[Medical Delegation to Physician Assistants (PAs): Organizational Liability as the Primary Risk in Borderline Cases]

The delegation of medical tasks to Physician Assistants (PAs) is legally permissible in Germany but subject to clear limitations. Potential risks arise particularly from organizational deficiencies.Two fictitious clinical case vignettes are used to analyze liability-relevant situations in which delegation decisions resulted in complications.Case 1 illustrates the risks associated with delayed physician oversight following PA-conducted examinations. Case 2 highlights the legal consequences of inadequately regulated invasive procedures. Both examples demonstrate that primary risks arise mainly from missing standard operating procedures (SOPs), unclear supervision structures, and insufficient documentation.Tasks legally reserved to physicians cannot be delegated. For delegable activities, civil and criminal liability requirements apply to physicians, PAs, and, in particular, to healthcare organizations. Ensuring patient safety requires not only individual responsibility but also clearly defined organizational structures.