The board of American Samoa's public hospital admits its decision to make its vital offshore treatment programme user-pays could cost lives, but says it had no choice.
The LBJ Medical Center says it can no longer pay for patients to have off-island tests or treatment in New Zealand and Hawaii - including lifesaving dialysis or radiation therapy - because it's run up to a million dollars over budget.
The president of the American Samoa Senate says the decision is unacceptable and people will die as a result.
But the chairman of the LBJ's board, Charles Warren, says it's up to the government to provide more money.
He says last year between 150 and 200 people were sent offshore for care, but he can't say how many might now miss out.
"Conceivably fatalities could increase but again, you can't forecast the future. It's a funding issue and the funds are provided to the hospital by the government. Obviously we're concerned but we're just one piece of this puzzle. There's an entire government that needs to be just as concerned as the hospital is."
Charles Warren says the government promised a special payment to reduce the programme's deficit before the end of the financial year last month, but the money never arrived.