At Ailing Wyckoff Hospital, Insider Deals and Lavish Perks Problems at Wyckoff Heights Medical Center in Bushwick, Brookyln, have included an ousted chief executive, financial difficulties and an investigation by the Brooklyn district attorney. In recent years, Wyckoff Heights Medical Center in Brooklyn has often gone hat in hand to the city and state, lamenting cuts in government assistance and questioning whether officials truly understood the burden of running a nonprofit hospital in Bushwick, one of the city's poorest neighborhoods. For much of that time, Wyckoff's chief executive was driving to work in a Bentley Continental GT, a $160,000 automobile, and at one point, the hospital paid thousands of dollars to insure the vehicle, according to hospital records and interviews. When the chief executive lost his license after an accident, hospital security guards chauffeured him and his wife around the clock in a Cadillac Escalade or a Lincoln Town Car. The chief executive, Rajiv Garg, was not the only one who benefited from his ties with Wyckoff. One member of the hospital's board obtained for the pharmacy that he owned the exclusive right to market prescription drugs to hospital patients. Another board member lent $2.4 million to the ailing Wyckoff at 12 percent interest, with the hospital required to put up several of its buildings as security. Local politicians also joined in. Allies of United States Representative Edolphus Towns, Assemblyman Vito J. Lopez and Councilman Erik Martin Dilan have landed high-level positions at the hospital, despite questionable qualifications, further weakening its management. Mr. Dilan's wife became the hospital's director of public relations. Many hospitals in downtrodden areas of New York City and across the state are faltering, raising concerns that a wave of closings will deprive poor people of badly needed care. A three-month investigation by The New York Times into Wyckoff, based on dozens of interviews and an examination of internal documents, offers a sobering portrait of how one such hospital has been undermined by the very people entrusted to run it. The hospital all but defaulted on its $109 million in state-secured bonds, forcing the taxpayers to cover $10 million due to bondholders before the state agreed in May to defer the hospital's overdue payments. Wyckoff no longer even carries malpractice insurance. Consumer Reports recently ranked Wyckoff among the worst hospitals in the New York region. After years of decline, the hospital is also attracting the notice of the authorities. The Brooklyn district attorney, Charles J. Hynes, has begun examining its management and has presented evidence to a grand jury, according to legal documents. Under pressure, the hospital's board recently ousted the president, Mr. Garg, who was being paid $700,000 a year. But some entrenched members of the hospital's board remain, and the hospital's doctors recently mounted an insurrection against Mr. Garg's replacement, Ramon Rodriguez. They circulated a letter saying that Mr. Rodriguez was not capable of running Wyckoff because of his "battles with depression." Mr. Rodriguez called the letter "character assassination," saying that the doctors felt threatened by his reforms. Wyckoff has been so troubled for so long that even the most accomplished leadership might have been unable to turn it around. But its recent difficulties have clearly been deepened by the management turmoil. Wyckoff, which has 324 beds, is typical of the city's distressed hospitals. Dedicated in 1899 as the German Hospital of Brooklyn, Wyckoff straddles the border with Queens in a neighborhood where poverty and unemployment have begun to fall with gentrification, but where almost one out of three people is still poor. The hospital cares for an average of 7,000 emergency room patients a month, most of whom do not have private insurance and rely on Medicaid, Medicare and other government programs to pay. While cultivating political officials, Wyckoff often seems to have done little to market itself to patients and improve care. Often, officials at failing hospitals point to their impoverished clientele as the cause of their problems. But there are middle-class patients just over the border in Queens, and artists and entrepreneurs are moving into Bushwick's lofts and row houses. Last year, a committee created by Gov. Andrew M. Cuomo identified Wyckoff and five other hospitals in Brooklyn as lacking the management quality, business model and financial strength to continue operating in their current form. The panel proposed to consolidate some of the hospitals. In Bushwick, people do not want to lose their hospital. The next-closest one, Woodhull, is nearly two miles away. But local leaders said Wyckoff's management had repeatedly let them down. "If community members feel you're an overtly politicized place, or if you're abusing hospital money, they lose faith in your ability to serve the community," said Theo Oshiro, deputy director of Make the Road New York, an organizing group in Bushwick. Abundant Spending Soon after becoming Wyckoff's chief executive in 2008, Mr. Garg took a doctor to dinner with their wives at La Grenouille on the East Side. The check was about $500, and he billed Wyckoff, according to records examined by The Times. Research was contributed by Jack Begg, Sheelagh McNeill, Lisa Schwartz, Jack Styczynski and Susan Weber-Stoger.Research was contributed by Jack Begg, Sheelagh McNeill, Lisa Schwartz, Jack Styczynski and Susan Weber-Stoger.