewand may contain 3 errors. Real -time data must be 24 Hour Rolling 5 Ug /m interpreted with caution. These data h 24-our 150U m g are provided for public awareness PM10 g/ Average only. They should not be used in any 3/4/2011 12:00:00 PM medical or sdentific study. Contact your regional air program manager to obtain quality - assured quarterly data Air Quality Index (AQl) summaries or access to fully - validated raw data. The AQl is an index for reporting daily air quality. It tells you how clean or polluted your air is. and what Particulate Matter PM10 assodated health effects might be a concern for you. The AQI focuses on health effects you may wq erience 3 within a few hours or days after breathing polluted air. Current Average 18 ug/m 3 Good Moderate Unhealthy Unhealthy Very for Unhealthy Sensitive a of 2 � f J 3/4/2011 12:32 PM Radon Grant: The Environmental Health Department received a grant in 2010 from the state health department to provide free radon test kits for residents. Test kits were given out starting in January, which is National Radon Action Month. This year in addition to free radon test kits we will be offering a "do -it- yourself' radon mitigation class. With Aspen's high cost of living plus higher costs for goods and services, many residents struggle with the costs of radon mitigation ($2500 or greater) and have been hesitant to move forward with mitigating their homes. Many people have the skills to install radon remediation systems in their own homes. The goal of this class is to give them the knowledge they need to move forward with mitigating their home for radon. Included in the project is funding to remediate one Aspen affordable housing home for the demonstration portion of the class. The DIY class is scheduled for May 21st, with the in -class portion from 9 -11 AM and a site visit to the mitigated homes afterwards. Pesticides We are meeting with landscape firms to draft an ordinance that will improve the current notification requirements for pesticide spraying. Currently, properties must be posted after they have been sprayed. We are considering a simple change to require the posting to occur two days before the spraying, so neighbors can keep pets and children away from the area or take other measures they deem appropriate. We would plan to pattern the ordinance after a very similar one that has been in place in Boulder for many years. Pharmaceutical Take Back event Environmental Health is teaming with the Aspen Police Department for the City's third annual pharmaceutical take back event. This event is sponsored for the second year by DEA and will be on April 30, 2011 from 10:00 am to 2:00 pm. This annual event provides a safe and environmentally friendly way for citizens to dispose of their medicines. The goal is to make sure that unwanted medicine does not pollute our waterways. Recent testing of U.S. waterways has identified nearly a hundred different pharmacological substances present according to the EPA (www.epa.gov /ppcp). Another goal is to prevent unwanted medicine from getting into the wrong hands, i.e. prescription drug abuse. A 2009 survey from the Centers for Disease Control and Prevention shows that prescription drug abuse is on the rise, with 20% of teens saying they have taken a prescription drug without a doctor's prescription Update on Local Public Health Imnrovffment Plan The Colorado Department of Public Health and Environment's program for creating local public health improvement plans has the potential to be a very significant workload issue, but we intend to use an approach that we believe is more reasonable for Aspen that will take a minimal amount of staff time and not require any consulting costs. Since many areas in Colorado do not have priority- setting, citizen input, and measuring processes as we do, the state's efforts are geared toward those areas. However, we already perform all of the functions envisioned by the state, so our efforts are geared toward putting what we already do into the state's plan format. What we are required to do and how we propose to do it: • 2012: develop our local public and environmental health improvement plan. We plan to use information we already have, which includes a wealth of material from citizen surveys, clicker sessions, and AACP process (Environment and Lifelong Aspenite chapters). These will provide the draft priorities for the local plan, which Council will rr_ O u_ Page 4 of 9 r, 0 0 approve in 2012 or 2013. Community Health Services will recommend priorities in the public health arena and we will focus on the environmental health priorities. The plan sets priorities which are implemented based on available funding. • 2012: complete the "public and environmental health assessment ". This will be a compilation of the large amount of data we already have. It includes everything from ozone and PM -10 levels to recycling volumes to greenhouse gas emissions to drinking water quality. • 2011: Identify all of the data we already have, so it can be quickly assembled. In summary, we already have a very large variety of data that tells us the status of our community's health and environmental quality and we do not recommend needing to spend any public funds to gather additional data. Based on the AACP and annual citizen surveys, we also do not recommend needing to spend public funds to gather additional data about what issues are priorities for our community. The state health department's Office of Planning and Partnerships will be meeting with staff from Aspen's public health agency (Cassin, Whitcomb and Oliver) in March to discuss our capacity to provide "core services" in these categories they have developed. The challenge with our planning process will be to put what we already do in a format the state uses without spending undue time in the process. o X core ca is colomdo e Ve "� yQ [y Idtp.//www Corc Swices 1og9101g].ptlf � • i W°l Y 'r : , ".^. x x ,.'.:. cP its ' * o fi `' -"t t, g s §k k" +@ cWap. p47.14t : aasa4 '_ =1 • * . , • *sans ®41vit g ¢+1 € a .:S el+f'CArgitn6! • V Drift Cat— x . i• p N [ . • 1 11 if 2 I . 0 7 5 3 sax . , '!4 tombola`' ,, sv"' i3 . X 'Vend pour l 10 Essential Public Wrote Worm & mr v. Lint rvsk a Core Wealth Services Monter Investigate s Mears Develop Meow.. peop'a to Assure a srtanlwess Contribute Services health health empo .ver community polices laws Si Maltocara ompilem l to status ["blown people ParmersMN swam regulations urvkea natMn ssa uieulry zvT Asultment & Amore 1 1 J J Vital Records & Stiffstia J 1 1 Investigate & Como Commune Gomel ✓ J J J J ✓ J J J iibienton & Proulatbn HeaI:C Promotion ✓ J J ✓ J J J ✓ .' Emergency Preparedness & Rasponse 1 J ✓ Ern 1,1 Heolth • J J J e ✓ J J Mmtntatrauha & G,.amanc ✓ ebi X Fnd mw 4 Clue * Preadws ✓ HighGgMpg 0 Meth case 0 Phrase not found [(] • Done S 0 R.. Page 5 of 9 r. 0 0 N IBC L ist o f proposed budget cuts Some of the items on the JBC's list of proposed budget cuts have the result of shifting programs to local agencies without accompanying funding, or shifting funds that used to provide local grants, to cover state program operations. Other cuts may result in future requests to Council from non - profits to fund some of their shortfalls. Some examples include: •Eliminate the Severance Tax fund transfer to Human Services for Low Income Energy Assistance Program, saving $3,250,000 •Transfer ALL State Severance Tax funds to the State General Fund including the Direct Allocation Funds paid to local governments, saving $142,864,000 •Transfer Severance Tax funds from CWCB for water projects, saving $46,000,000 •Transfer Severance Tax funds from Division of Reclamation, Mining, and Safety, saving $2,000,000 •Reduce funding for COGCC, saving $6,400,000 •Eliminate CDPH &E (Tobacco Settlement Funds) to local Health Departments for health and environmental duties, saving $2,286,355 •Transfer funds from Old Age Pension program, saving $1,850,000 •Delay payments for Medicare •Health Care Policy & Finance (HCPF) "whole program cuts" and "partial program cuts ", saving $519,000,000 •Numerous Human Services program cuts • Eliminate treatment & detoxification contracts, saving $3,779,216 • Eliminate State program for Aid to the Needy Disabled, saving $15,300,000 • Eliminate General Fund for Senior Services, saving $524,916 •Dept. of Local Affairs program cuts, saving $20,517,398 • Reduce or eliminate General Fund "per capita" funds for several "Local Public Health Agencies" • Eliminate Cigarette Tax rebates to local governments, saving $10,500,000 Informational items and updates: These are issues which we can discuss further if council has questions or wants more information. Air Quality Outreach Staff are partnering with Garfield, Eagle, Pitkin and Mesa County Environmental Health Departments in planning a regional air quality outreach media event during the first week of May. Such a regional collaboration on air quality is the first in its kind for the Western Slope. Each day of the week, an air quality pollutant (radon, ozone, second hand tobacco smoke, particulates, etc.) will be targeted for awareness on the issue, health effects and actions people can take to enhance healthy living. Smoking Ordinance Changes: Environmental Health staff worked with the City Attorney's office to make changes to the smoking ordinance to allow the City to post areas of City owned property as designated non smoking areas. Council adopted this ordinance on January 10. At this time, the only locations considered for posting of no- smoking signs are the bridge between the schools and ARC, the circular overlook above the ARC pool, and possibly the ARC main entrance. Those are areas where children and adults going to the health facilities sometimes must walk through cigarette smoke. rr 0 Page 6 of 9 r, c7 N February Centers for Disease Control Report COLORADO: For the week ending February 26: influenza activity appears to have peaked during the weeks ending Feb. 5 - Feb 19 and remained very elevated for the week ending Feb. 26. * Overall hospitalizations appear to have peaked the week ending 2/5. * Influenza -Like Illness (ILI) reported by Mesa County increased steeply from 1.9% to 3.8% and peaked in the week ending Feb. 19. ILI levels were highest in the 5 -24 year age group. *A total of 8 deaths (2 pediatric and 6 adult) have been reported. NATIONAL: For the week ending February 19, influenza activity in the United States remained elevated. The geographic spread of influenza in 44 states was reported as widespread. The proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold. Nanotechnology Information Update: EPA Awards $5.5 Million to Support Nanotechnology Research / Research to help determine whether health risks exist Release date: 02/17/2011 Contact Information: Latisha Petteway (News Media Only), petteway.latisha @epa.gov, 202 -564- 3191,202- 564 -4355 WASHINGTON - The U.S. Environmental Protection Agency (EPA) has awarded $5.5 million to three consortia to support innovative research on nanotechnology. EPA, in collaboration with the United Kingdom's Natural Environment Research Council, are leading this scientific research effort to better understand the potential risks to people's heath and the environment. The scientific information developed from the research can help guide EPA and other agencies in decisions about the safety of new materials and products that are made using nanotechnology. "The responsible development of nanotechnology can play a major role in sustaining a positive, healthy environment, a vibrant and growing economy, and a high standard of living," said Paul Anastas, assistant administrator for EPA's Office of Research and Development. "Understanding the risks posed by engineered nanomaterials is a global challenge that is best met through international collaboration, drawing on the combined expertise of researchers from diverse backgrounds." Nanotechnology is the science of very small matter called nanomaterials, which are structured in size