Deference to operational or engineering expertise is considered critical for maintaining safety in many industries. At the same time, legitimating specialized knowledge can help create "prima donnas," expert operators who attain considerable organizational status and informal power. Safety can be used as a lever to gain industrial advantage or maintain inequitable perquisites. This paper first considers the common consensus about the need to defer to expertise in safety-critical organizations and industries and assesses available research on the relationship between deference to expertise and safety. Then, it reviews two psychological literatures that illuminate some of the cognitions, behaviors and organizational dynamics behind a prima donna syndrome: one on entitlement and another on organizational narcissism. Conclusions and recommendations center on how to defer to expertise (not necessarily experts) while dealing with "prima donnas."