What happens if I disagree with the guardian’s medical decisions for my child? – North Carolina

Short Answer

In North Carolina, when a court-appointed guardian has authority over an adult child who has been found incompetent, that guardian generally controls medical decisions within the powers the court granted. If a parent disagrees with those medical decisions, the usual remedy is to ask the Clerk of Superior Court (the guardianship court) to review the guardian’s actions, limit the guardian’s powers, or replace the guardian. If there is an urgent safety issue, a parent can also ask the court for faster, emergency relief.

Understanding the Problem

In North Carolina guardianship cases, can a parent challenge a third-party guardian’s medical decisions for an adult child who is under a court-ordered guardianship? If the guardian and caregivers appear to be making choices that do not match the adult child’s needs, the decision point is whether the disagreement is serious enough to bring the issue back to the guardianship court to change the guardian’s authority or change who serves as guardian.

Apply the Law

North Carolina treats an adult who is under a guardianship as an “incompetent adult” for purposes of Chapter 35A, and the guardian’s power depends on the type of guardian appointed and the specific powers listed in the court order and letters of guardianship. A guardian of the person (or a general guardian) typically has authority to make health care decisions, but the guardian must act in the adult child’s best interests and within the limits set by the court. Disagreements about medical care are usually handled by filing a motion or petition in the guardianship file with the Clerk of Superior Court, asking the Clerk to review the decision, clarify authority, limit powers, or remove and replace the guardian.

Key Requirements

Standing and proper forum: The challenge is typically made in the existing guardianship case before the Clerk of Superior Court who supervises the guardianship.
Grounds tied to the guardian’s duties: The request should focus on whether the guardian acted outside the court-granted authority, failed to act in the adult child’s best interests, or failed to carry out required duties.
Evidence and a workable alternative: The court usually needs specific facts (records, timelines, provider notes, care plans, witness statements) and a clear request (for example, limit medical decision-making, require a second opinion, or appoint a different guardian).

What the Statutes Say

N.C. Gen. Stat. § 35A-1208 (Authority for health care decisions) – Addresses a guardian’s ability to seek an order affecting a health care agent’s authority and limits what a guardian can do regarding certain health care declarations.
N.C. Gen. Stat. § 35A-1212.1 (Parent’s written recommendation of guardian) – Allows a parent to recommend a guardian and desired limits on powers; the Clerk treats the recommendation as a strong guide but still decides based on the adult child’s best interests.

Analysis

Apply the Rule to the Facts: Here, the adult child already has a court-ordered guardianship managed by a third party and/or contracted service provider, and the parent believes the guardian and caregivers are not acting in the adult child’s best interests. Under North Carolina practice, that disagreement does not automatically transfer decision-making back to the parent; instead, it usually triggers a return to the Clerk of Superior Court to ask for court review of the guardian’s conduct and medical decision-making authority. If the parent can show specific decisions that appear inconsistent with the adult child’s needs or the court’s order, the Clerk can consider limiting powers, ordering safeguards, or changing the guardian.

Process & Timing

Who files: Typically the parent or another interested person in the guardianship. Where: The Clerk of Superior Court in the county where the guardianship is filed in North Carolina. What: A motion or petition in the guardianship file requesting review of medical decisions and/or removal, limitation of powers, or substitution of the guardian (the exact form and caption can vary by county). When: As soon as the disagreement involves a significant medical decision or an ongoing pattern that may harm the adult child’s welfare; emergency requests may be appropriate when time-sensitive treatment is involved.
Notice and hearing: The Clerk typically schedules a hearing and requires notice to the guardian and other required parties. The parent should be prepared to present medical records, communications, and specific examples tied to the guardian’s duties and authority.
Order and follow-through: If the Clerk finds a problem, the Clerk may clarify or limit the guardian’s authority, require additional oversight steps, or appoint a different guardian. Any new order should be shared with medical providers and care facilities so they follow the updated decision-making authority.

Exceptions & Pitfalls

The guardian’s powers may be limited (or broader) than expected: Some guardians have authority over the person, some over the estate, and some are general guardians. The court order and letters of guardianship control who can consent to treatment.
Health care agents and prior documents can complicate authority: If the adult child signed health care documents before being found incompetent, the guardian’s authority may interact with those documents. North Carolina law allows a guardian to ask the Clerk to suspend a health care agent’s authority in certain situations, but the guardian cannot simply undo every prior health care declaration.
Vague complaints rarely move a case: “Not acting in best interests” is more persuasive when tied to dates, providers, diagnoses, discharge plans, medication changes, refusal of recommended care, or failure to obtain needed care.
Focusing only on disagreement (instead of harm or authority) can backfire: The court usually looks for whether the guardian acted outside authority or failed duties, not whether a parent would have chosen differently.
Placement and medical care are often linked: If the goal is a return to the parent’s care, the request should address both medical decision-making and the practical care plan (appointments, transportation, supervision, home supports), because the court will consider whether the proposed change protects the adult child’s welfare.

Conclusion

In North Carolina, a court-appointed guardian generally controls medical decisions for an adult child under guardianship, within the powers the court granted. If a parent disagrees with those decisions, the remedy is usually to return to the Clerk of Superior Court to ask the court to review the guardian’s actions and, if appropriate, limit the guardian’s powers or replace the guardian based on the adult child’s best interests. The most important next step is to file a motion or petition in the guardianship case promptly when a major or time-sensitive medical decision is involved.

Talk to a Guardianship Attorney

If a third-party guardian is making medical decisions for an adult child and those decisions appear inconsistent with the adult child’s best interests, our firm has experienced attorneys who can help explain the court process, gather the right records, and present a clear request to the Clerk. Call us today at (919) 341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.