The hospital board in American Samoa has submitted several proposals to the governor in a bid to revive its off-island referral programme.
The programme was stopped last year after funds had run out, leaving scores of patients with serious illnesses on waiting lists for overseas treatment.
Our correspondent in Pago Pago Monica Miller reports.
"What they're proposing is either have an earmarked tax to fund the off island referral programme and either raise the excess tax on bear or cigarettes. Or to raise the fee for inpatients and outpatients now charged by the hospital. Of those are not approved then they are recommending that the hospital staff are reduced."