Crucial decisions on medical marijuana dispensaries, the future of Hawaii’s public hospitals and a tax to fund Honolulu’s financially struggling rail project hang in the balance as the Hawaii Legislature approaches a major deadline.

All bills must pass out of their chamber of origin this week, and those that don’t make the deadline will die.

The official day of the crossover deadline is Thursday, but the vast majority of the bills -especially anything controversial -will be taken up Tuesday. That way, the Legislature will have ample time to clean up messes or work out any problems with important bills. Senators also will take up Gov. David Ige’s nomination of Carleton Ching to lead the Department of Land and Natural Resources.

>> Medical marijuana. The drug has been legal in Hawaii for medical purposes since 2000, but patients don’t have a legal way to get medical marijuana other than growing it themselves or buying it on the black market. A bill up for a full House vote would create a system of at least 26 dispensaries and 30 production centers in the state.

>> Rail tax. The Honolulu Authority for Rapid Transportation is facing budget deficits estimated at up to $900 million to complete Oahu’s rail project. Lawmakers in the House and Senate are voting on proposals to extend a portion of the rail tax to help fill the gaping hole.

>> Rescuing hospitals. A bill in the Hawaii House would authorize Maui’s financially challenged public hospitals to enter into a public-private partnership to create a new nonprofit entity. Hospitals throughout the system have been cutting services to deal with declining revenues, and Maui Memorial Hospital has already closed its adolescent behavioral health unit.

>> Birth certificates. A proposal in the Hawaii House would allow transgender people to change gender on their birth certificates without having surgery. Advocates say requiring surgery is outdated, and transgender people will face fewer obstacles to obtaining employment and education if they’re able to get a birth certificate that conforms with the gender they physically present.

>> Disputed confirmation. A Hawaii Senate panel is scheduled to consider Ige’s nomination of Carleton Ching to become director of the Department of Land and Natural Resources. Environmental groups have decried the nomination, and one senator has already said he wouldn’t vote to approve Ching. The public hearing is Wednesday morning.