At least 50 employees of the LBJ Hospital in American Samoa face the prospect of losing their jobs this month.
As part of the LBJ's fiscal reform plan 80 hospital jobs are being eliminated.
Nearly 30 have already gone through attrition, saving the hospital an estimated 800-thousand US dollars.
The Chairman of the Hospital Authority Board, Charles Warren, said personnel actions for the rest should begin in early January.
Some top officials on the administration side are included in those losing their jobs.
Mr Warren said the fiscal reform plan needed to remain confidential for now as there were some potentially contentious provisions that he said needed finalisation.