Kudos for your Nov. 20 editorial on the devastating impact of rising malpractice insurance premiums and defensive medicine costs on the North Shore Birth Center and other medical facilities in Massachusetts.

("Birth Center's problems highlight need for tort reform").

Defensive medicine is not just a problem in Massachusetts. Nationwide the cost of such unnecessary procedures exceeds $124 billion annually.

The Bay State's poor tort rules have allowed this medical crisis to fester. Massachusetts is classified as a "sinner state" in the Pacific Research Institute's 2008 U.S. Tort Liability Index, a study I co-authored, due to its high tort costs and outsized litigation risks.

State policymakers must enact common-sense, meaningful tort reforms if they hope to keep medical facilities open, physicians practicing, and health care affordable.

LAWRENCE J. MCQUILLAN Ph.D.
Director, Business and Economic Studies
Pacific Research Institute
San Francisco, Calif.