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Abstract:
Since the emergence of the university law school as the primary educator of almost all American lawyers, some members of the profession have questioned its focus as unacceptably remote from law practice. Ironically, law schools grew in prominence in the nineteenth century against a backdrop of apprenticeships with practicing lawyers in which, for a fee, the trainees read Blackstone and Coke, copied legal documents, and watched their mentor do his work. This "hands-on" training lost any attraction it may have had to an aspiring lawyer very quickly. The arrangement had a tendency to degenerate into mere drudgery in the absence of a dedicated lawyer-teacher in the role of the supervising attorney. It is not surprising, then, that when Harvard Law School in 1829 filled its prestigious Dane professorship by the appointment of United States Supreme Court Justice Joseph Story, students who could afford it preferred life in Cambridge, Massachusetts, to what was the dreary routine of the law office apprenticeship.

The education of lawyers has long been characterized by the debate about how lawyers are best trained. Is the best preparation for the true lawyer the study of the law through noteworthy case opinions as a science within the classroom, or is it through apprentice-training under the supervision of lawyers, some of whom have themselves become skilled in its actual practice? A close reading of the seminal advocates of each approach belies the simplistic aspects of such a dichotomous question. Christopher C. Langdell, the father of the modern American law school himself, speaks of legal doctrine's application to human affairs as what endows its true significance. And Jerome Frank, the eminent New Dealer and the apostle of the "law clinic," recognizes the critical role of the knowledge of legal rules and principles of opinions in a lawyer's armamentarium. Thus, any consideration of how law schools may best prepare competent lawyers must necessarily accept that the answer is a matter of balance in emphasis, and not the exclusion of either the intellectual challenge or practical experience. Both knowledge and its application are essential, although at times through the history of legal education, one or the other has taken a secondary role.

In this essay, I will address two issues that provide the context for the place of a performance test in a bar exam alongside the multi-state objective and essay form components: First, what is the significance of the implementation of the performance test as part of the bar exam? Second, will the performance test affect the way law schools prepare students to be lawyers? After all, the emergence of the Multi-State Performance Test provides the law school with yet another opportunity to reflect on how it prepares its students for the practice of law.

legal education, law school curriculum, Multi-State Performance Test, MPT, lawyer, training, preparation, legal practice

Abstract:
This article addresses a problem often faced by poor individuals who receive Social Security benefits because of an identified physical or mental disability, or both, that is so severe that it prevents such individuals from working. Despite the permanent nature of one’s disability, a beneficiary may decide at some point that he or she would like to try to work. It is this event, although not only this event, that most often triggers the problem of overpayments for beneficiaries of government disability benefits.

This article demonstrates the complex nature of the overpayment situation and how it necessitates legal representation. Hiring a lawyer, however, is virtually impossible in most cases since an overpaid benefits recipient is already in the minus column and can rarely afford representation. Thus, unlike the disability claimant who successfully seeks benefits initially and whose counsel receives at least 25% of the past-due benefits, the disabled beneficiary has the most at stake but the least ability to challenge an overpayment.

The purpose of this article is to urge greater transparency within the Social Security Administration to inform both SSD and SSI recipients of how work and other income will impact their benefits. The article also asserts that local SSA offices must be outfitted with better record-keeping techniques to ensure that recipients who report changes are credited with those reports. This article contends that part of the process is that the SSA must provide recipients with clarity of information regarding what amounts they may earn without losing their SSD benefits, and what specific income may jeopardize the benefits of SSI recipients. Local offices must assign a specific employee to handle reports of income and resources, and must encourage recipients to call this person with any questions. This employee must answer the phone, or must tell callers when they will return their calls. All of these initiatives will help prevent the eventual overpayment situation, which is both costly to the Social Security Administration and stressful to the recipient.

Social Security Administration, equity, Social Security benefits, benefits, recipients, overpayments, transparency, record-keeping, reported earnings, SSI, SSD, instances of considerable hardship

Abstract:
How common is the disruptive dialysis patient? Are outpatient dialysis centers equipped to handle such patients, especially when they only use threatening words? At what point can it be said that the involuntary discharge of such patients is warranted? What happens to these patients? If they find legal representation, under what legal authority may they continue to be treated?

This Article, originally published in the American Journal of Law & Medicine, Vol. 32, p. 53, 2006, revolves around the difficult situation of a particular patient with end stage renal disease. Although this condition is fully covered by Medicare, the patient was banned from all access to dialysis care in the outpatient setting. His caregivers regarded certain comments he made as so dangerous and threatening that he was discharged from that facility, and every other facility in his geographical area. With no options in sight, a treating hospital arranged for his care in its inpatient facility. Although the treating hospital saved his life, it was an undesirable solution for both the hospital and the patient. The patient was unable to find an outpatient dialysis home despite assurances to potential facilities that his support network would participate in his care, and despite a court's finding that he presented no danger to his current caregivers. The patient's situation only improved after he received a kidney transplant.

This Article relates the challenges of representing such a client and discusses the current debate in the dialysis industry. The Centers for Medicare and Medicaid Services' then proposed Conditions for Coverage for End Stage Renal Facilities raise the question of the need for relevant regulations to be more patient-centered. The few legal cases that have been reported concerning such plaintiffs are examined. The Article concludes that private dialysis centers should not be free to dismiss their patients from care when their "disruptive" behavior may be addressed via certain accommodations by the facilities. Involuntary discharge must not occur without strict prerequisites, such as consent by the patient's treating nephrologists and documentation of efforts to resolve the situation.

Most dialysis chains are for-profit operations with health profit margins. They are situated, owing to a regular stream of Medicare funding, to maximize the talents in each of their centers in the form of interdisciplinary staff, and to face the challenges posed by the most difficult patients. The support and direction provided by the Renal Care Networks make it possible for even the most difficult patients to be treated without jeopardizing the safety of other patients and staff. No dialysis patient should receive a death sentence.

disruptive dialysis patient, hemodialysis patients, involuntary discharge, Centers for Medicare and Medicaid Services, outpatient dialysis centers, medical ethics, legal responsibility, Conditions for Coverage for End Stage Renal Disease Facilities, End Stage Renal Disease, ESRD