IN THE COURT OF APPEALS OF NORTH CAROLINA
No. COA25-577
Filed 20 May 2026
Guilford County, No. 23JA000599-400
IN THE MATTER OF: K.R.
Appeal by Respondent-Mother from orders entered 16 August 2024 and 14
March 2025 by Judge Ashley Watlington-Simms and Judge Angela C. Foster,
respectively, in Guilford County District Court. Heard in the Court of Appeals 10
February 2026.
Mercedes O. Chut, for Petitioner-Appellee Guilford County Department of Social Services.
Reeves Dienere & Wright, by Anne C. Wright, for Respondent-Appellant-Mother.
Administrative Office of the Courts, by Attorney Brittany McKinney, for the Guardian ad Litem.
CARPENTER, Judge.
Respondent-Mother appeals after a trial court adjudicated her son, Kayden,1
neglected and dependent. On appeal, Respondent-Mother argues that the trial court
erred by: (1) adjudicating Kayden as neglected; (2) adjudicating Kayden as
dependent; (3) appointing a Rule 17 Guardian ad Litem (“GAL”) for Respondent-
1 Pseudonyms are used to protect the identity of the juvenile and for ease of reading. See N.C. R. App. P. 42(b) (2025). IN RE: K.R.
Opinion of the Court
Mother; and (4) excluding Respondent-Mother’s hospital medical records. After
careful review, we affirm.
I. Factual & Procedural Background
After a hearing on 16 August 2024, the trial court entered an order that day
adjudicating Kayden as neglected and dependent. After a hearing on 8 November
2024, the trial court also entered a disposition order on 14 March 2025. Evidence
from the hearings tended to show the following.
Kayden was born in September 2023. While at the hospital, the Alamance
County Department of Social Services notified the Guilford County Department of
Social Services (“DSS”) that Respondent-Mother wanted to leave with Kayden, who
was experiencing breathing problems, against medical advice. The doctor eventually
convinced Respondent-Mother to keep Kayden in the hospital.
On 26 September 2023, DSS met with Respondent-Mother at the hospital.
Respondent-Mother said that she was facing eviction, but she was working to secure
pro bono representation to contest it. Respondent-Mother told DSS that she had a
hotel room nearby to wait for Kayden’s discharge, but she refused to share the
specifics. Respondent-Mother also stated that she suffered from depression and
anxiety and shared conspiracy theories about the hospital. After forty-eight hours,
Kayden’s breathing normalized.
On 26 September 2023, DSS filed a petition alleging that Kayden was a
neglected and dependent juvenile. DSS was granted nonsecure custody of Kayden on
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27 September 2023. Respondent-Mother agreed to a case plan, which required her to
obtain and maintain stable housing, complete a parenting psychological evaluation,
undergo a mental health assessment, and participate in therapy as needed.
Respondent-Mother also gave DSS access to her mental health records and her home.
Father, who is not a party to this appeal, had not been a part of Kayden’s life and was
not involved in the care of Kayden.
Respondent-Mother gave DSS the name of a potential alternative childcare
provider for a potential dependency adjudication, but the friend told DSS that she
refused to take on that role. When DSS told Respondent-Mother of her friend’s
refusal, Respondent-Mother continued to name the friend as the alternative childcare
provider and did not suggest anyone else. According to DSS, “it appeared that there
were some mental issues or, you know, there was something going on that we couldn’t
quite put a finger on it.” Respondent-Mother revoked access to her mental health
records on 30 October 2024, limiting DSS’s ability to investigate further.
The trial court conducted a hearing and on 11 October 2023 appointed a Rule
17 GAL for Respondent-Mother. On 25 October 2023, Respondent-Mother filed a
motion to remove the Rule 17 GAL. The trial court granted the motion and appointed
an attorney to represent Respondent-Mother. After another Rule 17 GAL hearing,
the trial court appointed a second Rule 17 GAL. The trial court also allowed two
appointed attorneys to withdraw and appointed a third attorney to represent
Respondent-Mother.
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On 16 August 2024, the trial court conducted an adjudication hearing. After
DSS rested its case, Respondent-Mother moved to unseal her hospital medical
records, which she had previously subpoenaed. The trial court denied her motion.
