The chief executive of Stoke Mandeville Hospital trust has been suspended and is to be investigated for waiting-list irregularities, following an independent inquiry into patients waiting more than 18 months.
The suspension of Sue Nicholls, together with two other senior managers involved in managing waiting lists, followed the completion of a district audit report into waiting-list mismanagement.
The public report was accompanied by a confidential report to the trust board concerning actions relating to the three individuals.
Ms Nicholls, who was appointed as acting chief executive last December, was moved to Buckinghamshire health authority for the duration of the review. She had previously been deputy chief executive at the trust.
Fiona Wise, who was chief executive at Enfield Community Care trust, was appointed on an interim basis from 1 April.
A total of 131 proven breaches of the 18-month waiting-time limit had been identified by the time the audit report started.
None of the breaches had been reported to regional office at the time, and 43 were due to patients being inappropriately suspended from the waiting list.
The report concludes that there was an environment in the trust that 'allowed individuals to manage waiting lists inappropriately, misrepresenting the true position' to the chief executive and the board.
But it is understood that the inquiry into the managers is likely to look at why systems were not in place to ensure that adequate information was made available to them.
Trust chair Tony Woodbridge said: 'It is quite clear that if the board had asked for more detailed information, it would not have produced anything further.
'I think there would be an expectation that the role of the chief executive in this situation would be investigated. '
It is understood the investigation could lead to Ms Nicholls and the other managers being dismissed.
An action plan has now been implemented, which will be added to following the completion of work with a modernisation team which is currently in the hospital looking at waiting-list management.
The number of people waiting more than 18 months has now been reduced by around 100.
Any further changes in management partly depend on a proposed merger between the trust and South Buckingham trust.