A $100 million road project that will allow ambulances to get patients to the new Midland hospital without being held up at a rail crossing may not be finished before the hospital opens next year.
A Main Roads source has revealed that, at the very best, it will be "touch and go".
The work - which includes an underpass under the railway at Lloyd Street and was expected to take 18 months - was originally scheduled to begin next month.
But the tender has still not been awarded.
The hospital is on track to be completed - and accepting patients - by the end of next year.
Shadow transport minister Ken Travers said "the down-to-the-wire planning beggared belief".
"This has become a farcical situation," he said. "We've known about this issue for several years, it's not new.
"The work should have been completed, or well under way, by now."
Mr Travers said the State Government's failure to financially commit to the project could have led to the delay in planning.
"This is another example of essential infrastructure being forgotten or overlooked," he said. "And now the chickens have come home to roost."
A spokeswoman for Transport Minister Dean Nalder said recurrent funding for the project was allocated in the 2013-14 State Budget.
The rail line runs along the northern side of the hospital. It is often used by long and slow-moving freight trains.
Vehicles can wait up to five minutes for a train to pass, including at the Lloyd Street crossing.
Ambulances coming from the Midland CBD or suburbs to the north, such as Viveash and Ellenbrook, will need to cross the rail line to get to the hospital.
According to the tender documents, the underpass at Lloyd Street was needed to give "unimpeded access" to the emergency vehicles.
Mr Nalder's spokeswoman said Main Roads was working closely with the North Metropolitan Health Service to ensure the road was open in time.
As part of early negotiations, it is understood Brookfield Rail, the operator of the rail line, has agreed to two 18-hour line closures during the construction of the underpass.