between 1 to 100 nanometers. A nanometer is 100,000 times thinner than a strand of hair. At extremely small sizes, nanomaterials can exhibit unique properties different than the same chemical substances in a larger size. This opens up new opportunities for the development of innovative products and services. d 0 LL Page 7 of 9 0 c‘i The grants EPA has awarded will help researchers determine whether certain nanomaterials can leach out of products such as paints, plastics, and fabrics when they are used or disposed of and whether they could become toxic to people and the environment. Many U.S. industries can benefit from the positive applications of nanotechnology, including environmental remediation, pollution prevention, innovative drug delivery and therapy, efficient renewable energy, and effective energy storage. In addition to EPA's $5.5 million, the Consumer Product Safety Commission (CPSC) has contributed $500,000 through a new research partnership between the two agencies. Grant awards were made to three consortia consisting of researchers from the U.S. and the U.K. Each U.S. team of researchers received $2 million from EPA and CPSC for a total of $6 million. Each U.K. team also receives $2 million from the U.K. agencies, resulting in a grand total of $12 million to conduct the research. More information about nanotechnology research: http_/ / www.e / pa.eov /nanoscience Community Health Services Updates YEAR END SUMMARY: Services provided by Community Health Services, Inc. in 2010 compared to 2008 and 2009. Family Planning program clients /visits PROGRAM 2008 2009 2010 Family Planning Program clients /visits 833/3783 895/3848 793/3107 Immunizations given, total 3741 5544 4027 Children's Vaccines 787 790 762 Adult and Travel Vaccines 1117 1028 1030 Flu (including H1N1) 1847 3729 2235 Prenatal 32 23 94 WIC clients /visits 107/261 128/281 126/316 Communicable Disease Investigations 42 65 41 Women's Wellness Connection: clients /visits 28/62 44/98 53/137 Total number of clients /visits 1730/8579 1910/10,584 1707/9328 co DZ 0 Page 8 of 9 0 0 N The Aspen to Parachute Dental Health Coalition has changed its name to the Aspen to Parachute Dental Health Alliance (APDHA) to reflect a long -term commitment to oral health for the uninsured in the region. We are currently in the process of applying for 501c3 status. With the business plan for the dental clinic completed at the end of 2010 by JVA Consulting, we are now prepared to submit grants to local as well as state -wide foundations such as Aspen Valley Medical Foundation, the Aspen Community Foundation, Colorado Health Foundation and Caring for Colorado. The Regional Oral Health Consultant, Kelly Keeffe RDH BA, is busy doing outreach and oral health education with children, adults and seniors throughout the region. She and other hygienists will be hosting the 10th annual second grade Dental Health Fair on March 18th at the Aspen High School gymnasium (formerly held at the Given Institute.) Second graders from Basalt Elementary, Aspen Elementary, Aspen Country Day and Aspen Community School are invited to attend. Articles of Interest from Aspen Medical Health Officer Dr. Morris Cohen: • "Autism and MMR Vaccine Study and `Elaborate Fraud', Charges BMJ" (4 pages) • "Science in One Room, Homeopathy in the Next ?" (2 pages) • "Investigator Planned to Make Vast Profit from Autism /MMR Vaccine Scare, BMJ Says ", (3 pages) • "Medical Establishment Buried Concerns About MMR /Autism Study, BMJ charges" (4 pages) • "Docs: No energy drinks for kids" (1 page) • "Withdrawal of Infant Cold Medicines Decreases ED Visits by Half, CDC Finds" (1 page) -J co CC 0 LL Page 9 of 9 !' O C \I kutism and MMR Vaccine Study an 'Elaborate Fraud,' Charges BMJ (p... http : / /www.medscape.conVviewarticle /735354 _print www.medscape.com Authors and Disclosures Journalist - Deborah Brauser is a freelance writer for Medscape. Deborah Brauser has disclosed no relevant financial relationships. From Medscape Medical News > Psychiatry MedSCape l Autism and MMR Vaccine Study an 'Elaborate Medical News Fraud,' Charges BMJ Deborah Brauser January 6, 2011 — BMJ is publishing a series of 3 articles and editorials charging that the study published in The Lancet in 1998 by Andrew Wakefield and colleagues linking the childhood measles- mumps - rubella (MMR) vaccine to a "new syndrome" of regressive autism and bowel disease was not just bad science but "an elaborate fraud." According to the first article published in BMJ today by London -based investigative reporter Brian Deer, the study's investigators altered and falsified medical records and facts, misrepresented information to families, and treated the 12 children involved unethically. In addition, Mr. Wakefield accepted consultancy fees from lawyers who were building a lawsuit against vaccine _ manufacturers, and many of the study participants were referred by an antivaccine organization. In an accompanying editorial, BMJ Editor -in -Chief Fiona Godlee, MD, Deputy BMJ Editor Jane Smith, and Associate BMJ Editor Harvey Marcovitch write that there is no doubt that Mr. Wakefield perpetrated fraud. "A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in 1 direction; misreporting l( was gross." Although The Lancet published a retraction of the study last year right after the UK General Medical A great deal of thought and Council (GMC) announced that the investigators acted effort must have gone into Dr. Fiona Godlee "dishonestly" and irresponsibly, " the BMJ editors note drafting the paper to achieve that the journal did not go far enough. the results he wanted: the discrepancies all led in 1 "The Lancet retraction was prompted by the results from the [General Medical direction; misreporting was Council] hearing and was very much based on the concerns about the ethics of gross. the study," Dr. Godlee told Medscape Medical News. "What we found was that it was definite fraud and that is a very important thing for the world to know. This article shows that the science was falsified and should be discounted," continued Dr. Godlee. This evidence "should now close the door on this damaging vaccine scare," the editorial authors add. J Damage to Public Health °� J Although it included only 12 patients, faced almost immediate criticism, and never had its findings replicated, the study 7 received wide media coverage and set off a panic among parents, with the result that MMR vaccinations decreased L _ r- D 0 of4 3/9/2011 2:02 PO kutism and MMR Vaccine Study an 'Elaborate Fraud,' Charges BMJ (p... htt p:// www. medscape .com/viewarticle /7353 dramatically. The 2003 to 2004 vaccination rate of 80% has now recovered slightly in the United Kingdom, but it is still well below the recommended 95% level recommended to ensure "herd immunity." A measles epidemic was also declared in England and Wales in 2008. "Perhaps as important as the scares effect on infectious disease is the energy, emotion, and money that have been diverted away from efforts to understand the real cause of autism and how to help children and families who live with it," the editorialists write. Mr. Deer did his first investigative stories on the Wakefield paper in 2004 for the Sunday Times in London and a UK television network. On the basis of his findings, the GMC's Fitness to Practice panel convened in 2007 and heard from 36 witnesses during a period of 2 and a half years. At the end of January last year, as reported by Medscape Medical News , the panel used strong language in condemning the study's methods and noted that Mr. Wakefield and 2 other colleagues had broken guidelines. The Lancet issued its retraction 5 days later, citing the panel's findings that the participants Mr. Brian Deer were not consecutive patients seeking treatment and that the study had falsely reported being approved by an ethics committee. Although the GMC later found that Mr. Wakefield and coauthor John Walker -Smith committed serious misconduct and struck them off the medical register, Mr. Wakefield has repeatedly denied doing anything wrong. In addition, he was not among the 10 of 13 coauthors who disavowed the study's findings in 2004. "Instead, although now disgraced and stripped of his clinical and academic credentials, he continues to push his views. Meanwhile, the damage to public health continues," the editorialists write. Multiple Discrepancies Found Last spring, the BMJ went to Mr. Deer to ask if there was more to this story. In this newest article, he reports that "multiple discrepancies" were found, including the following: • Only one of the studied 9 children actually had clear regressive autism and 3 did not have a diagnosis of any autism type; • Five had preexisting development concerns — although all 12 were classified in the study as "previously normal"; and • The exclusion of important allegations helped create "the appearance of a 14 -day temporal link." In addition, none of the 12 patients were "free of misreporting or alteration," he writes. "My number 1 takeaway is that it cost a tremendous amount of time and money It cost a tremendous amount to penetrate the veil of confidentiality that surrounded just these 12 children. So of time and money to how on earth would anybody penetrate the veil over other larger medical penetrate the veil of research? When Wakefield did what he did, it was on the assumption that no confidentiality that one would ever be able to find out the truth," Mr. Deer told Medscape Medical surrounded just these 12 News. J children. So how on earth would anybody penetrate BMJ fact - checked Mr. Deer's article against the 6 million –word transcript of the the veil over other larger GMC panel's hearing. Dr. Godlee said she is now calling for reexamination of all of Wakefield's past studies to determine whether others should be O u_ 0 0 of 4 il 3/9/2011 2:02 PM Autism and MMR Vaccine Study an 'Elaborate Fraud,' Charges BMJ (p... http://www.medscape.corn/viewarticle/735354_print medical research? When retracted. "Past experience tells us that research misconduct is rarely isolated Wakefield did what he did, it behavior," she writes. was on the assumption that no one would ever be able to But how did a small case - control study like this set off such a panic in the first find out the truth. place? "I think a lot of people would like to know the answer to that," said Dr. Godlee. "I think Andrew Wakefield is a terrifically good publicist. He managed to convince his institution to run a press conference for this very small piece of research. The media attention for this grew, and concerns were raised with his subsequent publications." In addition, she said that many parents have questions about why their children have developed autism and are looking for reasons to explain the onset of its behavioral symptoms. "MMR is a very common intervention, it seemed to fit the picture, and it's very hard to prove that something is safe despite overwhelming evidence that there is no link. "If you're looking for an explanation, this may seem plausible, although the science is nonsense. Overall, I think it's a combination of very desperate parents looking for answers and a very clever man who was willing to lie and cheat, who was willing to try to advance his own career and financial benefits," noted Dr. Godlee. Editor's Dread With questions raised almost from the start, how culpable is The Lancet? And how can other joumals protect themselves from publishing falsified studies? That is the dread of any editor," said Dr. Godlee. "I think editors' main responsibility is to make sure that what is published is valid in terms of being good research. And I think The Lancet's decision to publish this is the first place was a very questionable decision, especially as it dealt with such a serious issue. "Why publish research that is not going to advance science and is going to create a vaccine scare? I think there is culpability there. But as for fraud, that is very tricky because science is based on trust," she added. "None