“Gross malpractice” means malpractice where the failure to exercise the requisite degree of care, diligence or skill consists of:
1. Performing surgery upon or otherwise ministering to a patient while the osteopathic physician is under the influence of alcohol or any controlled substance;
2. Gross negligence;
3. Knowing or willful disregard of established medical procedures; or
4. Knowing or willful and consistent use of medical procedures, services or treatment considered by osteopathic physicians in the community to be inappropriate or unnecessary in the cases where used.