A review of quality of care at American Samoa's LBJ Medical Centre has questioned the on-going monitoring of the performance of physicians.
Board of directors found that there is a lack of physician performance evaluation or continued medical education as required under its policies.
The Board chairman, Charles Warren, says that the evaluation of physicians is required as part of quality of care.
The board has directed all committees relating to evaluating care to hold meetings immediately and take actions when required.
Members not attending such meetings have been threatened with punitive action such as the withholding of pay.