of us go back and ask for the case records of patients involved. But we need to become aware that any article that comes in could be fraudulent. And we have to be absolutely vigilant and investigate properly when concems are raised. It's a constant cycle of oversight that needs to be done." Medscape Medical News contacted The Lancet for its reaction to the BMJ series of articles, but officials there had "no comment on this." Dr. Godlee said that she would also hope that coauthors would serve as backup for honesty in reporting and that all of this study's investigators "failed in their duties as authors" — especially since there were only 12 patients involved. "Adding a name to a paper carries a responsibility to ensure that no fraud has been committed. This should serve as a wake -up call for other researchers in Adding a name to a paper the future. It's their reputation that can be damaged if they are found to be carries a responsibility to associated with someone else's failures of integrity." ensure that no fraud has been committed. This Diversion of Research Funds should serve as a wake -up The editors write that although a breach of trust this large is "almost certainly call for other researchers in rare," it raises questions about what could have been done earlier, what further the future. It's their inquiry is needed, and what can be done to keep it from happening again. reputation that can be m damaged if they are found to Future BMJ articles in the series, to be published during the next 2 weeks, will be associated with someone 0 CL �. of4 3/9/2011 2:02 PIO Autism and MMR Vaccine Study an 'Elaborate Fraud,' Charges BMJ (p... htt p:// www. medscape .com/viewarticle /735 deal with these questions and The Lancet's actions from study publication else's failures of integrity. through retraction. "We wanted to also look at what motivated Andrew Wakefield, looking at the commercial schemes he established to exploit the MMR scare, and then we examine what happened when the issues of concem were first raised back in 2004 and why it was not taken more seriously at that time," explained Dr. Godlee. "To people who might ask why we're interested in all of this now, the answer is that what Brian Deer has unearthed is much more substantial than what most of us knew or what came out in the GMC hearing. This study was not only bad research but fraudulent as well. And it's taken an enormous amount of time and effort and money away from legitimate lines of inquiry," she concluded. Mr. Deers original investigation was funded by the Sunday Times of London and the Channel 4 television network. The current articles were funded by the BMJ. He reported receiving no other funding except for legal costs from the Medical Protection Society on behalf of Mr. Wakefield. The editorial authors have disclosed no relevant financial relationships. BMJ. Published online January 6, 2011. Medscape Medical News 0 2011 WebMD, LLC Send comments and news tips to news @medscape.net. J CO J 1 Q Li_ h l of4 3/9/2011 2:02 PO Science in One Room, Homeopathy in the Next? (printer- friendly) http://www.medscape.com/viewarticle/735358_print www.medscape.com Authors and Disclosures Author(s) Paul A. Offit, MD Professor, Department of Pediatrics, University of Pennsylvania School of Medicine; Chief, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Disclosure: Paul A. Offit, MD, has disclosed the following relevant financial relationships: Co- inventor: RotaTeq® vaccine From Medscape Infectious Diseases > Offit on Vaccines Science in One Room, Homeopathy in the Next? Paul A. Offit, MD Posted: 01/11/2011 Hi. My name is Paul Offit, and I am talking to you today from the Division of Infectious Diseases at the Children's Hospital of Philadelphia in the Vaccine Education Center. What I wanted to talk about started, at least for me, with an event a few weeks ago. I was asked to speak at an Infectious Diseases Symposium in New York City, and present at that symposium were about 750 pediatricians and family practitioners (there to leam about common aspects of pediatric infections; I was asked to speak about the science of vaccines). In the other room were the exhibitors. One of the exhibitors was selling a homeopathic medicine called oscillococcinum. What is oscillococcinum? You take the liver and heart of a Barbary duck, homogenize it, and dilute it 100 -fold in water. Then you do another serial 100 fold dilution 200 times, which means that when you're done, there's not a single molecule of that Barbary duck's liver or heart left. In fact, if you look at the volume of the universe, which is roughly 3 x 10 cubic meters, it's more dilute than that. So what is oscillococcinum? It's basically a gram of sugar, yet it's being sold as something that helps flu -like symptoms, m such as feeling run down, chills, and fever, when clearly it is a placebo. What's interesting is that the company was distributing literature showing how this was better than placebo, which is amazing considering that it is placebo. re 0 LL L j oft 3/9/2011 2:04 PM`- Science in One Room, Homeopathy in the Next? (printer - friendly) http://www.medscape.com/viewarticle/735358_print Now you could argue that the advantage of something like oscilococcinum is that it's not the cough- and -cold remedies which can really have side effects and can be dangerous for children. But I think at the very least, it's not fair to advertise something as having a physiologic or medical effect when in fact, it's simply a gram of sugar. The FDA could choose to do something about this. They could crack down more on homeopathic medicines that are sold as drugs. This isn't something that would be protected by the 1994 Dietary Supplement and Health Education Act. At least to date, they've chosen not to do that. Thanks for your attention. Medscape Infectious Diseases ©2011 WebMD, LLC CI] J O N. 0 0 of 2 3/9/2011 2:04 PM?I [nvestigator Planned to Make Vast Profit From Autism/MMR Vaccine ... http://www.medscape.com/viewarticle/735721_print www.medscape.com Authors and Disclosures Journalist Deborah Brauser is a freelance writer for Medscape. Deborah Brauser has disclosed no relevant financial relationships. From Medscape Medical News > Neurology Mecis Investigator Planned to Make Vast Profit From tvtedical News Aut Vaccine Scare, BMJ Says Deborah Brauser January 13, 2011 — Andrew Wakefield, the lead author on the 1998 study that reported a link between the measles - mumps- rubella (MMR) vaccine and a new condition of regressive autism and bowel disease called autistic enterocolitis (AE), was planning to market a prestudy diagnostic testing kit with expected yearly sales of 28 million pounds (43 million US dollars), a new paper published online January 11 in the BMJ reports. In the second of a series of 3 investigative articles examining the MMR vaccine scare, UK journalist Brian Deer reports that Mr. Wakefield planned several businesses to develop not only the new test but also immunotherapeutics and a "safer single measles shot" — which he held a patent for. Mr. Deer writes that these would only be successful if public confidence in the MMR vaccine was damaged. "I think this new article very clearly lays out the extent of the financial motivation There was hope of a behind what we now know was a falsified paper," Fiona Godlee, MD, BMJ financial gain from all these editor -in- chief, told Medscape Medical News. businesses that were set up and I think the important "There was hope of a financial gain from all these businesses that were set up, thing was that these and I think the important thing was that these commercial dealings were commercial dealings were undisclosed. Some of the people at the Royal Free Hospital where Wakefield undisclosed. Some of the worked were involved and others were aware. Yet these dealings remained people at the Royal Free undisclosed as the vaccine scare unfolded," said Dr. Godlee. Hospital where Wakefield worked were involved and Following the Money others were aware. Yet these In the first article in the BMJ series, published last week and reported by dealings remained Medscape Medical News at that time, Mr. Deer reported that the investigators undisclosed as the vaccine altered and falsified medical records of the 12 children involved. This study scare unfolded. was published in The Lancet in 1998 and subsequently retracted early last year. In this new article, Mr. Deer "follows the money." He found that although the first study patient was still in the hospital, Mr. Wakefield met with managers from the Royal Free Medical School in London, England, to discuss forming a joint business. A week after publication of his research, he brought in business associates to the Royal Free to continue negotiations. - ' CO A prospectus obtained by Mr Deer that was aimed at raising an initial 700,000 pounds from investors says, "it is estimated that the initial market for the diagnostic will be liti•ation driven testing of patients with AE from both the UK and O u- N- o of 3 3/9/2011 2:09 PA' nvestigator Planned to Make Vast Profit From AutisndMMR Vaccine ... http://www.medseape.com/viewarticle/735721_print • the USA. "In view of the unique services offered by the company and its technology, particularly for the molecular diagnostic, the assays can command premium prices," adds the document. Several other businesses were planned and /or registered, including Carmel Healthcare Ltd, which was named after Mr. Wakefield's wife. "His magnitude of ambition was really quite surprising to find. I had no idea that there was this scale of commercial involvement," said Dr. Godlee. The article also explains in detail how a lawyer hoping to bring a lawsuit against vaccine Dr. Fiona Godlee manufacturers funded much of the study on the MMR vaccine. The lawyer...was forthright when later asked. He said he paid for The Lancet research," writes Mr. Deer. Other new details unearthed include the following drug industry support for Mr. Wakefield during 1999: • Overseas airfare from Axcan Pharma Inc; • Consultancy negotiations with Johnson & Johnson; and • "Longstanding connections" with both Merck and SmithKline Beecham. However, the "commercial deals" ended when Mr. Wakefield received a letter voicing concern that conflicts existed between his academic employment and involvement with Carmel, especially as "the company's business plan appears to depend on premature, scientifically unjustified publication of results." Although the school offered Mr. Wakefield a year's paid absence and help to try to replicate his results with a validated — study of up to 150 patients, he did not do the work, citing a need for "academic freedom." Damaging Health Scare "This isn't personal. We're focusing on what Wakefield has done, and he has fueled a very damaging health scare," said Dr. Godlee. He's still promoting his Ideas and I think it's important for "He's still promoting his ideas, and I think it's important for people to know that people to know that the the science behind them is fraudulent and that he had extremely sophisticated science behind them is and well - developed plans to benefit from this personally in ways that were not fraudulent and that he had made apparent," she said. extremely sophisticated and well- developed plans to The third and final article in their series will be published next week and will benefit from this personally focus on what happened when study concems were first raised by Mr. Deer in in ways that were not made 2004 and why they weren't taken more seriously. apparent. "None of what has appeared in the BMJ should imply for a moment that we don't sympathize with parents making very difficult decisions. What we're left with is that we need much better research into the cause of autism," said Dr. Godlee. In a new "Perspectives" article published online January 13 in the New [As a result of the Wakefield England Joumal of Medicine, 2 clinicians from the Mayo Clinic write that there study], a generation of