In the pages of the leather-bound photo album, Cindy Alvarado is a chubby baby getting a bath, a toddler sitting in a stroller. There are holiday snapshots of Cindy with her mother and of an older Cindy, with long dark eyelashes and wavy black hair, sitting in her wheelchair.

Over the years, Gloria Alvarado Zelaya collected the pictures as she prepared Cindy's feeding tube, caressed her after seizures and grew to accept that her firstborn would never speak. The mother-daughter bond was tested by Cindy's cerebral palsy and enormous medical needs.

A patchwork of social service providers would step in to convince Zelaya that the government could supply the necessary professional help. Eventually, Zelaya agreed that her daughter enter foster care.

Several weeks into the 2003 school year, a social worker told Zelaya that Cindy had become gravely ill. Cindy, a medically fragile 13-year-old girl who laughed often and clapped when she was happy, was dead.

"It didn't make sense to me," Zelaya said about the terrible news.

In August, nearly a year after her daughter died, Zelaya learned from an investigator's report that she had been told very little about her daughter's death. The new details were shocking.

A school nurse, the report said, had evaluated Cindy at C. Melvin Sharpe Health School in the District and wrote a note saying that the child needed urgent care. But Cindy was sent to her foster home on a school bus. When she arrived, she had stopped breathing and was turning blue. Cindy died of an intestinal blockage that can be successfully treated. The nurse's note would be found hours later.

On a recent evening, Zelaya, 32, flipped through her daughter's photo album and wept.

"Why didn't the nurse take Cindy to the emergency room if she knew that she wasn't okay?" Zelaya said. "Maybe she would be alive now."

Zelaya is eager to know if the government that she expected to take care of her daughter did everything it could to save her.

"I want to know everything now," said Zelaya, originally of El Salvador.

Investigations by the citywide Child Fatality Review Committee and University Legal Services, a federal advocacy group for the disabled, have led to calls for reform. But city officials have not indicated any new policies to protect disabled children. Vandalia Joyner-Taylor, the nurse who evaluated Cindy, still works at Sharpe. She declined to be interviewed. Ray Bryant, the top District schools special education official, recently said in an e-mail: "We have a joint work group with all parties reviewing and making recommendations as appropriate."

A Child and Family Services spokeswoman, responding to calls for additional monitoring, said that a clinical practice unit established in 2001 is working with the school system to track the health of foster children.

Zelaya has filed a $10 million lawsuit against the District, the nurse and the company that she worked for, alleging that they are responsible for Cindy's death.

A Washington Post review of Cindy's court records and interviews with Cindy's mother, foster mother and District officials offer a detailed look at the life and death of a child dependent on the government for her every need.

'It Was Hard to Leave Her'

From the day of Cindy's birth on May 20, 1990, Zelaya faced an emotional dilemma: Was it best to hold on, or to let go of her disabled child? Circumstances would force her to do both.

She waited for hours after giving birth for someone at Howard University Hospital to bring Cindy to her. Zelaya, then 18, who said she had regular prenatal checkups, feared that Cindy was missing an arm or a leg. A doctor arrived without the newborn and notified her that Cindy had cerebral palsy. Cindy would have to remain in the hospital.

"It was hard to leave her because I came with her, and then I left without her, " said Zelaya, who visited often during Cindy's seven-month stay. After Zelaya, who was living with her mother, took Cindy home, Roberto Alvarez, Zelaya's boyfriend and Cindy's father, left and never returned.

Over the next three years, Zelaya made late-night trips to the hospital when Cindy's seizures endured too long. She learned to insert a feeding tube. She also arranged special family moments -- Cindy's baptism at Shrine of the Sacred Heart in Northwest Washington, where she was surrounded by a knot of relatives and wore a white dress. Cindy cried when the Catholic priest poured holy water on her forehead. Then she laughed.

By age 4, Cindy had shuttled between hospital and home so many times that doctors recommended that Zelaya allow her daughter to be hospitalized again for an extended stay. Zelaya visited during Cindy's four years at the Hospital for Sick Children; she also got married and had a second child, Claudia.

When doctors said Cindy could come home, Zelaya's husband, Esteban Zelaya, was concerned about Cindy's medical needs, according to court records.

"I wanted my children to have a father, but at the same time, I was thinking about separating," for Cindy, Zelaya said. But in January 2000, as the details were being worked out, Zelaya discovered that she was pregnant with her third child. The decision would be more difficult.

Social workers recommended foster care for Cindy; for the third time, Zelaya allowed others to care for her daughter. Child and Family Services placed Cindy in a group home for disabled children.