In its adjudication order, the trial court made the following findings of fact:
8. It took great effort from the pediatrician to convince [Respondent-Mother] to allow [Kayden] to continue to be monitored at the hospital for an additional twenty-four (24) hours . . . . [DSS] diligently questioned [Respondent- Mother] to gather more information but [Respondent- Mother] would not answer any questions. The juvenile was ready for discharge, but the mother did not provide a clear explanation regarding her plan for housing. [Respondent- Mother] advised that she had a few bottles and two items of clothing, but she did not have a crib or bassinet for the baby. ...
10. [Respondent-Mother] acquired a hotel room in Greensboro, North Carolina for the night but did not disclose the location of the hotel room. She had no plan for housing moving forward. . . . [DSS] had to explain the Department’s concerns several times; however, [Respondent-Mother] only focused on Alamance County’s plan to discharge the juvenile to her.
11. [Respondent-Mother] explained that she was postpartum, experiencing a lot of emotions, wanted to experience being a mother and was unable to make any permanent decisions. [Respondent-Mother] exhibited paranoid behavior and accused the hospital of documenting inaccurate information in the patient chart. ...
25. The Court questions the logic and reasoning of [Respondent-Mother] regarding the acquisition of a hotel room due to the appointment for the minor child the following day and need to stay close. The Court takes
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notice that Alamance County is a neighboring county of Guilford County. Alamance County is in such a close proximity that it should and would not require a newborn to have to sleep in a “temporary” hotel location solely for a medical appointment scheduled for the following day especially when [Respondent-Mother] expected family from out of state to be visiting. ...
30. The Court finds that the admission of leaving a minor child in the nursery [of the hospital] due to her inability to adequately address the medical and feeding needs of the minor child after birth expresses to the court that the minor child did not receive proper care [or] supervision . . . at the time of the filing of the petition. ...
35. [Respondent-Mother] does not believe and will not admit that her decisions were not in [Kayden]’s best interest however [Respondent-Mother] acknowledges that she made some contradictory statements. The contradictory statements and unreliable statements made regarding housing, ability to feed the minor child, ability to address the medical needs of the minor child, prior mental health history of [Respondent-Mother], inability to provide alternative placement providers, inability to understand the need of alternative placement providers and verification by the Department based on the reports made to the Department have all been considered by the Court during this adjudication hearing.
The trial court also permitted supervised visitation with Kayden twice per
week for two hours.
Respondent-Mother then filed a civil suit and bar complaint against the second
Rule 17 GAL. At the disposition hearing, the trial court allowed the second Rule 17
GAL to withdraw.
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On 14 March 2025, the trial court entered a disposition order and set the
primary permanency plan for Kayden as adoption with a secondary plan of
reunification. It continued supervised visitation, finding that Respondent-Mother
“exercise[d] her visitation” and “[wa]s engaged” despite not always attending “due to
being upset with [DSS].” On 28 March 2025, Respondent-Mother filed a notice of
appeal from the adjudication and disposition orders. She also filed a petition for writ
of supersedeas, which this Court denied on 21 July 2025.
II. Jurisdiction
This Court has jurisdiction under N.C. Gen. Stat. §§ 7A-27(b)(2), 7B-1001(a)(3)
(2025).
III. Issues
The issues on appeal are whether the trial court erred by: (1) adjudicating
Kayden as neglected; (2) adjudicating Kayden as dependent; (3) appointing a Rule 17
GAL for Respondent-Mother; and (4) excluding Respondent-Mother’s hospital
medical records.
IV. Analysis
A. Initial Adjudications
Respondent-Mother argues the evidence and findings are insufficient to
adjudicate Kayden as a neglected and dependent juvenile. We disagree.
