The prospects are quickly dimming for the Maryland General Assembly to convene a summer session aimed at resolving nagging debates over slot machine gambling and medical malpractice, legislative leaders said last week.

House leaders will offer top aides to Gov. Robert L. Ehrlich Jr. (R) a final chance tomorrowat reaching a compromise on legalized gambling, House Speaker Michael E. Busch (D-Anne Arundel) said. The deal would give the governor wide latitude over the details of a gambling expansion but in return ask that he put the matter before voters in November -- an approach Ehrlich repeatedly has said he does not like.

"I think, at this point, we need a definite position from the governor," Busch said.

Without the governor on board, Busch said, he sees no chance for the matter to be resolved this summer.

Ehrlich was on vacation and could not be reached, but Maryland Budget Secretary James C. DiPaula said that the governor's views on authorizing slots through a constitutional amendment have not changed in recent days and are not likely to change.

The governor "hasn't ruled out" allowing the issue to go on the ballot, but he needs lawmakers to first agree on a program that lays out such pivotal details as the number and location of slot machines that would be permitted, DiPaula said.

The bottom line, he said, is that "there's no need to take this to a constitutional amendment. The constitution is the guiding document for your state. It should not be amended by whim."

Under Maryland law, the only way for lawmakers to put a question on the ballot is in the form of a constitutional amendment.

At the same time, intense discussion about medical malpractice insurance -- an issue Ehrlich has termed a crisis because it risks driving doctors, particularly obstetricians, out of business -- has not brought state leaders any closer to an agreement.

All parties say the prospects for a summer session on medical malpractice continue to appear remote, given a lack of consensus on how to proceed. Separate task forces created by Ehrlich and the Senate now plan to study the issue into the fall, while House leaders are mulling the resurrection of a bipartisan panel that worked on the issue during the past legislation session.

That said, some House leaders are holding out hope for an agreement on both topics, in the fall if not this summer. Del. Sheila E. Hixson (D-Montgomery) said the issues are so hotly disputed that there is a risk the legislature will be consumed by them when it formally reconvenes in January.

"I think a decision should be made on both of these issues," Hixson said. Otherwise, they will "cloud everything else," she said.

Del. John A. Hurson (D-Montgomery) said he hopes that, when presented with the latest offer on gambling, the governor will agree.

House leaders may agree tomorrow to offer Ehrlich substantial latitude in designing a slots plan, as long as he agrees to put it before the voters, Hurson said. That could mean scrapping the latest House and Senate plans and returning to an early concept for slots that placed the terminals only at the state's horse racing tracks.

"The speaker and the House leaders have come a very long way," Hurson said. "It's now time to come up with a compromise and get this off the table. The governor has to decide whether he really wants this or not. I think there's no doubt that the people will support this."

The offer is not without substantial risk for Busch, who would need to muster a supermajority in both the House and Senate to get such a plan on the ballot. Failure to do so could leave him facing pressure to accept the approach favored by Ehrlich and Senate President Thomas V. Mike Miller Jr. (D-Calvert): legalizing slots simply through legislation.

That is why, Busch said, he wants the governor to publicly support putting the matter before voters.

"We're open to negotiations to put whatever he wants on the ballot," Busch said, "understanding that any product that hints of impropriety or unjust enrichment will have a limited chance of passing."

While Busch said he is putting the issue of slots in the governor's hands, he is not ready to accept the governor's position on medical malpractice, even though there is some overlap in their views. He said he remains suspicious of the work being done by a task force Ehrlich appointed to find ways to curb escalating insurance rates paid by doctors.

Ehrlich has asked the group to start with an approach rejected by the Democratic-controlled Senate during the last legislative session -- limiting jury awards and settlements to people harmed by medical mistakes -- but to explore other strategies as well. Though Miller is entitled to name several members of the panel, he has refused to make appointments because he says the panel is stacked with doctors and insurance-industry executives who favor Ehrlich's approach.

"You have somewhat of a prejudiced task force," Busch said. "It just doesn't lend itself to a product that's going to come back and be embraced by the General Assembly."

Though Ehrlich has called for a special session on the issue, too, he has given his task force until November to craft recommendations.

At Tuesday's meeting, task force members discussed a variety of ideas, including a special court that would handle only malpractice cases. However, their largely unfocused two-hour discussion underscored how much work remains before proposals are crafted.

Doctors say Maryland is facing a crisis. The state's largest malpractice insurer, Medical Mutual Liability Insurance Society of Maryland, raised premiums for this year by 28 percent. The company has proposed a 41 percent increase for next year.

Ehrlich rejected a costly approach proposed in June by three competing interest groups -- doctors, trial lawyers and insurers -- that could have had an immediate effect on rates. Under the plan, the state would create a reinsurance fund that would allow insurers to freeze their rates.

Busch said the state bailout is the only idea discussed that would have an immediate impact on doctors' premiums. Other approaches, such as limiting payouts to victims, could take several years to be reflected in insurance rates, he said.