State Medical Board: Physician Assistant Failed To Meet Standards Of Care - JoCo Report

RALEIGH, N.C. — A physician assistant has been reprimanded by the North Carolina Medical Board following an investigation into prescribing practices, patient monitoring failures, and inadequate medical documentation involving multiple patients, including one who later died from an overdose. According to a consent order approved April 20, the board reprimanded James John Rapalje, P.A., of Benson, N.C., who had practiced in Fayetteville and has held a North Carolina physician assistant license since 1976. The investigation centered heavily on one long-term patient treated between 2018 and 2024 for attention deficit disorder and anxiety. Rapalje prescribed Xanax, a benzodiazepine, and Adderall, a stimulant medication, during that time. The medical board said Rapalje failed to perform pill counts, drug screenings, or routinely check the North Carolina Controlled Substances Reporting System despite signs of possible drug diversion. The patient later died from an overdose. Toxicology testing reportedly detected illicit drugs but did not detect the prescribed benzodiazepine medication. According to the consent order, Rapalje failed to document formal diagnostic assessments or ongoing evaluations while continuing long-term prescriptions for benzodiazepines and stimulants. The board also found Rapalje failed to properly monitor patients for dependence, misuse, adverse effects, or overdose risk and did not adequately document counseling patients about the dangers of long-term benzodiazepine use. The consent order identified additional deficiencies involving four other patients. In several cases, Rapalje prescribed benzodiazepines as a first-line treatment without attempting alternative therapies. In two cases, narcotic pain medications were prescribed alongside benzodiazepines without proper documentation of risk assessments or alternatives. One patient being treated for multiple myeloma and chronic pain received oxycodone prescriptions, but the board found there was no documentation showing reassessment of opioid effectiveness or monitoring for misuse and adverse effects. The board also found Mr. Rapalje was being supervised by his son, a physician practicing in Vermont but also licensed in North Carolina. Investigators concluded the supervising physician did not provide meaningful oversight, particularly involving patients receiving opioid therapy. Rapalje inactivated his physician assistant license on Feb. 9, 2026, according to the board. Under the consent order, Rapalje admitted his conduct constituted unprofessional conduct under North Carolina law and waived his right to a hearing or appeal. The name of the medical practice where Rapalje worked was not disclosed in the public filing. The reprimand is now part of the public record and will be reported to national medical disciplinary databases, including the National Practitioner Data Bank.