The article presents a comprehensive review of the legislation and technical standards that make up the legal and organizational framework for the supervision of medical gases in hospitals. A detailed discussion of key legal acts and standards will allow for the identification of areas of responsibility and challenges related to ensuring patient and staff safety in the context of their application. The aim of this article is to show the multi-layered and often paradoxical responsibility of the manager of a healthcare facility in the face of the supervision of medical gases. Although this topic concerns highly specialized technical, pharmaceutical, legal and organizational knowledge, the ultimate responsibility rests with a person whose formal education usually does not cover any of these areas. The article analyzes the complex legal landscape regulating the trade and use of medical gases and indicates the extent to which this system places the manager in the role of a hostage to regulations, interpretations and institutional imperfections.