The LBJ Medical Center in American Samoa is no longer paying the cost of patients sent off-island under its medical referral programme because it has no money.
The LBJ board chairman, Charles Warren, says the hospital will only be deciding who needs to be referred and to which hospital they will be sent.
Any costs will have to be covered by the patient.
He says in May, the LBJ notified the local government it has spent its referral budget
The hospital had warned that keeping the programme open would cause the LBJ to operate at a deficit.
He said LBJ was instructed to keep the programme open and to expect a special appropriation before the end of this financial year.
But, he said nothing materialised and the off-island program ran about three million US dollars over budget.
He said this over-run will need to be made up in the current financial year.