1. Standard of Review
“When reviewing a trial court’s order adjudicating a juvenile abused,
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neglected, or dependent, this Court’s duty is ‘to determine (1) whether the findings of
fact are supported by clear and convincing evidence, and (2) whether the legal
conclusions are supported by findings of fact.’ ” In re F.C.D., 244 N.C. App. 243, 246,
780 S.E.2d 214, 217 (2015) (quoting In re T.H.T., 185 N.C. App. 337, 343, 648 S.E.2d
519, 523 (2007)). “If such evidence exists, the findings of the trial court are binding
on appeal, even if the evidence would support a finding to the contrary.” In re T.H.T.,
185 N.C. App. at 343, 648 S.E.2d at 523 (citation omitted).
“Unchallenged findings of fact are deemed supported by the evidence and are
binding on appeal.” In re K.H., 281 N.C. App. 259, 266, 867 S.E.2d 757, 762 (2022)
(citation omitted). When reviewing challenged findings of fact in a juvenile order,
this Court sets aside findings “ ‘that lack sufficient evidentiary support’ and examines
whether the remaining findings support the trial court’s determination.” In re
A.J.L.H., 384 N.C. 45, 52, 884 S.E.2d 687, 693 (2023) (quoting In re A.C., 378 N.C.
377, 394, 861 S.E.2d 858, 874 (2021)).
The determination of whether a child is abused, neglected, or dependent is a
conclusion of law. See In re Ellis, 135 N.C. App. 338, 340, 520 S.E.2d 118, 120 (1999)
(citation omitted). We review the trial court’s conclusions of law de novo. In re G.C.,
384 N.C. 62, 66, 884 S.E.2d 658, 661 (2023). Under a de novo review, this Court
“ ‘considers the matter anew and freely substitutes its own judgment’ for that of the
lower tribunal.” State v. Williams, 362 N.C. 628, 632–33, 669 S.E.2d 290, 294 (2008)
(quoting In re Greens of Pine Glen Ltd. P’ship, 356 N.C. 642, 647, 576 S.E.2d 316, 319
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(2003)).
2. Neglect
Respondent-Mother asserts that the trial court’s findings failed to show
abandonment, improper care and supervision, and an injurious living environment,
and she challenges Findings 8, 10, 11, 29, and 30.
A neglected juvenile, in relevant part, is defined as:
[a]ny juvenile less than 18 years of age . . . whose parent, guardian, custodian, or caretaker . . . does not provide proper care, supervision, or discipline; has abandoned the juvenile . . .; has not provided or arranged for the provision of necessary medical or remedial care; or creates or allows to be created a living environment that is injurious to the juvenile’s welfare.
N.C. Gen. Stat. § 7B-101(15)(a)–(c), (e) (2025) (cleaned up). Only one basis is
required for an adjudication of neglect. See id.
Before adjudicating a juvenile neglected, the trial court must also find “ ‘some
physical, mental, or emotional impairment of the juvenile or a substantial risk of such
impairment as a consequence of the failure to provide proper care, supervision, or
discipline.’ ” In re Stumbo, 357 N.C. 279, 283, 582 S.E.2d 255, 258 (2003) (quoting In
re Safriet, 112 N.C. App. 747, 752, 436 S.E.2d 898, 901–02 (1993)). With newborns,
“the decision of the trial court must of necessity be predictive in nature, as the trial
court must assess whether there is a substantial risk of future abuse or neglect of a
child based on the historical facts of the case.” In re McLean, 135 N.C. App. 387, 396,
521 S.E.2d 121, 127 (1999). “ ‘It is well-established that the trial court need not wait
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for actual harm to occur to the child if there is a substantial risk of harm to the child
in the home.’ ” In re D.B.J., 197 N.C. App. 752, 755, 678 S.E.2d 778, 780 (2009)
(quoting In re T.S., III & S.M., 178 N.C. App. 110, 113, 631 S.E.2d 19, 22 (2006)).
“[F]or a court to find that the child resided in an injurious environment,
evidence must show that the environment in which the child resided has resulted in
harm to the child or a substantial risk of harm.” In re K.H., 281 N.C. App. 259, 266,
867 S.E.2d 757, 762 (2022) (citation and quotation marks omitted). “A parent’s failure
to make progress in completing a case plan is indicative of a likelihood of future
neglect.” In re M.J.S.M., 257 N.C. App. 633, 637, 810 S.E.2d 370, 373 (2018) (citation
omitted). Thus, a parent’s inability to provide stable housing in accordance with the
case plan is an important consideration in finding an injurious living environment.
See In re M.R., 381 N.C. 838, 846, 874 S.E.2d 554, 560 (2022).