has been opposition since the very first vaccine was introduced, with particular parents and their children mistrust over the smallpox vaccine in 1910. have grown up afraid of "Little has changed since that time, although now the antivaccinationists' media 2 of choice are typically television and the Internet...which are used to sway C} u_ of 3 3/9/2011 2:09 Plug'' Investigator Planned to Make Vast Profit From Autism/MMR Vaccine ... http://www.medscape.com/viewartiele/735721_print vaccines, and the resulting public opinion and distract attention from scientific evidence," write Gregory A. outbreaks of measles and Poland, MD, and Robert M. Jacobson, MD, from the Mayo Clinic Vaccine mumps have damaged and Research Group and the Department of Pediatric and Adolescent Medicine in destroyed young lives. Rochester, Minnesota. "Even though more than a dozen studies have demonstrated an absence of harm from MMR vaccination, Wakefield and his supporters continue to steer the public away from the vaccine," they add. "As a result, a generation of parents and their children have grown up afraid of vaccines, and the resulting outbreaks of measles and mumps have damaged and destroyed young lives." The editorialists note several recommendations to "hasten the funeral of antivaccination campaigns," including the following: • Fund and publish studies that investigate vaccine safety concems; • Maintain monitoring programs, including the Vaccine Adverse Events Reporting System; • Instruct healthcare workers, parents, and patients how to counter false claims; and • Expand public education. "We believe that antivaccinationists have done significant harm to the public health. Ultimately, society must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right," conclude the editorial authors. Mr. Deer's original investigation was funded by the Sunday Times of London and the Channel 4 television network. The current articles were funded by the BMJ. He reported receiving no other funding except for legal costs from the Medical Protection Society on behalf of Mr Wakefield. The Perspective authors report several financial disclosures, which are listed in the original article. BMJ. Published online January 11, 2011. N Engl J Med. Published online January 13, 2011. Medscape Medical News © 2011 WebMD, LLC Send comments and news tips to news ©medscape.net. 0 �— /L o u LL 3 of 3 3/9/2011 2:09 PIvIi Medical Establishment Buried Concerns About MMR /Autism Study, ... htt p:// www. medscape .com/viewarticle /736054jtrint www.medscape.com Authors and Disclosures Journalist • Deborah Brauser is a freelance writer for Medscape. Deborah Brauser has disclosed no relevant financial relationships. From Medscape Medical News > Psychiatry Medscape Medical Establishment Buried Concerns About Medic MMR/Autism Study, BMJ Charges The Lancet Says It Never Claimed the Study Proved a Link Between the Vaccine and Autism Deborah Brauser January 20, 2011 — The medical establishment "closed ranks" to protect Andrew Wakefield, the researcher whose 1998 study linked the measles- mumps - rubella (MMR) vaccine to autism, according to a third and final article of a special investigative series published online January 18 in the BMJ. UK journalist Brian Deer alleges that when he approached The Lancet editor Richard Horton in 2004 with concems about potential issues of research fraud, conflicts of interest, and unethical treatment of children discovered while researching an article about the study for the Sunday Times, The Lancet failed to ensure that a formal, independent investigation was conducted. 3 In his most recent BMJ article, Mr. Deer writes that failure to conduct such an investigation and the series of denials issued by Mr. Wakefield, his coauthors, and the Royal Free Hospital led to the public being "misled for 6 years" about the credibility of the article before The Lancet finally retracted it in February 2010. "That's really the nubbin of this story — the failing of The Lancet and the Royal Free to investigate adequately when questions were raised back in 2004," Fiona Godlee, MD, BMJ editor - chief, told Medscape Medical News. "Although it was discredited in some ways, this damaging article still sat in the literature for 6 Dr. Fiona Godlee years. And the GMC [General Medical Council] went through this incredibly lengthy and expensive investigation, which potentially might have been avoided to some extent," added Dr. Godlee. The Lancet Responds In a statement, The Lancet disputes Mr. Deer's "portrayal of events" in 2004. "We strongly disagree with his assessment and firmly stand by our actions and Although it was discredited decisions," they write. in some ways, this damaging article still sat in the The Lancet also notes that the original 1998 article did not assert that MMR literature for 6 years. And caused autism and that it was at a separate press conference where Mr. the GMC went through this Wakefield suggested this association. incredibly lengthy and J expensive investigation, It is the role of medical journals to foster debate, even disagreeable debate, 0 cc 0 n of [ 3/9/2011 2:1I Plc& Vtedical Establishment Buried Concerns About MMR/Autism Study, ... http:// www. medscape .com/viewarticle /736054jrint and we took this role seriously and responsibly," says The Lancet release. which potentially might have been avoided to some What none of us knew at the time, including many of his coauthors, was the extent. extraordinary part that Andrew Wakefield had been playing in this affair and the part that he was about to play. At no point did we actively defend [his] public statements about the link between MMR and autism." No matter how the events unfolded, Dr. Godlee writes in her Editor's Choice What none of us knew at the editorial this week that a new process is needed in the United Kingdom to time, including many of his ensure research integrity. Although the UK Research Integrity Office was co-authors, was the established in 2006, it lacks mandatory powers and is running out of funding. extraordinary part that Andrew Wakefield had been "Other countries have models we could adapt, [such as] the US Office of playing in this affair and the Research Integrity, which has a mandate to oversee institutional investigations part that he was about to of publicly funded research," she writes. play. At no point did we "In America, you've got a process set up that could possibly be improved, but actively defend [his] public in Britain we haven't got a good set -up at all. I think this case should be used as statements about the link a springboard for really improving and raising our game on that score," she between MMR and autism. added. In the first article in the BMJ series, as reported by Medscape Medical News, Mr. Deer wrote that the investigators altered and falsified medical records of the 12 children involved. In the second article, reported last week, Mr. Deer "followed the money." He found that while the first study patient was still in the hospital, Mr. Wakefield met with managers from the Royal Free Medical School to discuss forming a joint business. In this last piece, Mr. Deer writes that he first approached The Lancet in assumed confidence on advice from his editor at the Sunday Times for comment and "to be sure we were getting it right." False Reassurance According to the BMJ article, within 48 hours of this meeting, an editor from The Lancet met with the study's 3 senior authors and the joumal published "a We were falsely reassured. 5000 -word avalanche of denials in statements unretracted to this day." We were told by authoritative sources...that an Further statements reported that an investigation was undertaken by the Royal investigation had been done Free Hospital that "cleared Wakefield of wrongdoing" and cleared Wakefield of However, according to documents obtained under the Freedom of Information most charges. But as shown Act, the investigation was actually conducted internally by the coauthors by documents obtained themselves. Both the Royal Free Hospital and Medical School have now under the Freedom of confirmed that no formal investigation was performed, no physicians were ever Information Act, there was interviewed, and no documents generated. no proper investigation, merely a 48 -hour 'scramble' "We were falsely reassured," writes Dr. Godlee. "We were told by authoritative to protect reputations and sources...that an investigation had been done and cleared Wakefield of most discredit the story. charges. But as shown by documents obtained under the Freedom of J Information Act, there was no proper investigation, merely a 48 -hour 'scramble' m to protect reputations and discredit the story." z The Lancet statement also says that it followed the guideli0es by the Committee on Publication Ethics when speaking to �� O r- of 3/9/2011 2:11 P15v1 Medical Establishment Buried Concerns About MMR/Autism Study, ... http:// www. medscape .com/viewarticle / the study authors after Mr. Deer brought his concerns to them in 2004 and published a partial retraction by 10 of the study's coauthors soon after. Major Flaws in Peer Review Process According to the BMJ article, the GMC became involved soon after the allegations were made, but it took the panel 6 years to substantiate the allegations. "Were it not for the GMC case, which cost a rumored 6 million pounds, the fraud by which Wakefield concocted fear of MMR would forever have been denied and covered up," writes Mr. Deer. "It is hard to escape the conclusion that this represents institutional and editorial misconduct, and its impact has been substantial. The intemational damage might have been lessened by earlier definitive action," adds Dr. Godlee. "This case reveals major flaws in pre- and postpublication peer review," said Dr. Godlee in a release. "Allegations of research misconduct must be independently investigated in the public interest. But it's still too easy for institutions to avoid extemal scrutiny, and editors can fail to adequately distance themselves from work they have published and then defended" She noted that "this is where coauthors become crucially important. If coauthors are going to sign their names to a paper, I think they need to have real knowledge and understanding of the entire study." Dr. Godlee added that "it was interesting" that the Wakefield study had case reports on just 12 children but had 13 authors. "One would think it would be difficult to be fraudulent with so many coauthors, but he's obviously a person who is very compelling and persuasive and managed to achieve this without them being alerted to it." Need for Healthy Skepticism In an accompanying article, clinicians from Seattle, Washington, write that there is an urgent need to fix a research system that failed to protect its subjects and the public from the consequences of fraudulent science. • "So much has been written about Wakefield himself, but we felt that, especially in light of ee s VS Ell • articles, there were a lot of unindicted coconspirators here," Douglas J. Opel, MD, MPH, acting • • assistant professor at the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute, Washington, told Medscape Medical News. f t±y 1 '. ' I think it's important...to look into and investigate why these existing safeguards that are meant ., ▪ • s ` '" to protect research subjects didn't do their job. Wakefield was able to circumvent them and conduct unethical and fraudulent research. We need to understand what those defects are, fix them, and prevent situations like this from happening again," added Dr. Opel. Dr. Doug Opel The editorialists offer several suggestions for preventing future "research adverse events" including the following: • Empower everyone in research to raise questions throughout the process; • Train research leaders to manage inquiries once raised; • Not allow journal editors to "take the word" of researchers after allegations are made against them; and • Train research leaders to recognize that they may have