The state eugenic sterilization program spent its last years in a private struggle to change its course away from a pattern of operations ordered without proper consent, ones performed on children and ones based on flawed IQ testing.

More than 1,400 documents released last week to the Winston-Salem Journal tell for the first time the story of the end of the Eugenics Board of North Carolina, which ordered the sterilizations of more than 7,600 people, often young women living in poverty, from 1929 through 1974. It continued to order the operations through its last years, but reforms advocated by some board members might have spared Elaine Riddick Jessie of Atlanta, who was sterilized in Chowan County in 1968 when she was 14, as well as hundreds of others. "It was just too late," said Jessie, who was sterilized shortly after the birth of her first and only child. "The damage had been done."

Almost 35 years later, Jessie finally has the chance to talk to state officials about what happened to her. A committee appointed by Gov. Mike Easley to consider reparations and other methods of compensation for those sterilized wants to hear from her and as many of the others as it can. The Eugenics Study Committee held its first meeting Thursday.

Easley apologized for the program in December in response to a Journal investigation, and widespread news coverage has followed.

But it attracted little attention in 1974 as the N.C. legislature moved to end the program. The law ending it didn't take effect until 1975. Even in the last year there was no public acknowledgement from Gov. Jim Holshouser and no explanation from the board to those it had sterilized in a relatively routine fashion, with little direction but to sterilize as many as possible - until its last years.

"These things that we do come in on kitten's feet," said Wade Smith of Raleigh, a former state representative who worked on a bill that was instrumental in disbanding the board. "They come in and we're hardly aware that they're going on. We should be aware that they're going on."

Some who served on the five-member eugenics board were happy it was over.

"I just know I was glad to be off that thing," said Bonnie Allred of Raleigh, who represented the state director of social services on the board during its last days. "I just didn't want to participate in something like that. It was sort of like playing God."

Turning the tide

Allred is one of the few former members who will talk publicly about the board's work. Of the former members still alive, others say they remember little of it, or that they don't want to talk about it.

Allred, like many who served on the board, attended only a few meetings, acting on orders from her boss. Seasoned agency heads also served.

The board was part of the Department of Public Welfare, and its members were not appointed by governors. Instead, state law set the membership at one representative each from the attorney general's office, Dorothea Dix Hospital, the state Department of Public Health, the state Department of Mental Health and the state Department of Public Welfare (later the state Department of Social Services).

The board met monthly in Raleigh to consider petitions for sterilizations from social workers statewide, rapidly reading brief case descriptions and usually voting to sterilize. Dedication on the part of the members was sometimes lacking, according to one of the documents released by the N.C. State Archives in Raleigh.

"The members are all busy with their own work," Ellen Winston, a board chairwoman, wrote in a 1955 memo. "They, therefore, have little opportunity to give thought to their responsibility to this other important program."

In other documents, board members speak of their dedication to a program inspired by the eugenics movement, which made exaggerated claims that mental illness, genetic defects and social ills could be eliminated by sterilization. Some members occasionally voiced opposition to the program, but that was rare until 1970. The new decade dawned with a growing awareness of civil rights, particularly the rights of women and blacks - who by then made up the majority of those sterilized. There were other changes as well.

To the public, eugenics board members continued to say only positive things about their work. The documents released last week tell a different story.

"With the liberalization of sterilization and abortion laws and recent developments in contraceptive measures and their increasing availability, we feel that many cases coming before the board could be handled in the community through existing laws and resources," Clifton Craig, a board chairman, wrote in a 1970 letter.

By the next year, he was proposing something more radical. "It continues to be my belief that the Eugenics Board is outmoded in law and operation and that new laws must be adopted," he wrote in a letter to his fellow board members. Craig, who was also the head of the state department of social services, wrote that several organizations "are expressing concern over the present Eugenics Board and the laws relating thereto."

Among those groups, he wrote, were the N.C. Medical Society and the Human Betterment League - an organization based in Winston-Salem that had been created to promote the sterilization program and spent its last years touting birth control.

Almost every other state had ended or sharply cut back their sterilization programs right after World War II. Even in their attempts to reform North Carolina's program, Craig and some of his fellow board members were decades out of step with science and social policy.

Yet rather than resign his seat, Craig stayed on the board, trying to change it from within.

Under his leadership, the board continued to order sterilizations, but at a slower rate. At a June 1972 meeting, it ordered five operations and turned down petitions for two others. But at the same meeting, it adopted several policies that would limit the sterilizations it had once ordered freely.

"Alternatives to surgical sterilization such as oral contraceptives and intra-uterine devices should be considered and reasons why such measures are inadequate or inappropriate should be noted in the material presented to the Eugenics Board with a petition for sterilization," according to minutes from that meeting. In a sense, the board was returning to its roots. In the 1930s, members had a flurry of correspondence with a New York agency that promoted birth control. Yet the board never embraced that idea, focusing instead on sterilization.

At the June meeting, the board also mandated that "approval for sterilization will be granted only rarely when the patient or family opposes the procedure" and that social workers produce more documentation to support their petitions for sterilization. "There must be actual indications that conception is a likely possibility," it said.

The board ruled that "IQ alone is at times a questionable indication of mental retardation. A request for sterilization based on IQ alone, especially when the figure is over 55, indicates the need for further evaluation."

