Of the many chasms that separate our region’s well-off west from its less-affluent east, one of the starkest is in the quality of hospitals.

Residents of Montgomery and Fairfax counties, and the District west of the Anacostia River, can choose from numerous first-rate hospitals: Suburban in Bethesda, Sibley Memorial in Northwest, the Inova system in Northern Virginia.

By contrast, Prince George’s residents routinely leave their own county — if they have the means — rather than undergo treatment at Prince George’s Hospital Center in Cheverly. About 25,000 county residents a year go elsewhere for hospital visits, by far the highest number in Maryland. The District has only one hospital east of the Anacostia River. It’s had such troubles that Mayor Vince Gray just called for it to hire “turnaround specialists” and switch its focus to outpatient care.

So it was major news when a deal was announced in July to build Prince George’s first full, academic teaching hospital by 2017 to replace the Cheverly facility. The new, top-quality hospital would serve not just that county but also Southern Maryland. It would be a huge step toward narrowing the health-care gap in our region.

But it turns out there was a catch, and it’s a big one. Maryland Senate President Thomas V. Mike Miller Jr. (D-Calvert), who will have a large say in the matter, said the only way to raise all of the $600 million or so needed for the hospital is for Prince George’s to allow slot machine gambling.

Miller, who has long been Maryland’s most influential slots advocate, wants the county to allow the machines at Rosecroft Raceway in Fort Washington, just south of the Beltway.

“With no other way to raise money for this teaching hospital . . . those monies could come from that source,” Miller said in an interview.

“Right-thinking people will say this is not the ideal way to fund government,” Miller said. “It’s not the best answer, but it’s an answer.”

Miller’s stance has put Prince George’s and its county executive, Rushern L. Baker III (D), in an awkward position. Prince George’s didn’t want slots for itself back in 2008, when state voters agreed in a referendum to allow them in five other counties. Baker consistently opposed slots — until now. He’s turned neutral on the issue since taking over the county’s top job, because he might need the dough.

I’m no fan of slots and voted against them in the referendum. But I’m also fairly tolerant of minor social ills, so I wouldn’t get all worked up and self-righteous if Prince George’s accepted them. After all, I endorsed legalizing marijuana for recreational use. I think it would be a tad hypocritical to say pot’s okay, but don’t you dare gamble.

At the same time, I think it would be outrageous if Prince George’s had to choose between slots and the new hospital that state and local politicians have long promised. The county should not have to compromise its principles, and spoil efforts to improve its image, just to placate gambling interests and their powerful friends in Annapolis.

So if Prince George’s opts against slots, then the state should find a different way to raise its share of money for the hospital. County officials say the understanding in July was that each of the three parties — Prince George’s, the state and the University of Maryland Medical System — would shoulder about a third of the cost. Nobody said then slots were part of the deal.

“Why should the quality of health of the citizens of Prince George’s County, and for others who would come to such a hospital, be conditioned on people losing money” through gambling? asked the Rev. Jonathan Weaver, a pastor in Bowie and national president of the Collective Empowerment Group, a religious coalition that opposes slots.

County Council Vice Chairman Eric Olson (D-College Park), a slots opponent, said the county should stick to its strategy of raising revenue over time by luring top-quality companies to increase its tax base.

“If we become known as the Atlantic City or Las Vegas of the D.C. area, I don’t think that helps us with our goals of attracting business,” Olson said.

Olson sponsored a bill banning slots, but it failed by one vote on Nov. 15. Instead, the council voted 5-4 to ask the state legislature to hold another referendum authorizing slots in Prince George’s. Council members said they didn’t necessarily support slots, but wanted the voters to decide.

All of this promises high drama in the legislative session beginning Jan. 11. A key person to watch will be Gov. Martin O’Malley (D). Prince George’s gave him more votes than any other county when he was reelected in 2010. Will he repay the favor by leaning on the legislature to pay for the hospital without slots, if that’s what Prince George’s wants?

O’Malley was happy to appear at the announcement in July and say the long-sought pact was “not just a promise.” Now it will be time for him, and others, to deliver.

I will discuss local issues at 8:51 a.m. Friday on WAMU (88.5 FM).