The Changing Structure of Opportunity: Recruitment and Careers in Large Law Firms

Growth and bureaucratization have begun to transform patterns of recruitment and career development in large law firms. Based on a case study of four large Chicago firms, this article examines these changes and their implications. The findings indicate that the social composition of large firms has become substantially more heterogeneous with respect to the status of law school attended, gender, and ethnoreligious background. However, data on lawyers' careers suggest that associates entering firms today face an increasingly bureaucratic organizational context marked by higher levels of turnover, earlier and more intensive specialization, decreased levels of client responsibility, and more frequent assignment to large-scale litigation. The article also addresses the dynamics of individual choice over type of work performed in firms. Lawyers initially working in litigation fields are far more likely to change fields of practice than are lawyers who begin in office practice fields, reflecting the increased tendency for firms to assign new associates to litigation as well as the alienating propensity of large-firm litigation for many associates. Paradoxically, a greater proportion of lawyers in traditionally organized, general service firms than in bureaucratically organized, specialty firms report that their choice of work was dictated by the firm. Also, somewhat surprisingly, the frequency with which firms explicitly direct lawyers into particular fields has not increased from earlier periods. The article concludes that these anomalies result from the fact that firms control the career choices of lawyers, and always have, but that the way such control is exercised varies across firms and historical periods.     

Private Representation in Washington: Surveying the Structure of Influence

Despite the significance of interest representation to theories of law and politics, the social organization of interest representation has not received systematic empirical analysis. Based on interviews with 776 individuals engaged in the representation of private interests concerning national policies on agriculture, energy, health, and labor, this article reports some findings concerning the social and political characteristics of representatives, the nature of their work and their relationships with client organizations. Three models of the social organization of interest representation are developed and examined: a model based on substantive expertise, an institutional targets model, and a client-based model. The findings indicate that representation is predominately organized around client interests Although lawyers constitute a significant and distinctive group among representatives, they are neither as numerous nor as active in policy making as is commonly assumed. The analysis suggests that representatives are not likely to exercise influence in the policy-making process that is autonomous from client organizations.     

Accurately assessing elderly fall deaths using hospital discharge and vital statistics data

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states.This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD.Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.     

Massive systemic silicone embolism: a case report and review of literature

Subcutaneous injections of inert or quasi-inert plastic material designed to smooth out wrinkled skin or to create a more esthetically sought appearance have become very popular with the American public in general, and, in particular, with certain groups highly focused on their physical image. The case of the injection procedure has attracted into the field of plastic medicine a substantial number of illegal, incompetent, and unscrupulous operators. Their ignorance of involved medical risks and procedures not uncommonly results in severe complications, disfigurement, and death of patients. We report the typical pathological and chemical findings of a systemic fatal silicone embolism in a 53-year-old heterosexual woman following illegal chronic injections of silicone in her hips and buttocks. The injected subcutaneous silicone apparently migrated rapidly from the interstitial subcutaneous tissue into the general blood stream resulting in a fatal systemic silicone embolism. An analysis of the presented case in conjunction with a review of the pertinent medical literature, including a recent article, revealed a marked similarity in the clinicopathologic findings between silicone embolism and fat embolism.