The policy changes made concrete a direction that the board had been taking since 1970. Since then, it had been routinely turning down petitions for reasons of questions on IQ, other options and lack of documentation, as well as because those targeted for sterilization were too young. And although the board had long relied on summaries that condensed the lives of those to be sterilized down to a page, it now asked for "photocopies of all material presented with petitions." Those decisions came too late for Jessie and others like her. Just a few years earlier, Jessie had been sterilized after board members read a few paragraphs that included lines about "reports of her running around" and a listing of her IQ as 75. She never got a chance to be heard by the board and her father, a shell-shocked alcoholic, signed the consent form for her operation.

A slower pace

The policy changes caused dissent among many social workers who had grown accustomed to having most of their petitions approved. "I have already felt the rumblings of dissatisfaction from all directions regarding the number of negative decisions being made by the Board," June Stallings, an executive secretary for the board, wrote in a 1971 memo.

Incoming petitions slowed, and so did the approval rate of those petitions. In 1971, the board considered 165 petitions and approved 106. In 1973, it looked at 47 petitions and approved 19, according to board documents.

A July 1973 meeting in which two sterilizations were approved and five turned down was typical. "Due to the patient's youth and the absence of positive evidence that sexual involvement exists, temporary contraceptives were recommended," read one of the rejected petitions.

At a meeting in September 1973, all four petitions presented were either delayed or denied, including one recommending a castration. "It was brought out that recent behavioral research indicates that castration does not necessarily inhibit the sex drive," according to minutes from the meeting.

And at a December meeting, a petition was denied because of "research findings that a high percentage of individuals afflicted with mongolism are naturally sterile. They (board members) believe the chances of Miss -- becoming pregnant are very slim and that surgical sterilization is not justified."

But the board continued to approve petitions for women with mental illness or extremely low IQs who were at risk of geting pregnant. In doing so, it held to a program that had been abandoned decades earlier in most other states.

Critics who took on the eugenics board weren't interested in its efforts at reform, if they even knew about them. Nial Cox Ramirez, who had been sterilized in Washington County in 1965, filed the first federal lawsuit against the board, seeking $1 million in damages. Jessie also filed suit against the board. Both suits would fail, but they led to some public scrutiny of the state's eugenics program. And in 1973, Caspar Weinberger - the secretary of health, education and welfare under President Richard Nixon - issued a memo to state officials that "directed a review of guidelines in order to protect rights of individuals in cases of sterilization."

Here, eugenics board members talked to the N.C. Attorney General's office about revising the state law on sterilization.

Yet ultimately, the end of the board came from outside. Action by the legislature abolished the board and gave district court judges the power to order sterilizations.

Stallings, the board's executive officer, praised the action in an April 1974 memo to board members: "Perhaps you have already heard the good news that 'our' legislation was enacted."

Renee Hill, the chairwoman of the board (by then called the eugenics commission), also approved. "The Commission has been actively involved since 1970 in efforts to bring revisions to these laws and is quite pleased with the outcome," Hill wrote in a memo.

Smith, the former state representative, said that he couldn't remember any members pushing to end their board, but it's likely that was the case.

"I don't get an awful lot of credit," said Smith, now a prominent trial lawyer in Raleigh. "I get some. But I think there must have been lots and lots of people working on this, providing the leadership, and I would just be one of those people who were involved."

One can assume, he said, that there were courageous people on the board doing their best to change it. "I'm assuming that if they stepped down completely, there were certainly people out there who would have believed in this, who would have occupied those seats on the board."

It's hard to know what to do in such a situation, he said. "I think the easier thing to do would be to resign and say, 'I'll have no part of this.'"

Jessie would have preferred that course of action. "They should have just walked away," she said. "It just was something they should not have done, period."

'I want to know why'

By the eugenics board's last year, Craig had left, having retired from the department of social services. He died in 1986.

Allred, who went to a few board meetings in 1974 before becoming a member, said she had never even heard of the program until then.

The few meetings she went to made her uncomfortable, Allred said. "In one sense … I felt like it was the right thing to do. In another sense … it made you feel inner-conflicted.

"Had it continued, I would not have stayed on the board.… I was just not comfortable making those decisions for people."

By then, the pace of the board had slowed even more. It didn't meet at all in January or February 1974 because it had received no petitions for sterilization, letters to members state.

Allred was at one of the last meetings of the board in October 1974. Other members shared her relief that the program was ending, she said.

"My best memory is they seemed to behave as if they were glad it was over. It's just not a pleasant thing to serve on."

That day, the board ordered sterilizations on two more people. They were among the last of generations sterilized through the program. The two ordered sterilized vanished into history, their names withheld for reasons of medical confidentiality. Almost 30 years later, they, just like Jessie, could use the Eugenics Study Committee as a forum to talk about what happened to them.

Jessie looks forward to telling her story. "I want to know why.… I want to know if they (the eugenics board members) would have done it to themselves and some of their family members."

• The biennial reports from the Eugenics Board of North Carolina and its handbook will be available online beginning Monday at the State Library Web site: http://statelibrary.dcr.state.nc.us

• Victims and their families who want to get involved withthe committee on the state's sterilization program can call Care-Line, an information and referral service of the N.C. Department of Health and Human Services, at (800) 662-7030.

• John Railey can be reached at 727-7288 or at jrailey@wsjournal.com
• Kevin Begos can be reached in Washington at (202) 662-7672 or at kbegos@mediageneral.com
• Danielle Deaver can be reached at 727-7279 or at ddeaver@wsjournal.com

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