Further, a parent’s mental health issues, particularly when unaddressed by
treatment, can contribute to an adjudication of neglect. See In re G.W., 286 N.C. App.
587, 595, 882 S.E.2d 81, 89 (2022). However, “[t]he causal connection between the
mental illness and the incapacity to provide proper care must be clear.” In re J.M.W.,
179 N.C. App. 788, 793, 635 S.E.2d 916, 920 (2006) (citation omitted). Thus, a
“repeated failure to comprehend and protect the children from the risks of harm to
which she exposed them” can provide clear and convincing evidence of neglect. See
In re L.H., 378 N.C. 625, 637, 862 S.E.2d 623, 631 (2021). Additionally, a parent’s
refusal to cooperate with DSS shows a substantial risk of future harm to the juvenile
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that can support an adjudication of neglect. See In re T.R.T., 225 N.C. App. 567, 572,
737 S.E.2d 823, 827 (2013).
Here, although we agree with Respondent-Mother that the trial court’s neglect
by abandonment conclusion is unsupported, there was clear and convincing evidence
that she failed to provide Kayden with the proper care or supervision and allowed the
creation of an injurious living environment. See N.C. Gen. Stat. § 7B-101(15)(a)–(b),
(e).
First, Respondent-Mother’s desire to leave the hospital with Kayden despite
his unresolved breathing problems tended to show a substantial risk of future harm.
See In re Stumbo, 357 N.C. at 283, 582 S.E.2d at 258. Although Respondent-Mother
ultimately agreed to keep Kayden in the hospital, the doctor had to convince her to
do so. Due to concerns about Respondent-Mother’s ability to care for Kayden because
of her insistence on leaving with Kayden against medical advice, the hospital involved
the Alamance County Department of Social Services. Further, there was clear and
convincing evidence that Respondent-Mother did not understand the risks associated
with Kayden’s breathing issue, the importance of additional treatment, or the reason
for DSS’s involvement. See In re L.H., 378 N.C. at 637, 862 S.E.2d at 631. These
facts tend to show a substantial risk that Respondent-Mother may disregard or not
seek necessary medical care for Kayden in the future. See id. at 637, 862 S.E.2d at
631; In re D.B.J., 197 N.C. App. at 755, 678 S.E.2d at 780.
Second, there was clear and convincing evidence of a causal connection
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between a substantial risk to Kayden and Respondent-Mother’s mental health issues
as evidenced by her revocation of consent for DSS to review her medical records and
lack of treatment. See In re D.B.J., 197 N.C. App. at 755, 678 S.E.2d at 780; In re
J.M.W., 179 N.C. App. at 793, 635 S.E.2d at 920. While Respondent-Mother shared
that she suffered from depression and anxiety, DSS had additional concerns about
Respondent-Mother’s ability to understand Kayden’s needs and her situation with
DSS. See In re J.M.W., 179 N.C. App. at 793, 635 S.E.2d at 920. Indeed, DSS believed
“there was something going on that [it] couldn’t quite put a finger on . . . .” DSS,
however, was unable to assess and recommend mental health services for
Respondent-Mother due to her having revoked consent to access to her records. See
In re T.R.T., 225 N.C. App. at 572, 737 S.E.2d at 827. Thus, Respondent-Mother was
noncompliant with her case plan, which recommended mental health assessments
and therapy. See In re M.J.S.M., 257 N.C. App. at 637, 810 S.E.2d at 373; In re G.W.,
286 N.C. App. at 595, 882 S.E.2d at 89. There was substantial cause for concern
regarding Respondent-Mother’s mental health, therefore, there was clear and
convincing evidence of a causal connection between her mental health and a
substantial risk to Kayden. See In re D.B.J., 197 N.C. App. at 755, 678 S.E.2d at 780.
Third, there was clear and convincing evidence that Respondent-Mother did
not have secure housing for Kayden. See In re M.R., 381 N.C. at 846, 874 S.E.2d at
560. Respondent-Mother was facing eviction, which meant that DSS could not
confirm that Respondent-Mother could provide stable housing for Kayden. See id. at
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846, 874 S.E.2d at 560. Thus, Respondent-Mother was not in compliance with her
case plan to obtain and maintain stable housing. See In re M.J.S.M., 257 N.C. App.
at 637, 810 S.E.2d at 373. Respondent-Mother also refused to share with DSS the
location of her hotel room during Kayden’s hospitalization. See In re T.R.T., 225 N.C.
