Ending a seven-day civil trial, a six-person jury on Tuesday found that Dr. Kizhake Kurian, a cardiologist who practices in Palm Coast with AdventHealth Medical Group, was not negligent in the death of Richard Starr, a 38-year-old Palm Coast resident who had been in relative good health until a series of heart-related medical episodes in the last days of March 2018.
Attorneys for the defense argued in sum that his death resulted from “actions or inactions” of people–including Starr–who were out of the defendants’ control or supervision.
The trial did not focus only on Kurian by any means. The questions litigated included whether Starr himself was negligent leading up to his death and further questions of potential negligence on the part of the Starr’s primary care physician’s office, with percentages of negligence made to weigh on one side or another. The highly technical trial combined examinations of medical records and the intricacies of cardiac medicine–all of which the jury had to absorb–with personal habits, histories and routines, down to the deconstruction of what took place in the final dozen days of Starr’s life.
Starr died on March 27, 2018.
He was working at Zeno Office Solutions, a Xerox subsidiary, at the time. He’d been with the company 20 years, and by March 2018 was a supervisor of the Central Florida area. He had a son who graduated high school the same year Richard died, and was married to Kachina Starr for almost 16 years, after a previous marriage. He had diabetes and hypertension, for which he was medicated. There was a time in 2017 when he’d been over 300 pounds, but he’d adopted a rigorous bike-riding exercise and diet regimen, down to portioning his food, and had lost some 60 pounds by the time he died in March 2018.
Eleven days before he died–on March 16–Richard had collapsed as he was crossing the living room at a friend’s house that evening. He hadn’t completely lost consciousness, but wasn’t fully lucid. It was just for a brief moment. His wife and friends assisted him, gave him an orange, and he was back to his old self. He thought his blood sugar had fallen too low.
Three days later he saw Dr. Florence Fruehan, his doctor at Palm Coast Urgent Care. (Fruehan was still a practicing physician at the time. His troubles with the law and the state Board of Medicine on unrelated matters would come later that year, when he was compelled to give up his license in a deal with the state. He was later convicted of a felony.) Richard got an EKG and had a cyst removed from his back.
On March 21 he went by himself to see Dr. Kurian at Kurian, with an order for two tests in hand. Kurian had him do a stress test. (Kurian by then had worked with AdventHealth for 8 years, with his office at the hospital on Medical Memorial Parkway.) “Then the doctor talked to him and said, you have a heart of a 40-year-old man,” his wife recalled, based on a text message they exchanged and a conversation afterward. “That was the end of it. He sent him on his way. He said, you’re fine.”
She recalled her husband saying no echocardiogram was done “because he did so well on the stress test.” That evening all was going well. “He was really happy. He was fine,” his wife recalled.
Records would show that Fruehan had also ordered a holter monitor, though the monitor would not have been something he’d have gotten at Kurian’s office. Kurian in a deposition said the echocardiogram would also not have been done in his office, but by other cardiology care personnel at the hospital, though Kurian would have read the echocardiogram. Either way, no echocardiogram was done, and Starr did not seek out the monitor.
Richard subsequently had no physical complaints–no shortness of breath, no chest pains, no dizziness, according to his wife’s recollections. He kept track of his blood pressure and sugar levels. But he had what his wife described as “off and on” fatigue in the days between the March 16 collapse and his death.
He was back at Fruehan’s office on March 23, but for a follow-up on the cyst removal, to repack his back. Early the morning of March 26, Richard couldn’t catch his breath. He felt tightness in his chest and jaw pain for 20 minutes, but when he woke up Kachina he was feeling better. She asked if he wanted to go to the ER. He did not. He had an appointment with Fruehan that morning before work, again for the cyst follow-up. An EKG was conducted, “came back clean, fine,” his wife said, relaying Fruehan’s words: “He said, You’re good. Nothing is wrong. We’re not seeing anything. We’ll see you in a couple of days.”
Kachina said he had no reason to see Kurian again based on those results. “There was no need to go back to the cardiologist because the cardiologist had done his job supposedly. We put our trust into that,” she said in her deposition.
Fruehan, according to Travase Erickson, an attorney for the defendants, citing documents from Fruehan’s office, asked Kachina during one of two depositions if she was aware that Fruehan had documented asking Richard to go to the ER and that he would arrange transport for him. “He never did that,” Kachina claimed. “We have full insurance. There’s no reason we would not go to the ER that day if we were told to. He was never told to go to the ER.” Nor did Richard decline the offer, Kachina told the attorney. “That’s very inaccurate,” she told him.
That evening, Richard had no complaints. “It was a wonderful night. We had a nice dinner,” his wife recalled. “We went to bed. We cuddled. It was great.”
At 5:30 the following morning–March 18–her stepson woke her up screaming. Richard was on the kitchen floor, a broken glass next to him, eyes open, unresponsive. (He had woken up at 5 to do some work, computer records would show). While her stepson called 911, she started CPR, getting a light pulse. Deputies showed up, picked up with the CPR. Paramedics arrived shortly afterward and transported Richard to the hospital. But Kachina wasn’t in the hospital long before a physician came out, sat next to her, and said: “I’m sorry.” Richard had been pronounced deceased at 6:23 a.m.
The cause, she was told by hospital authorities, was hypertension and diabetes, with no autopsy ordered, though that would charge when Kachina’s mother showed up. She ordered a private autopsy done at UF Shands. “I said 38-year-old men do not drop dead in the kitchen, he’s getting an autopsy,” Kachina’s mother said in a deposition.
“We didn’t feel right about it, something wasn’t right,” Kachina said. “Then we also retained an attorney.” The autopsy would show “cardiomegaly with mild artherosclerotic disease of the coronary arteries, two ostia over the left aortic cusp and atrial septal defect,” according to a court pleading. In other words, he had “anomalous coronary arteries with both coronary arteries originating from the left aortic sinus, which resulted in his sudden cardiac death.”
Grant Kuvin, the Morgan and Morgan attorney for Kachina Starr, filed the six-page wrongful death lawsuit was filed on June 19, 2020, naming AdventHealth Medical Group and Kurian, alleging that Kurian had provided an incomplete and inaccurate stress test, with no further testing. (One count alleged negligence on Kurian’s part, another alleged vicarious liability on the part of AdventHealth Medical Group.) The lawsuit alleged that Starr’s condition was treatable and survivable.
But in the end, the jury found Kurian not negligent in Starr’s cause of death, making further matters of damages owed moot.