Guam's hospital faces losing its accreditation after a survey found a raft of problems had not been fixed.
The hospital's administrator, Peter John Camacho, said the Joint Commission, which accredits US healthcare services, threatened to revoke accreditation for not complying with its standards.
Mr Camacho said an inspection found that problems identified in previous surveys had not been addressed.
Problems included stained ceiling tiles and broken walls, which present infection risks, as well as a lack of equipment and staff.
Mr Camacho said the hospital would not shut down if accreditation is lost - in fact, it operated for 26 years without accreditation until 2010 - but it would be a bad look.
He called on lawmakers to step up and provide adequate funding for the hospital, which loses an average US$30 million a year.