App. at 572, 737 S.E.2d at 827. Considering Respondent-Mother’s reluctance to
continue necessary medical care for Kayden, mental health concerns, and unstable
housing, the trial court did not err in concluding that there was a lack of proper care
or supervision and that an injurious living environment existed to support an
adjudication of neglect. See N.C. Gen. Stat. § 7B-101(15)(a), (e).
3. Dependency
Respondent-Mother challenges Finding 25, in which the trial court questioned
Respondent-Mother’s decision to stay in a hotel during Kayden’s hospitalization. She
also contends that the trial court erred in adjudicating Kayden as dependent because
Respondent-Mother could provide for Kayden’s care and supervision. We disagree.
“[T]he purpose of an adjudicatory hearing is to determine only ‘the existence
or nonexistence of any of the conditions alleged in a petition.’ ” In re V.B., 239 N.C.
App. 340, 344, 768 S.E.2d 867, 869–70 (2015) (quoting N.C. Gen. Stat. § 7B-802
(2013)). During the hearing, “an important aspect of the trial court’s role as finder of
fact is assessing the demeanor and credibility of witnesses, often in light of
inconsistencies or contradictory evidence[;] . . . appellate courts may not reweigh the
underlying evidence presented at trial.” In re J.A.M., 372 N.C. 1, 11, 822 S.E.2d 693,
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700 (2019).
A dependent juvenile is defined as a:
juvenile in need of assistance or placement because (i) the juvenile has no parent, guardian, or custodian responsible for the juvenile’s care or supervision or (ii) the juvenile’s parent, guardian, or custodian is unable to provide for the juvenile’s care or supervision and lacks an appropriate alternative child care arrangement.
N.C. Gen. Stat. § 7B-101(9). A trial court cannot adjudicate a juvenile as
dependent so long as at least one parent can provide or arrange for adequate care and
supervision of the child. In re V.B., 239 N.C. App. at 342, 768 S.E.2d at 868.
Here, Respondent-Mother was unable to provide proper care or supervision.
See N.C. Gen. Stat. 7B-101(9). As explained above, there was clear and convincing
evidence that Respondent-Mother could not provide proper care for Kayden through
her disagreement with the doctor about discharge, her mental health, and her lack of
secure housing. See In re T.R.T., 225 N.C. App. at 572, 737 S.E.2d at 827; In re L.H.,
378 N.C. at 637, 862 S.E.2d at 631. Thus, even assuming Finding 25, which appears
to illustrate the trial court’s credibility concerns, was unsupported and should be set
aside, the trial court’s conclusion as to improper care or supervision remains
supported. See In re J.A.M., 372 N.C. at 11, 822 S.E.2d at 700; N.C. Gen. Stat. § 7B-
101(9).
Respondent-Mother similarly failed to show the availability of appropriate
alternative childcare. See N.C. Gen. Stat. § 7B-101(9). Respondent-Mother does not
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challenge the trial court’s finding that Respondent-Mother identified her friend, who
was unwilling to serve as an alternative childcare provider. Respondent-Mother also
does not challenge the trial court’s finding that Respondent-Mother continued to
assert to DSS that her friend was her alternative childcare provider, despite DSS
telling Respondent-Mother that her friend had declined. Moreover, Respondent-
Mother does not challenge the trial court’s finding that “there were no other viable
options or reasonable alternatives for placement at the time of the filing of the
petition.” These findings are binding on appeal. See In re K.H., 281 N.C. App. at 266,
867 S.E.2d at 762. Further, there is no other parent available to provide care for
Kayden. See In re V.B., 239 N.C. App. at 342, 768 S.E.2d at 868. Accordingly, the
trial court did not err in adjudicating Kayden as a dependent juvenile. See N.C. Gen.
Stat. § 7B-101(9).
