"The inquiries (of senior managers) really did not go beyond asking if everything was OK," lead counsel Michele Hollins told retired Justice John Vertes in her summation.
"Their inquiries resulted in no action or no further investigation."
Hollins suggested Alberta Health Services — the delivery arm of the province's Health Department — may be setting the bar too high for when an investigation can be called.
"Maybe some sort of less formal audit procedure would have allowed this matter to have been looked at in more detail at an earlier time."
Vertes is hearing final submissions before he writes his report on any findings, causes and remedies for queue-jumping in Alberta. The inquiry was called to fulfil an election promise by Premier Alison Redford to examine any problems.
Vertes's report was due at the end of this month, but that deadline has been extended by the province to Aug. 31.
Over the last four months, doctors and health-care workers have testified before Vertes about random preferential treatment for friends and family.
But the strongest evidence has been about systematic queue-jumping involving the private Helios Wellness Centre and the publicly funded Colon Cancer Screening Centre, both in Calgary.
Screening centre clerks have testified that from 2008 to 2012 — at the direction of management — they slotted in low-risk patients belonging to Dr. Ron Bridges and others from Helios within weeks or months. The wait for everyone else was three years.
Bridges is an associate dean of medicine at the University of Calgary
Helios is a non-profit private clinic that dispenses yoga, exercise and diet advice and, along with the public screening centre, rents office space from the university.
Hollins said questions remain.
"Although we believe that the evidence demonstrated a pattern of preferential access given to a particular group of people (at Helios) without reference to medical need, it is not entirely clear why this happened," she said.
The inquiry was told that Helios patients paid yearly membership fees of $10,000. Helios donated $200,000 or more annually to the university to fund medical scholarships and other projects.
Bridges is a key fundraiser for the university and, according to testimony at the inquiry, delivered fast-track care for Helios patients at not only the public screening centre, but also at the University of Calgary's medical clinic.
Bridges, former president of the Canadian Association of Gastroenterology, raised funds for and founded the public screening clinic in 2008.
Administrator Darlene Pontifex has testified that while Bridges didn't have a formal role at the clinic, he exercised ongoing authority.
Bridges has testified he never knowingly pushed a patient up the queue. He said he booked patients through the screening centre's managers because he didn't realize arrangements were supposed to be made by booking clerks.
Hollins and fellow counsel Jason Wilkins, in a written submission to Vertes, said they were skeptical.
"It is difficult to believe that as the founder of the clinic, he did not know that what he was doing was outside the norm," they wrote.
"The evidence shows Dr. Ron Bridges taking active steps to book (private clinic) Helios patients outside of the regular referral process," they added.
"Dr. Bridges has been prepared to use those (public facilities) however he sees fit, often for the benefit of particular people."
Helios staff have conceded they end-ran the booking procedure at the public clinic and went through Bridges, but they said it wasn't to have their patients seen faster. They said they were trying to find ways to get their patients entered on what they perceived to be a dysfunctional screening clinic database.
The inquiry has also heard testimony from numerous supervisors at the centre and at Alberta Health Services who have testified that Bridges is a well-connected, influential physician.
Dr. Alaa Rostom, hired by Bridges in 2008 to run the medical side of the public clinic, denied that he was warned about the queue-jumping before 2012. He said when he was told, he didn't investigate because he didn't have the time or resources.
Pontifex told the inquiry she did not recall being sent emails directing Bridges's patients be moved up on the waiting list, but conceded she didn't always read her email.
Barb Kathol, an executive director at the Foothills Hospital responsible for the public screening centre, said when she heard talk about what was going on, she didn't go to Bridges, but followed the chain of command and went to Rostom, who told her there was nothing to worry about. She let the matter drop.
When Rostom's boss, Dr. Francois Belanger — head of the Calgary health region for Alberta Health Services — caught wind of goings-on, he, too followed the chain of command. He testified that Rostom told him there was no problem.
Brent Windwick, lawyer for Alberta Health Services, told the inquiry Wednesday that while there were warnings, they were restricted to doctors talking amongst doctors. He said the key supervisor didn't get a heads-up until 2012.
"While it is accurate to say that concerns about irregularities at CCSC were raised as far back as 2010, it's not fair to say that they were 'consistently dismissed' nor that there was 'no real investigation,'" said Windwick in a written submission.
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