conflicts of interest in looking into allegations. "We perhaps need a paradigm shift in the research world. We need to look to what we're doing in the clinical world with respect to quality improvement and I think it's important..to look patient safety and determine whether some of those can be applied to the into and investigate why research realm to protect human subjects," said Dr. Opel. �f /2-D r-- CD of4 3/9/2011 2:11 P W Medical Establishment Buried Concerns About MMR/Autism Study, ... htt p:// www. medscape .com/viewarticle /736054_print "We...need to rethink and reform our customs and culture. The disastrous these existing safeguards impact that Wakefield's study has had on vaccine coverage, recrudescence of that are meant to protect disease, public trust, and, most of all, science requires that we do so in haste," research subjects didn't do write the editorial authors. their job. Wakefield was able to circumvent them and Dr. Godlee added that when it comes to medical joumals, clinicians should conduct unethical and also maintain a healthy skepticism. fraudulent research. We need to understand what "We work hard to make sure that what we publish is accurate, and I'm sure the those defects are, fix them, same is true with The Lancet. One is aware that clinicians are going to be and prevent situations like reading this and using the information to treat and advise their patients. Yes, this from happening again. there can be inaccuracies, and we know that there will be fraud. But how often that happens is almost impossible to judge," she said. "So physicians need to, one hopes, not be cynical but absolutely question. The whole scientific enterprise is organized skepticism, where we all are meant to look at what's put in front of us and submit it to a process of questioning intemally in terms of whether this is valid and relevant," she concluded. Mr. Deet's original investigation was funded by the Sunday Times of London and the Channel 4 television network. The current articles were funded by the BMJ. He reported receiving no other funding except for legal costs from the Medical Protection Society on behalf of Mr. Wakefield. The editorial authors have disclosed no relevant financial relationships. BMJ. Article and editorial published online January 18, 2011. BMJ. Editor's Choice published online January 19, 2011. Medscape Medical News 02011 WebMD, LLC Send comments and news tips to news @medscape.net J 0 e 4 of4 3/9/2011 2:11 PM i a - E a c ..._ {y �a8 as p +M' _ y H y ` O ' ...S: 6 ^ ;lit ryry o y e 0. 0 CD O,I w n � . E' 6 ' (: • eD � - fN et p p a g . .• � R C o r p Oa y A RIM A G 3 � P. F• a ° n - r p.. a 9 , o , w R . pW a w ea5`,gm� nod; ^a_ , • ;V/. z • . 4. m= y a a . 0 O Ra al w 1 a. q , cg g• S' N' o tgi 9. • c . .` 1 g � • i s:r o ff^°^ ^ mm °�� m'�" m^ o T ttli M Ill � . N • e o, p tr y � ��, � p g + / pi . t ' eg a k a g : N • G m ' P t O ^ Th OQ A 4 P. w .. (/�\ o • .. n . :4 rn o " o �. 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Despite earlier ion- such as designing bottles that require fleets a national sample of 63 hospi- cetns at might shift to using a needleless syringe to extract the tats with 24 -hour emergency depart- pain medications or antibiotics tot rtes • •, •. ments. ,The scientists examined the infants' cold and coughsymptoms, the urther study is needed to assess number of emergency department vis- authors did not find evidence of an in -. the effect of changes to the labels of its involving childrereslrsseof the - crease in adverse eventsrelated to such cold and cough medicines in late counter cold and cough medicines for medications in this age group. • 2008 that state the products should . 14 -month periods before and after the However, the overall number of not be used in children younger than • infant formulations were voluntarily emergency department visits among 4 years. 0 • MA, December 22/29, 20 10— Vo1304, No. 29 - 2E16 LA E 1 1 �J ?ormat Dynamics :: CleanPrint :: http: / /www.denverpost.com/fitness /... http: / /www.denverpost.com/fdcp ?1299705555752 denverpost cam DENVER POST fitness your guard down. Turn sideways to walk down hills. But caution: How To: Avoid Never cross one foot over the other, leaving you with no balance. Bend your knees slightly if the injuries on ice incline is steep. Use your arms for balance. Keep your hands out of your pockets, allowing your arms to swing By The Denver Post normally or stretch out sideways, and don't carry Posted: 01/24/2011 01:00:00 AM MST heavy loads. Many cold - weather injuries result from falls on Protect your,dominant arm. If you must break a icy surfaces. Here are tips from emergency bone, it's better to hurt the hand you don't rely officials and doctors to help you stay on your on for writing and other daily tasks. One idea: feet: Hold your coat or anything you're carrying in your dominant hand, leaving the other one free to Wear the right shoes. Many people fall because break any fall. they wear shoes with heels or that have smooth, flat surfaces instead of slip- resistant soles. Clear paths quickly. Remove snow, and spread salt on porches, sidewalks and steps i Keep your feet apart. You'll have better balance mmediately after a storm, before the snow gets if you walk with your legs spread more than packed down. McClatchy Tribune usual — and, if it's very slippery, your knees slightly bent. "You may feel that you look funny, but it's worth it," says Dr. Ronald Grelsamer, a hip and knee surgeon at New York's Mount Sinai Hospital. Take small steps. Use a short, shuffling stride with your feet pointed slightly outward. Curl your toes under and walk as flat- footed as you can, keeping your shoes in contact with the ground as much as possible. Always look ahead. Small patches of ice can linger on surfaces that are mostly clear. Don't let Advertisement DIRECTV has more of what you want DIRECTV. to watch! • Switch today! iiYa cn9z '41 _a.Lti ad rtquiffl z.pl All d 1.a, nk w.ptntmd Yudos y I.mar q, tom] .I9.2 Hayartala faMvary may arc* = F'C,bI. u;e tar aaunlrtN mrtyarP11' the wtlnl cnldo ± Ote 4n riId'I m Print Powered By !ffS I crmat Dynamics - I a cc 34, u of 1 3/9/2011 2:19 PNj` MEMORANDUM TO: Mayor and City Council FROM: Randy Ready, Asst. City Manager DATE: March 11, 2011 MEETING DATE: March 15, 2011 RE: Additional Information from Finalists for Wheeler Restaurant Space SUMMARY: Attached is the 2/28/11 letter to finalists for the Wheeler Restaurant Lease Space requesting additional information about their proposals, followed by the responses from the four finalists. The finalists will be prepared to meet with City Council and the Wheeler Board during the March 15 work session beginning at 4:30. Each finalist has been asked to prepare up to ten minutes of comments about their restaurant concept and a summary of the additional information provided in response to Council's direction and questions regarding tenant finish, affordability and value. After each presentation, you will have an opportunity for Q &A with the restaurateur. The staff and outside consultant evaluation team has had an opportunity to review this additional information. The evaluation team recommendation unanimously remains the same as discussed during the February 22 meeting with Council. Three of the four finalists indicated that they can make their restaurant concept work under the conditions from City Council outlined in the 2/28 letter. However, one applicant, Fiercely Local, indicates an inability to comply with the request for a separate retail space, a 5 -year lease term, or an 8% percentage of gross clause in the lease. We look forward to receiving Council direction on March 15. Please let me know if you have questions about this in the meantime. February 28, 2011 Finalists for Wheeler Restaurant Lease Space: CP Restaurant Group Fierecly Local Rieger Restaurant Group Ute /Syzygy RE: Summary and Requests of Finalists for the Wheeler Lease Space Finalists: Thank you for the clarification of your proposal and your presentation to the proposal review committee during the week of February 14. Congratulations on being considered as a finalist in the review process. City Council met on February 22 to discuss the tenant selection process for the Wheeler lease space(s). After reviewing the four finalists' proposals, Council's direction is as follows: 1. Maintain a separate small retail storefront (approximately 500 s.f.) with existing entrance along Mill St. (See attached proposed First Floor Plan.) 2. To follow up on point #1, move away from the concept of providing separate performance space (if proposed), but continue to explore ways to present small - scale entertainment options within the restaurant from time to time, primarily in support of Wheeler programs. 3. Enter into an initial lease term not to exceed 5 years, with options to renew for additional 5 -year terms. 4. Establish a lease rate that includes a fixed minimum base rent with an 8% of gross sales percentage rent to determine the total rent paid each year. 5. City Council is willing to negotiate on City participation in the costs of tenant finish, due to the 5 -year lease term and especially due to the requirement that menu pricing remains affordable throughout the term of the lease. 6. Determine specifically how each finalist proposes to maintain an affordable menu that provides value and customer satisfaction. What is the proposed pricing for menu items, as well as the anticipated average check for lunch and dinner service? How are bar beverages proposed to be priced? How will value be maintained? (i.e., What is the size of the hamburger to be offered for a certain price ?) 7. Require that an affordable lunch/bar menu be available all day, as an option for evening diners who would rather not order from the dinner entree menu. 8. Assure affordability and value by agreeing on initial menu concept and pricing and then including a lease term that requires the restaurateur to justify any price increases above the Consumer Price Index to the City prior to implementing. Please review the requests and conditions that City Council outlined above. Indicate whether or not you have the ability and willingness to comply with each of those conditions, and your specific response to each of the questions asked. Your responses should be submitted in writing to the Purchasing Department, Attention: Rebecca Hodgson on the 2 "1 Floor of City Hall by no later than 4pm Wednesday, March 9. City Council would like to meet with the finalists that are still under consideration at a public work session on Tuesday, March 15 starting at 4:30 pm in Council Chambers. If you would like to continue to participate in the evaluation process, please be prepared with up to ten minutes of comments on your proposed restaurant concept, and elaboration on the tenant finish, affordability and value aspects of your proposal, followed by Q & A with the council members. Thanks again for your interest in this restaurant opportunity. We look forward to hearing from you on March 9 and to seeing you on March 15. If you have any questions in the meantime, please email them to rebecca .hodgson@aci.aspen.co.us. Best regards, Randy Ready, Assistant City Manager City of Aspen • +CP RESTAURANT GROUP+ PROPOSAL FOR THE WHEELER OPERA HOUSE 1. Our proposal has always included a separate retail storefront with existing entrance on Mill Street, and complies with the First Floor Plan provided by the City. 2. A separate entertainment space was not part of our proposal. However, we would be glad to support any small -scale entertainment options requested by the Wheeler as a complement to their programs. This would entail working with the architect to provide a portable stage and necessary hook - ups/wiring within the proposed First Floor Plan (with the additional costs to be carried by the City) 3. Our original proposal fits the required lease terms. 