B. Rule 17 GAL
Respondent-Mother next argues that the trial court abused its discretion in
appointing her a Rule 17 GAL because it decided twice that she did not require the
assistance of one. We disagree.
“A trial court’s decision concerning whether to appoint a parental guardian ad
litem based on the parent’s incompetence is reviewed on appeal for abuse of
discretion. In re T.L.H., 368 N.C. 101, 107, 772 S.E.2d 451, 455 (2015) (citation
omitted). “An ‘[a]buse of discretion results where the court’s ruling is manifestly
unsupported by reason or is so arbitrary that it could not have been the result of a
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reasoned decision.’ ” Id. at 107, 772 S.E.2d at 455 (quoting State v. Hennis, 323 N.C.
279, 285, 372 S.E.2d 523, 527 (1988)).
A trial court may appoint a Rule 17 GAL for an incompetent parent during
adjudicatory and termination proceedings, N.C. Gen. Stat. § 7B-602(c) (2025), upon a
“reasonable basis” that the parent is either incompetent or has diminished capacity
without the ability to adequately act in her own interest, In re P.D.R., 224 N.C. App.
460, 466, 737 S.E.2d 152, 157 (2012). A trial court, however, “should always keep in
mind that the appointment of a guardian ad litem will divest the parent of their
fundamental right to conduct his or her litigation according to their own judgment
and inclination.” In re J.A.A., 175 N.C. App. 66, 71, 623 S.E.2d 45, 48 (2005) (citation
omitted). Thus, a trial court abuses its discretion by failing to provide a party notice
and an opportunity to be heard before appointing a Rule 17 GAL. See In re A.T., __
N.C. App. __ __, 923 S.E.2d 841, 847 (2025) (citation omitted).
A parent’s legal counsel and Rule 17 GAL “serve different roles during the
termination proceeding[s].” In re A.S.Y., 208 N.C. App. 530, 540, 703 S.E.2d 797, 803
(2010). Thus, a trial court should appoint a new Rule 17 GAL after the first has
withdrawn, despite the respondent retaining independent counsel, if questions
regarding the respondent’s competency remain. See id. at 539–40, 703 S.E.2d at 802–
03.
Further, “ ‘it is generally the appellant’s duty and responsibility to see that the
record is in proper form and complete and this Court will not presume error by the
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trial court when none appears on the record to this Court.’ ” GEA, Inc. v. Luxury
Auctions Mktg., Inc., 259 N.C. App. 443, 453, 817 S.E.2d 422, 430 (2018) (quoting
King v. King, 146 N.C. App. 442, 445–46, 552 S.E.2d 262, 265 (2001)). Rather,
“ ‘where the record is silent on a particular point, we presume that the trial court
acted correctly.’ ” Id. at 453, 817 S.E.2d at 430 (brackets omitted) (quoting Granville
Med. Ctr. v. Tipton, 160 N.C. App. 484, 488, 586 S.E.2d 791, 795 (2003)).
Here, the trial court did not abuse its discretion by appointing a new Rule 17
GAL for Respondent-Mother. See In re T.L.H., 368 N.C. at 107, 772 S.E.2d at 455.
Respondent-Mother did not include a transcript of the hearing resulting in the
appointment of the second Rule 17 GAL. See GEA, Inc., 259 N.C. App. at 453, 817
S.E.2d at 430. Respondent-Mother also does not contend the trial court failed to give
her notice, and the cold record shows the trial court conducted an independent inquiry
and afforded all parties the opportunity to be heard. See In re A.T., 923 S.E.2d at
847. Indeed, despite mixed evidence on this issue, the trial court’s order indicates it
resolved material conflicts and made a reasoned decision based on its Rule 17 GAL
inquiry. See In re P.D.R., 224 N.C. App. at 466, 737 S.E.2d at 157. Presuming that
“the trial court acted correctly[,]” see GEA, Inc., 259 N.C. App. at 453, 817 S.E.2d at
430, we cannot say that the trial court abused its discretion in appointing a Rule 17
GAL for Respondent-Mother, see In re T.L.H., 368 N.C. at 107, 772 S.E.2d at 455.
