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

Key Points:

• The North Carolina Medical Board reprimanded physician assistant James John Rapalje for improper prescribing practices, inadequate patient monitoring, and insufficient documentation, involving multiple patients including one who died from an overdose.
• The investigation focused on a long-term patient treated for ADHD and anxiety from 2018 to 2024, where Rapalje prescribed Xanax and Adderall without conducting pill counts, drug screenings, or consistently checking the Controlled Substances Reporting System.
• Rapalje failed to document formal diagnostic assessments, monitor patients for dependence or overdose risk, and provide adequate counseling on the dangers of long-term benzodiazepine use.
• Additional deficiencies included prescribing benzodiazepines as first-line treatments without trying alternatives, co-prescribing narcotics and benzodiazepines without proper risk assessments, and inadequate monitoring of opioid effectiveness and misuse.
• Rapalje’s supervising physician, his son, was found to have provided insufficient oversight, especially concerning opioid therapy, and Rapalje voluntarily inactivated his license in February 2026, admitting to unprofessional conduct and waiving his right to a hearing.