related to this:
Error Installing Version 5.0.2
wouldn’t expect the problem in mariadb 10.2.25 or lower
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Prior to MariaDB 10.2.26, 10.3.17, and 10.4.7, MariaDB didn’t properly calculate the row sizes while executing DDL, so “unsafe” tables could be created, even with innodb_strict_mode=ON set. This was fixed by MDEV-19292. As a side effect, tables that could be created in previous versions may get rejected after the latest releases.
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that being said better solution would be to convert some of the varchar(255) fields to TEXT fields. That why seeing your patient_data schema would be helpful to see how many more custom fields you have (legacy OpenEMR added varchar(255) fields there while modern OpenEMR adds text fields.