C. Medical Records
Lastly, Respondent-Mother contends that the trial court erred and violated her
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due process rights by excluding her hospital medical records. Specifically,
Respondent-Mother asserts that the trial court erroneously required her to follow
certain steps for admissibility not present in Rule 803(6) and that the exclusion of her
hospital medical records was prejudicial. We disagree.
As Respondent-Mother failed to raise a constitutional objection, see In re J.N.,
381 N.C. 131, 133, 871 S.E.2d 495, 497 (2022), we review the trial court’s ruling
regarding the admissibility of evidence for abuse of discretion, see Brown v. City of
Winston-Salem, 176 N.C. App. 497, 505, 626 S.E.2d 747, 753 (2006) (citation omitted).
Under Rule 803(6) of the North Carolina Rules of Evidence, a party can
circumvent the hearsay rule and admit evidence of regularly conducted activities as
business records, including medical records. N.C. Gen. Stat. § 8C-1, Rule 803(6)
(2025). Under Rule 45 of the North Carolina Rules of Civil Procedure, however,
“[c]opies of hospital medical records . . . shall not be open to inspection or copied by
any person, except to the parties to the case or proceedings and their attorneys in
depositions, until ordered published by the judge at the time of the hearing or trial.”
N.C. R. Civ. P. 45(c)(2) (2025).
In other words, “hospital medical records” subpoenaed under Rule 45 arrive at
the clerk’s office sealed to protect confidentiality. See, e.g., Bass v. Sides, 120 N.C.
App. 485, 487–88, 462 S.E.2d 838, 840–41 (1995) (the trial court finding an attorney
violated Rule 45 by removing the medical records from the clerk’s office without the
trial court’s approval); Doe v. Doe, 263 N.C. App. 68, 79–80, 823 S.E.2d 583, 591 (2018)
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(the trial court sealing sensitive documents to protect confidentiality). Thus, before
moving to admit the hospital medical records into evidence, a party must make a
motion to unseal them. See N.C. R. Civ. P. 45(c)(2).
A timely-filed motion to unseal notifies the trial court of delivery and initiates
any additional pre-publication actions, which may include in camera review,
redaction, and distribution to the parties under a protective order. See, e.g., Sessions
v. Sloane, 248 N.C. App. 370, 382, 789 S.E.2d 844, 854 (2016) (explaining that a party
must submit a motion and request an in camera review of sealed records); Miller v.
Forsyth Mem’l Hosp., 174 N.C. App. 619, 621, 625 S.E.2d 115, 116 (2005) (Pre-
publication actions allow “the trial court to direct that the requested information be
produced under seal [from the clerk’s office] for determination . . . of relevancy or
potential for leading to discovery of admissible evidence.”); In re J.S.L., 177 N.C. App.
151, 157, 628 S.E.2d 387, 390 (2006) (determining that the trial court did not err in
admitting hospital medical records into evidence after it entered an order in
accordance with Rule 45). When a trial court grants a party’s motion to unseal, the
certified copies, “unless otherwise objectionable, shall be admissible in any action or
proceeding without further certification or authentication.” N.C. R. Civ. P. 45(c)(2).
Here, the trial court did not abuse its discretion in excluding Respondent-
Mother’s hospital medical records. See Brown, 176 N.C. App. at 505, 626 S.E.2d at
753. While medical records are generally admissible, see N.C. Gen. Stat. § 8C-1, Rule
803(6), the certified copies of Respondent-Mother’s hospital medical records were
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sealed, see Doe, 263 N.C. App. at 79–80, 823 S.E.2d at 591. Respondent-Mother,
however, did not move to unseal or otherwise raise the issue of her hospital medical
records until after DSS rested its case at adjudication. Under these circumstances,
where the first and only request to unseal occurred mid-trial, it was not arbitrary or
unreasonable for the trial court to exclude sealed records that no party had an
opportunity to review or redact. See Miller, 174 N.C. App. at 621, 625 S.E.2d at 116;
Brown, 176 N.C. App. at 505, 626 S.E.2d at 753.
V. Conclusion
In sum, we conclude that the trial court did not err in adjudicating Kayden as
neglected and dependent, appointing a new Rule 17 GAL, or excluding Respondent-
Mother’s hospital medical records.
AFFIRMED.
Judges ARROWOOD and GORE concur.
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