4. Please refer to updated Lease Summary document. b. Per the RFP, we understand the City of Aspen, as the landlord, would provide all rough -Ins per the architectural drawings provided by CPRG. Additional tenant finishes for negotiation are noted by *: • Electrical • Plumbing • Restrooms ADA compliant • ADA compliant lift • Building fire sprinkler system • Kitchen exhaust system (hood, duct work and fans) • Grease Trap • HVAC system • All structural work, drywall, etc. * Vault restoration * Fire Suppression System (ancillary) * Awnings * Entertainment stage and hook -ups, per #2 above 6. Please refer to Sample Menu with prices and Check Average documents provided. Bar. We have plans for an amazing drink program with a mandate for affordability. This will include wine, liquor, and beer programs, locals' specials, etc. CPRG is also positioned to offer special pricing due to our economies of scale In Aspen. 7. CPRG will provide affordable menu options all day. 8. The RFP mandate for affordable dining is the driving factor in our calculations. Our experience over the last 8 years managing our own restaurants Informs our pricing and revenue projections. To assure affordability throughout the life of lease, we plan to be consistent with our concept and price points. CPRG promises continuing transparency and an open door in our dealings with the City of Aspen. 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Cv O0 -A+mO V (0006 Jw V � WOWV -fOi1 a a — O 5 � g � N a EA to �"NU° 1 � 1 , ' o 2 ��m� 8 6.8 8 MEMIEEMI &ths n0/A V tOtg a i -e>1 PROPOSED BRUNCH MENU 4 BRUNCH MENU BREAKFAST PLATES Two Eggs any Style — JB's Breakfast Potatoes, with a choice of bacon, sausage, or ham 8.75 Egg -in -a -Hole -7 Miner's Scramble —' chorizo, Lulu's Breakfast Potatoes, onions, jalapeno, pepper jack 9 House Crafted Bacon with a Fried Egg —. red chili mayo, herb salad 8 Pancakes with Vermont Maple Syrup — 5 wagon wheels stacked high, butter 75 Steak and Eggs — Flatiron, JB's Breakfast Potatoes, sliced tomato, HP sauce 12 French Toast with Strawberries —' gran marnier, whip cream 8 Biscuits and Sausage Gravy — three biscuits and spicy gravy 75 Granola and Yogurt — fresh fruit 6.75 LOCAL EGG OMELETS Banker's Omelet, ham, mushrooms, bell peppers, onions, chives 9.75 Garden Omelet, served open faced, tomatoes, zucchini, parmesan, mint 10 Duck Confit Omelet, spinach, goat cheese, peach sauce 11 Mushroom Omelet, grilled onions, garlic, goat cheese, scallions 10 Garlic Steak Omelet, bell peppers, grilled onions, provolone 12 Tomato and Pesto Omelet, burst cherry tomatoes, ricotta, basil 13 All our Omelet Plates are served with JB's Breakfast Potatoes and a choice of red or green chili LUNCH PLATES Tomato Soup — fresh cracked pepper 8 Shepherds Pie — Mashed Potato Crust 13 Chargrilled Burger — Roquefort Cheese, Shoestrings 9.5 Rocket Salad with Shaved Porter Cheddar — crispy leeks, aged balsamic 9 Buffalo mozzarella — bacon, figs & rocket, honeyed dressing 13 Five Cheese Macaroni 9 Grilled Cheese on Pullman Bread — Choice of: Cheddar, Taliegio, Gruyere 8 ti add caramelized onions 1- add heritage country ham 2 Grilled Flatiron Steak Sandwich — Gruyere, carmelized onions 15 BBQ Brisket Sandwich — fennel - shallot slaw, Fried Crushed Potatoes 12 JB's BLT on Rustic Bread 10 EXTRA PLATES 1 -2 Add an Egg — Breakfast Potatoes — Biscuits — Gravy — Sausage, Bacon, or Ham - Toast PROPOSED LUNCH MENU '- LUNCH MENU STARTERS Flatbread — woodland mushrooms, carmelized onions, parmesan 12 Hot Artichoke Dip — crispy bread 10 Oysters on the Half Shell — champagne, chili mignonette 15 Tomato Soup fresh cracked pepper, rustic bread 8 Chili & Salt Calamari — lime, harissa dipping sauce 12 Jumbo Lump Crab Pan Fritter —' lemon aioli 14 Pot of Fried Pickles 5 Steamed PEI Mussles Hefeweizen broth, garlic aioli 14 SALADS Rocket Salad - Shaved Porter Cheddar — crispy leeks, aged balsamic 9 Buffalo mozzarella ti bacon, figs & rocket, honeyed dressing 11 Chicken Salad — greens, pear, dried cranberries, blue cheese, roasted shallot vinaigrette 12 MAINS — Fish & Chips — tartar sauce 11 Berkshire Pork Sliders — Pickles & Wholegrain Mustard 10 Shepherds Pie Mashed Potato Crust 9 Chargrilled Burger — Roquefort Cheese, Shoestrings 9 Five Cheese Macaroni 9 Grilled Cheese on Pullman Bread — Choice of: Cheddar, Tallegio or Gruyere 8 add caramelized onions — add heritage country ham Grilled Flatiron Steak Sandwich — Gruyere, carmelized onions 13 BBQ Brisket Sandwich — fennel - shallot slaw, Fried cruched potatoes 12 JB's BLT - crispy pork belly, rocket, tomato relish, shoestring fries 10 Grilled Market Fish Sandwich — thyme- garlic -lemon Aioli 11 SIDES 7— Shoestring Fries — Mixed greens — lemon vinaigrette — Mashed Potatoes — Fennel - Shallot Slaw FOR THE LITTLE ONES Margherita Flatbread and Ice Cream 8 SUNDAY ROAST Available on Sundays from 12pm — Chef's Inspiration .� PROPOSED DINNER MENU DINNER MENU STARTERS Flatbread — woodland mushrooms, carmelized onions, parmesan 12 Oysters on the Half Shell — champagne, chili mignonette 18 Soup of the Day — chef's inspiration 8 Chili & Salt Calamari — lime, harissa dipping sauce 12 Chicken Liver Bruschetta — chopped capers, whole grain mustard 9 Jumbo Lump Crab Pan Fritter — lemon aioli 14 Warm Olives — sea salt, fresh herbs 6 Pot of Fried Pickles 5 Steamed PEI Mussles Hefeweizen broth, garlic aioli 14 Peach -Chili Glazed Pork Belly — collard greens, black eyed peas, chives 14 SALADS Shaved Market Vegetable Salad — lemon vinaigrette, toasted pecan 10 Rocket Salad with Shaved Porter Cheddar crispy leeks, aged balsamic 9 Buffalo mozzarella — bacon, figs & rocket, honeyed dressing 12 MAINS • Fish & Chips - tartar sauce 11 Berkshire Pork Sliders — Pickles & Wholegrain Mustard 10 Shepherds Pie — Mashed Potato Crust 10 Chargrilled Burger — Roquefort Cheese, Shoestrings 12 Five Cheese Macaroni 9 Grilled Cheese on Pullman Bread — Choice of: Cheddar, Tallegio, Gruyere 8 add caramelized onions 1— add heritage country ham Grilled Flatiron Steak Sandwich — Gruyere, carmelized onions 15 BBQ Brisket Sandwich - fennel - shallot slaw, truffle potato chips 12 JB's BLT on Herb Parsley Bread — crispy pork belly, rocket, tomato relish, shoestring fries 10 Grilled Rocky mountain Trout — thyme, garlic, lemon 16 SIDES 7— Shoestring Fries - Kale & Bacon — Mixed greens — Mashed Potatoes — Fennel - Shallot Slaw I Average Weekly Check L/D (June 15th /Sep 15th) SUMMER SEASON DAY FOOD LIQ /BEER AVG CHK #COVERS TOTAL TOTAL REV Monday L 12 5 17 50 $ 850.00 Monday D 18 10 28 85 $ 2,380.00 Tuesday L 12 10 22 55 $ 1,210.00 Tuesday D 18 10 28 90 $ 2,520.00 Wednesday L 12 10 22 50 $ 1,100.00 Wednesday D 18 10 28 100 $ 2,800.00 Thursday L 12 10 22 75 $ 1,650.00 Thursday D 18 10 28 110 $ 3,080.00 Friday L 12 10 22 80 $ 1,760.00 Friday D 18 20 38 185 $ 7,030.00 Saturday,. 12 10 22 85 $ 1,870.00 SaturdayD 18 15 33 195 $ 6,435.00 SundayL 12 10 22 85 $ 1,870.00 SundayD 18 10 28 95 $ 2,660.00 TOTAL AVERAGE WEEKLY CHK 27.8 1340 $ 37,215.00 $ 483,794.99 Average weekly Check UD (SEP 15th /Dec 15th) OFF SEASON DAY FOOD LIO /BEER AVG CHK #COVERS TOTAL TOTAL REV Monday L 10 5 15 10 $ 150.00 Monday D 15 5 20 20 $ 400,00 Tuesday L 12 5 17 20 $ 340.00 Tuesday D 15 5 20 40 $ 800.00 Wednesday L 12 5 17 30 $ 510.00 Wednesday D 15 5 20 30 $ 600.00 Thursday L 12 5 17 10 $ 170.00 Thursday D 15 10 25 40 $ 1,000.00 Friday L 12 5 17 15 $ 255.00 Friday 0 15 10 25 50 $ 1,250.00 SaturdayL 12 5 17 10 $ 170,00 SaturdayD 15 10 25 40 $ 1,000.00 SundayL 10 5 15 10 $ 150.00 SundayD 15 5 20 10 $ 200.00 TOTAL , AVERAGE WEEKLY CHK 20.8 335 $ 6,995.00 $ 87,035.00 GROSS REVENUE ##### # # ## gygme Weekly Check UD (Dec 15th /ADril 15th) WINTER SEASON DAY FOOD LW/BEER AVG CHK *COVERS TOTAL TOTAL REV Monday L 12 5 17 45 $ 765.00 Monday D 18 10 28 60 $ 1,680.00 Tuesday L 12 5 17 45 $ 765.00 Tuesday D 18 10 28 90 $ 2,520.00 Wednesday L 12 5 17 50 $ 850.00 Wednesday D 18 10 28 85 $ 2,380.00 Thursday L 12 5 17 70 $ 1,190.00 Thursday D 18 10 28 60 $ 1,680.00 Friday L 12 10 22 80 $ 1,760.00 Friday D 18 20 38 105 $ 3,990.00 SaturdayL 12 10 22 70 $ 1,540.00 SaturdavD 18 20 38 100 $ 3,800.00 SundayL 12 10 22 80 $ 1,760.00 SundavD 18 10 28 80 $ 2,240.00 TOTAL AVERAGE WEEKLY CHK 25.4 1020 $ 26,920.00 $ 465,331.41 Average Weekly Check UD (ADril 15th /June 15th) OFF SEASON DAY FOOD LIO /BEER AVG CHK *COVERS TOTAL TOTAL REV Monday L 10 5 15 10 $ 150.00 Monday D 15 5 20 20 $ 400.00 Tuesday L 12 5 17 20 $ 340.00 Tuesday D 15 5 20 40 $ 800.00 Wednesday L 12 5 17 30 $ 510,00 Wednesday D 15 5 20 30 $ 600.00 Thursday L 12 5 17 10 $ 170.00 Thursday D 15 10 25 40 $ 1,000.00 Friday L 12 5 17 15 $ 255.00 Friday D 15 10 25 50 $ 1,250.00 SaturdayL 12 5 17 10 $ 170.00 SaturdayD 15 10 25 30 $ 750.00 SundayL 10 5 15 10 $ 150.00 SundayD 15 5 20 10 $ 200.00 TOTAL AVERAGE WEEKLY CHK 20.0 325 $ 6.745.00 $ 73,231.43 March 9, 2011 To: Randy Ready and the Wheeler Lease Space Selection Committee From: Fiercely Local LLC, Michele Ki ley (970. 948-9209, 4kiley @earthbnk.net) RE: Response to Summary and Requests of Finalists for the Wheeler Lease Space We appreciate being a finalist for the Wheeler lease space. We have carefully considered each of your questionslcominents and provided answers below. These responses are consistent with the concept that we have presented over the course of this proposal process, and many aspects of the original concept have been maintained - in order to establish a sustainable business model 1. Maintain a separate small retail storefront (approximately 500 s.t) with existing entrance along Mill St. (See attached proposed First Floor Plan) We developed our concept based on the option to occupy the full space, and we would like to maintain the ability to occupy the 500 square feet of space to allow for our cafe/retail concept. We have a strategic plan for use of the retail storefront space, which allows us to generate more volume than the square footage would allow In a traditional restaurant format. We believe that this brings vitality to the location, provides a valuable amenity to the public in the downtown core, and provides sustainabtUty to our business. The two distinct but related restaurants, Wheeler Bar & Grill and Haberdashery Cafe, will share resources such as the kitchen, espresso machine, bathrooms, storage and office areas, et. From the retahUcafi3 spore, we are proposing to provide healthy, affordable hot and cold items for both dine -in and take -away, 7am -tipm. The grab & go case would house breakfast and lunch items that am packaged Inclvidually (primarily salads, sandwiches and soups), providing affordable convenience and capitalizing on the foot traffic in this prime location. Key would utilize this space to continue to serve her existing consumer base of catering clients for home entertaining, primaniy focused on cheese, charcuterie, locally-baked breeds, gourmet Items, etc. 2. To follow up on point #1, move away from the concept of providing separate performance space (if proposed), but continue fo explore ways to present small-scale entertainment options within the restaurant from time to time, primarily in support of Wheeler programs WHEELER ti$n„ ice,. ............. Bar as Grill Page 11 We we not proposing any sort of performance space, but the restaurant will have an advanced SLV (sound, light & video) system to accommodate entertainment options if desired. To address the Wheeler's specific needs, we are committal to the following: a) Utilizing our team's extensive experience in catering to handle artist meals, special events and other activities that require foodservke. The Haberdashery Cafe space will be dosed after (ipm, providin a semi - private dining space for artists if needed. b) Offering an all-day menu that will allow for pre -show dining (beginning at 4pm), with " overture " specials that feature an entree that can be prepared/served quickly. c) Offering a late night menu (9.11 pm) featuring small plates, desserts and cordials that are ideal for sharing with a group after a show, as well as weekly bar specials featuring 7 items under $7. d) Establishing and maintaining a positive and operative relationship with the Wheeler, with the understanding that the success of their programs and ease of their operations positively Impacts our business. Kiley and Marco have developed and maintained a very strong relationship wth their current landlord over the past 7 years, as supported in the reference letter in the Appendix of our original proposal. 