"It was so hard to decide that, that she wouldn't be with me," Zelaya said.

Court reports tracking Cindy's progress in foster care described Zelaya as an involved parent, calling often, visiting at least once a month, speaking to Cindy in Spanish. Mama esta aqui; te amo. "Mommy's here; I love you."

At the sound of her mother's voice, Cindy's eyes would move back and forth. Whenever Zelaya readied to leave, Cindy's dark eyes turned sad.

A Mom and Foster Mom

Zelaya had never relinquished her parental rights, but for three years social workers, District school officials and a judge made key decisions for Cindy.

Cindy had started to attend Sharpe, but at the group home, she received little therapy, according to court records, and so D.C. Magistrate Judge Karen Aileen Howze wanted to place her in a private home. In March 2003, social workers found foster mother Nora Carmichael, who cared for Cindy for $96.70 a day, the agency's standard rate for medically fragile children.

Howze directed Child and Family Services to arrange for parental visits because Zelaya had been involved when Cindy lived at the group home. Although Cindy continued at Sharpe, Carmichael was concerned that the hour-long ride to school from her home in Fort Washington was too long. Howze appointed a special education advocate to look into the issue.

Less than a month before she died, Cindy was set to attend Tanglewood, a special education school in Clinton, Carmichael said in an August 2003 court hearing. But last fall Cindy returned to school at Sharpe because the transfer was not complete.

Zelaya knew none of this. When she arrived at the group home to visit Cindy in April 2003, employees told her that Cindy had been moved. Zelaya said that she left several messages with the social worker and that no one returned her calls.

The agency notified Zelaya by mail but learned later that the address was incorrect, said spokeswoman Mindy L. Good. The agency had no record of any calls from Zelaya, Good said.

"She knew we had her child," Good said. "If she was concerned or wanted to know what was going on, she could have contacted us, but she didn't."

Months earlier, social workers had broached the subject of adoption with Zelaya, who was still considering the request. Unable to find Cindy and worried about where she might be living, Zelaya sought comfort from her Catholic faith. She prayed for Cindy's safety and hoped that one day she would see her again.

'Something Was Very Wrong'

On that Friday morning more than a year ago, Zelaya's heart was beating fast. She had not seen her daughter for six months but remembered that Cindy had attended the Sharpe school. She suddenly wanted to go there to find her but without someone to cover for her, she remained at work.

That day, Sept. 26, 2003, Cindy was at Sharpe, crying and sleeping more than usual.

Her teacher thought she looked ill and called school nurse Joyner-Taylor, who took Cindy's vital signs and noted that Cindy appeared "uncomfortable," the Legal Services report stated. According to the investigation, the nurse told school officials that she called Carmichael, Cindy's foster mother, and left a voice-mail message. By the end of her shift, when she did not receive a return call, she wrote the note: "Please evaluate re: emergency room ASAP."

Carmichael said she had never received a call. At the end of the day, school workers placed Cindy on the school bus for the trip to her foster home. She arrived at 4:40 p.m.

"It was very simple to see that something was very wrong," Carmichael recalled.

She touched Cindy. Her body was cold. Carmichael called the ambulance that took Cindy to Fort Washington Hospital Center. At 5:20 p.m., a doctor pronounced her dead. The medical examiner's report found that the cause of death was volvulus, a type of intestinal blockage. "If prompt, appropriate treatment is rendered, the condition can be successfully treated," the legal services report stated.

Rummaging through a school backpack hours after Cindy's death, Carmichael found the nurse's note.

Network of Strangers

For Cindy's funeral, strangers turned caregivers handled the final details. Carmichael picked out a peach-and-cream-colored dress from a Latino-owned store in Adams Morgan. A social worker prepared the program for the service, held at a Northeast Washington funeral home. The minister, who never met Cindy, delivered the eulogy in Spanish. And Child and Family Services covered the expenses: $4,993.86.

Zelaya said that she cannot recall anything from that day. Mother and foster mother met for the first time at the service. Carmichael said Zelaya thanked her.

"She said something about Cindy having two mothers," Carmichael recalled.

Cindy is buried at Mount Olivet Cemetery in Northeast. Zelaya ordered a red-speckled headstone. With the marker finally in place, Zelaya can touch her daughter's name -- a way, perhaps, of holding on while letting go.

Researcher Bobbye Pratt contributed to this report.

The grave of Cindy Alvarado, who was severely disabled. Her mother filed suit against the District, a nurse and the nurse's employer.