State Medical Board: Physician Assistant Failed To Meet Standards Of Care
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.
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What a medical professional decides to treat his patients with is between him & said patient. Law enforcement has zero business in healthcare. So what if he prescribed these medications. The practice of medicine is not one size fits all. You have no clue what the person who took those medication may have been diagnosed with.
Law enforcement needs to stay in their lane and out of exam rooms. Just wait until the dipsh*ts who will surely defend this crap are on the receiving end of law enforcement practicing medicine with a license.
Ridiculous. But bend the knee & lick those boots, sheep.
genuinely where did you get law enforcement from any of this? the order was from the NC Medical Board which a majority of the members are practicing physicians or nurses. 3 of which are normal civilians. The NCMB is what gives out licenses to all practicing physicians as well… without it then anyone could be one.
Nothing in your post is accurate.
Ah, where to start with this idiot…
1) As others have said, it is the NC Medical Board who did the investigation. Not law enforcement.
2) If an investigation was done by the board and something rose to the level of a criminal act, they are required to involve law enforcement. The article didn’t say that this happened.
3) If law enforcement did an investigation after being requested, they absolutely would know what the patient had been diagnosed with due to the paperwork that would have been provided by the board.
Seriously, you are so h*ll bent on showing how anti law enforcement you are that you don’t even understand how life works.
Did I miss something in the article? The way I read it, the Medical Board investigated the case and made the findings, not law enforcement. They are not the same.
Sounds like someone wants their benzos.
Wow can you not read? Medical board does not equal law enforcement. There are procedures and protocols for reasons.
As a retired nurse who practiced for 39 years, I completely agree. The elderly especially suffer from all this over the top regulating. Heaven forbid pain medication is prescribed for severe chronic pain. Just have to suffer. And I am well aware of the opioid crisis but that should not impede good pain management.
Having managed a medical practice for many years. Read in the article that none of the prescribed meds were in the patient’s system. This is the reason for monitoring with drug tests, etc. Most likely the prescribed meds were being sold in order for the patient to buy their drug of choice. Too much of this happens and has been happening for years.