3. Enter into an initial lease term not to exceed 5 years, with options to renew for additional 5-year terms. We have demonstrated our long -term commitment to this venture by submitting 20 year rent rolls to the City. The lease term that would be acceptable to us is a 10 year lease with two 5 year extensions with tenant option to renew. Please see the enclosed rent roll for details. 4. Establish a lease rate that includes a fixed minimum base rent with an 8% of gross sakes percentage rent to determine the total rent paid each year. In order to establish and maintain a quality, affordable establishment, we are unable to offer a percentage of gross sales to the City in addition to the fixed base rent. Our proposal begins at $51 /sq ft and climbs to over $67/sq ft In the lest 5 years. Please see the enclosed rent roll for details. 5. City Council Is willing to negotiate on City participation in the costs of tenant finish, due to the 5- yearlease term and especially due to the requirement that menu pricing remains affordable throughout fhe term of the lease. WHEELER Bar & Grill Page t2 • We are eager to define the details of landlord vs. tenant work. We hope to have the opportunity to establish a key contact at the City with whom we can have a conversation to address our outstanding questions and finalize the details of this venture. 6. Determine specifically how each flnalistproposes to maintain an affordable menu that provides value and customersatisfadion. What is the proposed prkhng for menu items, as well as the anticipated average check for lunch and dinner service? How are bar beverages proposed to be priced? How will value be maintained? (1..e., that Is the size of the hamburger to be offered for a certain price ?) Between the Wheeler Bar & Grill and Haberdashery Cafe, ticket averages range from $B-13 per person for breakfast or $18 -25 per person for dinner (includes meal, drink & sales tax). Our ability to keep prices low Is a result of the volume, speed of execution and long business hours that we are able to maintain with this - business model. Please see the enclosed all-day menu and late-night menu with pricing, as well as sample checks that demonstrate our affordabiflty. In addition to these menus, we will offer specials such as "7 under $T weekly specials on small plates, wines and bees, "overture' specials for pre -show dining, and healthy, affordable grab & go offerings from Haberdashery Cafe. 7. Require that an affordable lunch/barmenu be available all day, as an option for evening diners who would rather not order from the dinnererdree menu. Yes, that has been an essential component of our concept from the start. Please see all -day menu enclosed. 8. Assure affordability and value by agreeing on initial menu concept and pricing and then including a lease term that requires the restaurateur to justify any price increases above the Consumer Price Index to the City prior to implementing. No. We are fully committed to maintaining affordabiflty and recognize that it Is in our best interest to do so over the lifespan of our business venture. WHEELER HEELER v Bar&Grill Page 13 Wheeler Bar and Grill / Haberdashery Cafo Pro tected Rent Roll Rent Roll Year % increase Year Monthly Annual 1 2011 412,105 -$145,264 2 2012 412,105 4145,264 3 2013 412,105 4145,284 4 2014 412,105 4145,264 5 2015 412,105 4145,264 6 10% 2016 413,316 4159,790 7 2017 413,316 4159,790 8 2018 413,316 4159,790 9 2019 413,316 4159,790 _ 10 2020 413,316 4159,790 11 10% 2021 414,647 4175,769 12 2022 414,647 4175,769 13 2023 - $14,647 4175,769 14 2024 414,647 4175,769 15 2025 414,647 4175,789 16 10% 2026 416,112 4193,346 17 2027 416,112 4193,346 18 2028 416,112 4193,346 19 2030 416,112 4193,346 20 2031 418,112 - $193,346 Total Rent for 20 years 43,370,647 Average Rent per month 414,045 Wheeler Proforma CONCEPTUAL DRAFT Rent Roll k WI_rEELER, 1 Bar & Grill . LL , A-DAV MENU 6 nwie Housenade Roasted led Pepper Hummed 810 PalFarner's Salad Spring greens, roast turkey, white *9 with fresh vegetables and pita beans, roasted tomatoes, local chevre, pistachios, basil vkaigrette Mac and Obese Smoked gouda, fresh chives, SSO roasted mushrooms Chopped Ddhdien Salad Romaine, radicchio, roasted 519 chicken, Fuji apple, sweet con, tomato, avocado, farm Gilled Vegetable QueeadNa Green chilies, 810 fresh eggs, spiced walnuts, local chevre, house -made red - aged white cheddar idle ranch dressing Slow Roasted fork Belly Sliders House-made 57 Southwestern Steak Salad Crisp lettuce, black beets, 518 pickles, mustard Molt sweet com, cherry tomatoes, tortilla strips, licama, avocado, roasted pumpkin seeds, aged white cheddar HemenladsSoft Ptetset Fleur desel, 54 raspberry mustard green8alad Mixed greens and market fresh vegetables; *8 add steak chicken, turkey or grilled shrimp teraieme CidckeaLOlgpops with house-made blue cheese 5R . or red chili ranch dipping sauce Routed Tomato and Ban Son local chevre crostini 58 Morino Canted Capstan & Reek sbrimp $19 Rust CWeken and Green Chili UboMder Smoked bacon 59 Roasted Tomato, spicy mustard moll and sweet wet • Lamb Stew Guinness Stout, locally rolled lamb, potatoes, i9 • CHEESE SELECTION cnaty bread Four hand - selected cheeses from Haberdashery j Turkey 0601 Three beans, New Mexican red chill 8R Cafe, with crostini & olive marmalade _ '�!� +� -Qo _- Tee Burger Choose Colorado ground chuck 0: short rib *9 patty, horse- madeveggie or turkey burger, with shredded lettuce, tomato a house- madepkkles Tempura Battered HalMt & Olds Hand -cut 817 fries, malt vinegar, house -made sweet diU Add bacon, cheddar, swiss, blue cheese, green chili, fried tartarsauce egg or roasted mushroom coral each aaawtenReaeted8abeon Roasted red $20 'flukey & Brie Santo with fresh spinach enMidland 819 pepper/parmesan potenta and spinach Baking Company focaccia Short Rib Stroganoff over browned butter 818 ag woo palm* Roasted red pepper, gruyere, 519 pamhesan noodles arugula and olive marmalade Rasmd nicks Breast Free -range bone -in 815 R smolder Peach & bourbon barbeghesauce, 819 breast, herb mutate, creamy sauce of white on an onion roil wine, lemon ft capers �$hIed flat Iran Steak wltti hand-cut fries 019 The Reuben House-made corned beef, ramble rye, 518 sauerkraut, gruyere, and thousand island dressing Rock 8delmpPmae Creamy roasted tomato- *18 grilled Veggie Wrap with sprouts, local chevre, and *19 basil sauce green chili atoll Mi , AR sandwiches tome with your chalet otslde ��u,,��, Hand -cut fries - and H ouse- nad pretzel dr HncuW OPEN DAILY Tiam -lUM !Locate* AT TRe morro C Wham aR Ovens HOY= Vann HA9mRDASHIRY CAP* riexy DOOR FOR TAKH -AWAY AND SPECIALTY P0005 7AM -Bet • CONCEPTUAL DRAFT WHEELER Bar & Grill 1� 'r LATE NIGHT MENU p / 1.(a/La AVAILABLE 9: T1:00P1d 6 41.4 p a! €47r cir.,�Qitse Eoua-0mdeROaatedRed Pepe Hummhe 810 Chopped CbItha Saud Romaine, radiccha, roasted 818 with fresh vegetables and plta chicken, Fuji apple, sweet corn, tomato, avocado, farm fresh eggs, spiced walnuts, local chevre, house-made 1100 EMOheese Smoked gouda, fresh chives, 810 red chile ranch dressing masted mushrooms ThheSteger Choose Colorado ground chuck & short nb 80 _ Brined vegetable Camaaka Green tellies, s jo ply, house -made veggie or turkey burger; with aged welts cheddar shredded lettuce, tomato & house -made pickles Add bacon, cheddar, swiss, blue cheese, green chili, • Stow koaslad Pork Hey BMus House -made *7 fried egg or roasted mushrooms MCI eacb pickles, mustard atoll Turkey& Brie PEEN with fresh spinach on Midland gjg Housbdade SofPretael Fleur de Set. PI Baking Company focacda raspberry mustard Resat Potk Moulder Peach & bourbon barbeque sauce, 818 Cfdekea Lauipopswlth house -made blue cheese 80 on an onion roll or red chili ranch dipping sauce Gdl edVeggie Wrap with sprouts, local chevre, and m Paaaemo Crusted Calmed 411s* Shrimp 818 Breen chili aioli Roasted Tomato, spicy mustard atoll OnehgaMd MScedlreensardmerkethesh SB All sandwiebes some with your aholeso fside: fries vegetables; add steak chicken, turkey or grilled Sm green salad shrimp Mel mare House -made soft pretzel Roasted Tomato and Basil Soap Local 8S chevre crostini BREAKFAST BURRITO Turkey Chill Three bears, New Mexican SS Hatch green dale, crispy potatoes, melted red chili cheddar, roasted tomato salsa. Choice of chonm, bacon or sausage. $11 T /46444/6 SS oath Fall Apple wean Pudding Salted caramel, vanilla T4yl ca, bean ice cream Mom's Chocolate Cake Three layers covered in Hot ?Odd)! Black Velvet chocolate ganache NammothNoeba Filthy Martial Vea0la Ben & dread Mender Crd>tmBtWea Ardsanal Maps Seer Bloody Mary dot Fudge Sundae House-made hot fudge, whipped cream and spiced walnuts 'n'eosl *Ii Masao Whiskey KITCMN OPEN DAILY 11A14-IPM I LOCATED AT THE HECTOR= WHEELER OPERA HOUSE Visa HAERROAn1ERY CAP* PSXY DOOR FOR TAKE -AWAY AND ORWAYM POODe 7AM -8PM - • CONCEPTUAL DRAFT WHEELER Bar & Grill 7 UNDER $7 THIS WEEK'S SPECIALS Rot Dog Chicago style: yellow mustard, dropped $4 white onions, sweet relish, house-made pickle • Soup and Half Salad Mixed greens and market 87 fresh vegetables with our daily selection of soup Spaghetti ' BeofDoo Half bowl with $S tomatoes and fresh basil Minoad Pot Plc $7 Weft Drinks Budweiser Draft House Cabernet or Pinot ftriglo $4.6 CONCEPTUAL DRAFT is � -[= f z F - v r � ..' <� I L l P � yL 4 E :—.1',1_ c C it y � hit °� r r i r�i � 1 M�A < 1 � ' + ' �)I ,df)S 1 , t v 1 v ,! �. 1 ,,,dti t, 3314 � t r iv iv �a°we 9� � 4 t 'T "�Sxt1`y' { s .r'w��3�e AP s 3 4 f J1��.t 6) C w d'1 " � a +eC � • f �P� !_ � � ny��i� r.° a s i F'd ♦ '' +" 14 �+u L e t t k 6 't t fz h l'i e Y e 1v ,z L' t��.� { E } � ♦ i $,,� A 0. a ��4 � T ^+ rt�st .� 'V � sr s • t 'A +.w,k - ,''�' 5 �+. s j p w • �, .r - 2.2.2{ 61 . x , t t s �.42.t% P B *' a [ r Kt -iJ " tVi r S 6 k , c+ . 0 tl @ ty" ` S Ff T`9Y i2" - 1 t � Il r � -2' TrRnVi N. i N: F. \zk} L 11' 77` pi . 3 )-v R ct .v �pq s y + � t t� 7.SacrF-4 e<� 1 c� rt�xa ,�� ,.�r< n dr •<,/�s� t f�'` L r+� T ,Sa rw l ti • h `Y �l�a ;'45 ' , y 4 ' "' tv ev4'i �s� r. s P 5 s cli • °' ' # ift. .L' T i, f 'l X . f.s ti �� r 9 4 4 , , lid' � -V" p 4 s i 4 7,5 4 t v y „ a ^ e N �i etm �. kos ..2� t� y� ��,��M 3 i j s•••4 Y a t :4 ; • r? 7 i k' n a t � 1 , n M 1' + • 3` k + - " n k 3 v 0, n ! r4h[7 7sk P I"' K r L p " F f a ` . 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N t i k i �i �' J t MT y. t � : 4' r r :m y , x $ 4 2. ,Wi " Sc S t4 t t i t i ' 5 ,a,,,S 4 M' 'P r y„ ` Y' h� :R '� y, fs i k c ' i ) 9t ?y I f x � �' � � �� R � �}` Sv I y � #x�,,��h �3�>z7, ��.�n.4' '��y�'oy '' t'i >F ,� � ,3 W r .'.: 't x y � ,n a* 1,k; -' ti '� c\t,- t4 _ tv ':F' i n..ax 1x0 Y 7 -?∎4- " Y } t t t 1 �..11t 1, h�4 a4.°� 1 ?y �a tt j , t n . .'1.}.�,.ti�: ..fin,t- tS5.#,.a, x , f : ka�S',C sl k . 4 CS a " 1 Guest: Grab & Go Breakfast 2 Guests: Pre -show (cafe seating) CONCEPTUAL DRAFT WHEELER S RESTAURANT & BAR Proposal for Wheeler Opera House Lease Spaces Round 3 March 9, 2011 Presented by: The Rieger Restaurant Group Kenichi Restaurants David Johnston Architects Caroline-Edwards Interior Design CYR Construction Company John Miller Electrical T &E Marshall Enterprises CITY OF ASPEN REQUEST FOR PROPOSALS FOR WHEELER OPERA HOUSE FIRST FLOOR LEASE SPACE ROUND 3 TABLE OF CONTENTS Section I. RESPONSES TO CONDITIONS & QUESTIONS Section II. REVISED FLOOR PLAN OPTION A Section III. REVISED FLOOR PLAN OPTION B Section IV. COCKTAIL PRICE COMPARISONS Section V. MENU • • We have the ability, willingness and enthusiasm to accommodate Council's agenda, and to promote thls historic space. For those conditions requiring additional Input, please see the outline below. 