The American Samoa Senate has rejected governor Togiola Tulafono's nomination of Elisapeta Ponausuia as director of the Health Department.
Ms Ponausuia needed 11 votes to be successful but garnered just six.
Her appointment had been accepted by the House earlier in the week, but she needs endorsement from both bodies.
The governor can now re-submit the same nomination or put forward a new candidate for health director.
