The chief executive of American Samoa's LBJ hospital is defying calls for managers to step down amidst a financial crisis.
Staff are calling for a change in the leadership of the hospital, which needs 15 million US dollars to pay off its debts and keep running.
The employees want to trim down the number of hospital administrators, and want an increase in government subsidies.
But the chief executive John Faumuina won't heed their calls.
"The change has already been done, the new board has come in. No matter how much changes you make, unless you have the finances and the money to run the hospital, you've only got to come in and do miracles round here, so I don't know what these employees are grumbling about."
Mr Faumuina says the hospital has problems meeting deadlines in making weekly purchases of drugs, which may result in shortages of medicines.
He says the cash flow problem could be solved by making monthly pre-paid purchases as the hospital relies on one flight a week from a single medicine supplier.