1. Acceptable, please see revised floor plan. 2. At your direction, we have moved away from providing a separate performance space. In addition, the banquet style and moveable tables of our revised layout provide a means to support programs from the Wheeler or other small scale entertainment. 3. Acceptable, a five year primary term with two option periods of five years each can be accommodated. 4. Acceptable, please see original proposal. 5. We understand that a shorter lease would result in less investment by the tenant. 6. Corporate Executive Chef, Bodhi Durant, has designed many value oriented menus for all of our locations. Our recent accolades in the Aspen limes for Best Burger, Best Bar & Best Bartender in regards to our most recent venture are testament to this, along with our recognition in the New York Times for our world class Fish & Chips. a. Our anticipated check averages are $18 for lunch service, $20 for dinner service from the lunch /bar menu, and $30 for dinner service from the entr €e menu. b. We will continue the competitive and affordable beverage pricing structure utilized at all of our restaurants. It is our practice to perform semi - annual competitive cost comparisons on both our food and drink menus. Please see attached sheet of price comparisons that we performed for our Bad Billy's concept at the start of 2011. In addition, we will offer a competitive and affordable wine program to coincide with our menu. This program will be promoted by the wine wall located between the Lounge & Dining Room, and will include select premier wines. c. Value will be maintained through experience (Le consistency, staff training, cost analysis, consumer price Index, etc.) Our goal is to offer an affordable menu in a family friendly environment. The 20+ years spent building purveyor relationships allow us to receive special value, which we in turn pass on to the customer. d. The Award Winning burger on the current Bad Billy's menu is half pound, Harris Ranch Natural, fresh, never frozen, beef. We also have the added advantage of having a multi- unit relationship with Harris Ranch. 7. Our primary objective is offering an affordable lunch menu all day and night. In addition, an affordable "higher" end menu available for dinner, with no menu items over $22. 8. Acceptable, we look forward to reviewing the proposed language. in a. V W O S . at K Z O F N i 2 t r .... G 0 et: • • IIIIWi W JL . 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WHEELER'S APPETIZERS EDAMAME w/ sea salt $4 i SPICY EDAMAME a Kenichi classic! $( CHEESY FRIES w/ melted aged cheddar $( BASKET OF ONION RINGS $g shiner bock tempura battered w/ homemade ranch FRIED PICKLES a Local fav! $g w/ homemade ranch ARTICHOKE & SPINACH DIP $9 made from scratch w/ house made tortilla chips CHICKEN STRIPS w/ homemade bbq sauce $10 CHICKEN WINGS $10 buffalo, teriyaki or sweet chili HUMMUS PLATE $10 house made hummus w/ sun -dried tomatoes, warm pita triangles, celery sticks, carrot sticks, sliced cucumber & kaiamata olives SENOR BILLY'S NACHOS $9 house made tortilla chips, pico de gallo, jalepenos, cilantro & melted aged cheddar ADD: Red Bird Natural Chicken or Beef $3 j LOBSTER & IMPORTED BRIE QUESADILLA $12 carmelized onions, mango salsa & lime crema II WHEELER'S BREAKFAST ITEMS Served all day COLORADO BLACK WALNUT WAFFLES $g Grade A maple syrup, whipped butter BREAKFAST TACOS $ (2 per order) scrambled eggs, bacon, cheese, guacamole & salsa WHEELER'S EGGS BENEDICT $10 Louis Swiss English Muffin, grilled asparagus, poached eggs, maple glazed ham 1 & rocky mountain hollandaise sauce (also available vegetarian with spinach instead of ham) SOUPS & SALADS ADD TO ANY SALAD: chicken $3 — shrimp $4 — ahi tuna $5 HEIRLOOM TOMATO GAZPACHO $10 blackened tiger shrimp & basil oil BROKEN ARROW RANCH WILD BOAR CHILI $7 slow cooked goodness!!! THREE BEAN ORGANIC CHILI $ organic vegetables & spices. slow cooked organic goodness!!! MISO CAESAR $9 organic romaine hearts, shaved parmesan & honey - samba) croutons MIXED GREENS $9 organic greens, tomato, cucumber, carrot, chic peas, sunflower seeds & honey-balsamic dressing THE WEDGE $10 iceberg, tomato, warm bacon, bleu cheese crumbles & bleu cheese dressing TACO SHELL SALAD $10 romaine lettuce, black beans, guacamole, pico de gallo, cheddar cheese, orange slices & chipotle ranch dressing GREEK • $10 romaine, feta cheese, cucumber, kalamata olives, red onion, artichoke hearts, anchovies & greek herb dressing WHEELER'S BETWEEN BREAD & MORE all sandwiches are available low -carb (no bun, wrapped in iceberg lettuce) BAD BILLY BURGER w/ fries $11 • voted best burger in Aspen 2010 Aspen Times Local's Choice Award. A half pound of Milagro Ranch locally grown, grass fed, certified humane beef on a toasted Louis Swiss locally baked bun w/ basil atoll, lettuce, tomato, onion, pickle (substitute garden burger if preferred) TOPPINGS ($1 each) Cheese: American, Cheddar, Swiss, Bleu • Grilled Onions Bacon Guacamole Mushrooms Jalapenos BBQ Sauce Add Cheese Sauce to Fries Fried Egg HOMEWRECKER w/ fries $13 bad billy burger w/ fried egg, grilled onions, cheddar cheese & bacon BLACKENED CHICKEN SANDWICH w/ fries $11 red bird natural chicken, lettuce, tomato, onion & pickle, on grilled bun w/ basil aioli add any topping from above ASIAN SLOW COOKED "FALL OFF THE BONE" BABY BACK RIBS $12 hoisin, plum wine & brown sugar bbq sauce ORGANIC GRILLED VEGETABLE & HAYSTACK MOUNTAIN GOAT CHEESE SANDWICH $11 i (Boulder Produced) served warm with organic herb aioli, caramelized sweet onions, beefsteak tomatoes & Louis Swiss focaccia STEAMED PEI MUSSELS $10 roasted poblano cilantro butter, white wine, garlic, shallots & lime HAWAIIAN MAHI MARI SANDWICH w/ fries Si 1 pineapple hoisin chutney & asian slaw on toasted bun BODHI'S MINI TUNA TACOS local fav $11 (3 per order) blackened ahi tuna, guacamole, sriracha, asian slaw & mixed green salad ADD A TACO $3 SHINER BOCK FISH & CHIPS $11 tempura beer battered atlantic cod & house made tartar sauce WHEELER'S • KENICHI NOODLES & PASTA MAC & CHEESE $4 / $6 w/ house made aged cheddar cheese sauce KENICHI WIDE NOODLES &'VEGGIES $11 CHOOSE: Red Bird Natural Chicken, Shrimp or Tofu CHOOSE: Pineapple coconut red curry, Sweet chili, Teriyaki PENNE PASTA w/ garlic toast $11 home made marinate or herb, garlic & olive oil ADD: meatballs $3 — mushrooms $2 — red bird natural chicken $3 — shrimp $4 DAILY SPECIALS RED BIRD CRISPY COLORADO FRIED CHICKEN $12 sweet potato fries & honey drizzle MILAGRO RANCH MEATLOAF $12 mashed potatoes, gravy & green beans CHICKEN FRIED STEAK $12 country gravy, mashed potatoes & sauteed asparagus • SMOTHERED PORK CHOP WITH THYME $12 sauteed mushrooms, crispy bacon & herb roasted potatoes SENORBILLIOS GRINGO TACOS $12 CHOOSE: Red Bird Natural Chicken, Beef or Fish) refried beans, spanish rice, salsa, sour cream & guacamole HARRIOT'S SPINACH & RICOTTA SAUSAGE LASAGNA $12 (also available in a vegetarian version) garlic bread & mixed green salad BRAUDIS' SLOW COOKED SUPER TENDER POT ROAST $12 mushroom gravy, roasted potatoes, carrots & onions BAKED ZITI $12 homemade marinara sauce, Italian sausage, fresh basil & ricotta cheese WHEELER'S DINNER MENU RED BIRD NATURAL HERB ROASTED CHICKEN $19 butternut squash puree, caramelized brussel sprouts & pan jus PAN SEARED ROCKY MOUNTAIN TROUT $19 saffron wild rice pilaf, garlic sauteed spinach, citrus honey drizzle & Chefs Farms (local) micro greens DUCK LEG CONFIT $20 parsnip puree, mustard greens & dried bing cherry syrup PECAN CRUSTED SOFTSHELL CRAB $22 shrimp etouffe, Creole fat free "bearnaise sauce ", Chefs farms (local) micro greens MUSHROOM, SUASAGE & BASIL STUFFED DOUBLE BONE PORK CHOP $21 . creamed Olathe sweet corn, roasted yams & pan gravy BLACKENED PORTERHOUSE STEAK $22 caramelized shallots, yulcon gold potato puree & crispy onions POMEGRANATE GLAZED GRILLED COLORADO LAMB CHOPS $22 sauteed asparagus, rosemary roasted potatoes & red wine reduction CRISPY SCOTTISH SALMON $22 truffled risotto w/ porcini mushrooms & balsamic drizzle DESSERTS PAONIA PEACH BREAD PUDDING $7 organic berries, ginger creme anglaise & whipped cream TRIPLE CHOCOLATE THREE LAYER CAKE $7 dark, mills & semi -sweet chocolate with palisade cherry compote PINEAPPLE UPSIDE -DOWN CAKE $6 GRANDMA WHEELERS WARM CHOCOLATE CHIP BROWNIES $7 hot fudge sauce, caramel drizzle & toasted walnuts MANGO CREME BRUME $6 Alameda (Vanilla, coffee or chocolate ice cream) $3 BANANA SPLIT $g HOT FUDGE SUNDAE $6 WHEELER'S KIDS MENU HOT DOG $4 grilled 'A lb all beef MILAGRO RANCH SLIDER $3 mini burger w/ cheese GRILLED CHEESE $4 american, swiss or cheddar BUTTER NOODLES $4 w/ parmesan cheese CHICKEN FINGERS $4 (2 per order) FRENCH FRIES $3 DRINKS $3 soda, juice, hot chocolate or cider BROWNIE SUNDAE $5 w/ vanilla ice cream, chocolate sauce, caramel sauce, whip cream & cherry { UTECITY/SYZYGY PROPOSAL ROUND 3 • We believe that the retail space is a critical component for the Wheeler space. Retail can afford a much higher rental component than restaurants. We will also try to allow for mare than 500 sq ft with our design if possible. • Small scale entertainment that works with the Wheeler events would be welcomed. • 5 yr terms are workable • We maintain our lease structure of $10,000 a month, $120,000 a year. We would not desire to start the 8% kicker until our third year of operations. When a new restaurant opens, if everything is done correctly, a "honeymoon" effect takes place. The honeymoon period varies in time and season, the second year can actually dip from the first. With this in mind, we would like to not start the 8% until the third year, just in case a shortfall is encountered the 2nd year. • City participation would be imperative with a Syr lease. Some of the items we would like to discuss are kitchen equipment, bathroom build out and handicap lift. • As we have already shown with Ute City, our price point is primarily $15 -$25, we can produce a quality product at a reduced price. Our price range at Syzygy is $22 -$45. We give same attention to detail at Ute City as at Syzygy. Our price point for the Bentley's will be between $10 -$20, there may be a couple of items higher than this range but only for a product that is considerably more expensive to us i.e.: different cuts of steak, maintaining a similar item within our price range. Our check averages for lunch $12.50, which very closely resembles the current operators average, and dinner $30. Our dinner average reflects adult customer eating and drinking habits, it is not intended to include family dining. We will have a very kid friendly menu and pricing available all day long. We intend to maintain a good selection of beers on tap, beer on tap is less expensive than bottled or cans also greener, our wine by the glass will be value and flavor oriented as will the wine list and the liquor selection will be varied without being expensive. As to the hamburger question, well, the quality vs quantity battle begins. A cheap burger can be sold anywhere, anytime, but after eating said burger would you eat it again and how do feel an hour later. We're not trying to push for an expensive burger; however food of any type cannot be measured by price alone. • We mentioned before that a bar menu would be part of our program • It would be impossible to set a menu and it's pricing in stone! Many products that are essential parts of a menu have fluctuations that soar beyond CPI i.e.: meat, poultry, fish, corn, wheat, tomatoes, fresh fruit, and orange juice. Unless the powers that be, would prefer everything to come from a can or a freezer this thinking is absurd. If the price of meat increases by 30% this will not be reflected by the CPI enough to maintain a form of profitability, this is not a bad word. With this in mind, we would not have thrown our hat in the ring if we did not believe that we could not only provide a quality product at a great price but profit from our labors. We believe that the Bentley's space deserves a new lease on life and we are prepared to make that happen.