Patients Cannot Dictate Diagnostic Tests: Doctor’s Diagnostic Prerogative and the Need for a Justiciable Cause in Writ Proceedings

1) Introduction

Case: ARUN P.K v. STATE OF KERALA (2026 KER 51586)
Court: Kerala High Court
Judge: Justice Bechu Kurian Thomas
Date: 13-07-2026

The petitioner, a retired Indian Air Force personnel, approached the Kerala High Court under writ jurisdiction seeking directions to the State and the General Hospital, Ernakulam, to ensure that he undergoes “proper medical examination” by a competent specialist and diagnostic investigations including CT and MRI scans, or other tests deemed necessary.

The core issues before the Court were:

  • Whether the pleadings disclosed a justiciable cause warranting intervention under writ jurisdiction.
  • Whether a patient can seek a writ compelling a government hospital/doctor to conduct specific diagnostic tests (CT/MRI) on demand.
  • Whether the petitioner provided sufficient material to establish that he consulted a doctor and that there was a denial of appropriate medical care.

2) Summary of the Judgment

The Court declined to grant the reliefs sought and held that:

  • No justiciable cause was made out because the petition lacked basic materials proving that the petitioner actually consulted a doctor; even the doctor’s name was not disclosed.
  • A patient must follow the advice of the doctor; the doctor is not bound to follow the “directions” of the patient.
  • Whether CT/MRI or other tests are required falls within the diagnostic prerogative of the doctor; a patient cannot dictate which scan must be prescribed.

Nevertheless, on the Government Pleader’s submission that the hospital doctors were ready to treat the petitioner when he approaches them, the Court closed the writ petition, leaving the petitioner free to approach the appropriate hospital (including the second respondent) for diagnosis and treatment.

3) Analysis

A) Precedents Cited

The judgment, as provided, does not cite any prior case law. The Court resolved the dispute based on fundamental principles governing:

  • Maintainability of writ relief in the absence of a pleaded and supportable cause of action, and
  • Institutional limits on judicial direction in matters requiring professional medical judgment.

The absence of cited precedents is itself instructive: the Court treated the matter as one capable of disposal on first principles—pleadings, proof of consultation/denial, and the boundary between judicial review and medical discretion.

B) Legal Reasoning

  1. Failure to disclose a verifiable factual foundation (no justiciable cause):

    The Court accepted the State’s submission that, apart from the outpatient ticket, there was no record demonstrating that the petitioner consulted a doctor. Crucially, the petition did not disclose even the name of the doctor. In such circumstances, the Court held it was not possible for the respondents to identify the alleged lapse or verify the truth of the allegations.

    This reasoning underscores a threshold requirement in writ proceedings: the petitioner must plead and place sufficient material to show a real, concrete, and verifiable grievance. A writ court generally does not proceed on unparticularised allegations where verification is practically impossible.

  2. Medical testing is not a patient’s command but a clinician’s judgment:

    The Court drew a clear line between a patient’s right to seek medical care and a patient’s attempt to dictate the diagnostic pathway. It observed:

    • Doctors typically prescribe diagnostic tests after examination and a provisional assessment.
    • Whether a CT/MRI is indicated is a matter of diagnostic prerogative—a domain requiring clinical expertise.

    The Court’s principle is institutional: courts can ensure access to care and address demonstrable arbitrariness or denial, but they will not ordinarily replace clinical judgment with judicial mandates, especially at the level of directing specific tests absent medical records supporting necessity.

  3. Balanced closure: access preserved without judicial micromanagement:

    While rejecting the petition’s maintainability and merits, the Court recorded the Government Pleader’s assurance that doctors were ready to treat the petitioner. The petition was therefore closed with liberty to approach the hospital. This reflects a “least intrusive” approach—maintaining access to public healthcare while declining to convert the writ jurisdiction into a forum for prescribing diagnostic protocols.

C) Impact

  • Higher threshold for writs demanding specific medical tests:

    Future litigants seeking CT/MRI or specialist evaluation via writ are likely to face dismissal unless they produce concrete materials (consultation records, referrals, discharge summaries, or documented refusal/denial) showing a real deprivation of care or arbitrariness.

  • Reinforcement of clinical autonomy in public hospitals:

    The judgment strengthens the proposition that diagnostic decisions remain primarily with doctors, and that patient preference—without clinical endorsement—does not translate into enforceable public law directions.

  • Procedural lesson for healthcare grievances:

    Individuals alleging improper refusal of tests in government hospitals will likely need to pursue fact-supported routes—hospital grievance cells, written requests for clarification, medical superintendent review, or documented second opinions—before invoking constitutional remedies.

  • Limits of Article 226 in medical decision-making disputes:

    The decision signals that writ jurisdiction is not a substitute for clinical evaluation or a mechanism to compel specific investigations in the absence of medical substantiation. It may reduce “test-on-demand” litigation and encourage documentation-driven claims.

4) Complex Concepts Simplified

Justiciable cause
A dispute fit for court determination—there must be a real grievance supported by enough facts and material so the court can meaningfully examine it and grant relief.
Writ petition (Article 226 context)
A constitutional remedy used to challenge unlawful state action or enforce public duties. It is typically not used to adjudicate disputed facts without records, nor to supervise technical professional choices unless illegality/arbitrariness is shown.
Diagnostic prerogative
The clinician’s authority and responsibility to decide what tests are medically indicated, based on examination and clinical judgment. Courts generally avoid substituting their views (or a patient’s demand) for medical expertise.
Outpatient ticket (OP ticket)
A basic record indicating a hospital visit/registration; by itself, it may not establish what medical consultation occurred, what findings were recorded, or whether there was any refusal of indicated care.

5) Conclusion

ARUN P.K v. STATE OF KERALA (2026 KER 51586) crystallises two practical rules in public-law challenges involving healthcare: (i) writ relief requires a verifiable factual foundation—vague allegations without identifying details (such as the treating doctor or consultation records) may fail at the threshold; and (ii) courts will not compel government doctors to order specific tests like CT/MRI merely because a patient demands them, since such choices lie within the doctor’s diagnostic prerogative. At the same time, the Court preserved the petitioner’s access to treatment by permitting him to approach the hospital for proper diagnosis, reflecting judicial restraint coupled with a facilitative stance toward access to care.