The Scottish Executive is investigating trusts' procedures for staff to consult with boards following the controversial amputation of healthy limbs in private operations at Falkirk Royal Hospital.
The first operation, to remove part of a leg from an English patient suffering from a psychological disorder in September 1997, went ahead after surgeon Dr Robert Smith consulted colleagues and with written permission from the then chief executive, Margaret Duffy.
But an operation on a German patient in April took place without new chief executive Jim Currie's permission.
Trust chair Ian Mullen said last week that he did not believe it was 'appropriate' for an NHS hospital 'to be importing patients' privately for such operations.
A Scottish Executive spokesperson said: 'Where the proposed treatment is in such a controversial area, and is carried out in an NHS hospital in Scotland for patients coming from overseas specifically for such an operation, we would expect the trust board to be fully involved.'