of the University Hospital, but when Act No. 248 went into effect the two former hospitals were made approved hospitals for afflicted children, the Marquette clinic remaining as a branch of the University Hospital.
In a 1935 ruling the commission provided reimbursement to the state by the counties for expenses incurred in cases of children suffering from adult types of tuberculosis, venereal diseases, or other communicable diseases and committed to hospitals under the Afflicted Children's Act. This became law in 1939.
The sweeping change of policy involved in Act No. 248 of 1933 caught most local officials unaware, and thousands of court orders under the old children's law of 1913 had to be returned for correction. But despite flaws, mostly corrected later, the act had a more pronounced effect on the over-all administration of children's hospital relief than did the special legislation and establishment of the Crippled Children Commission in 1927. The University, in June, 1933, was the only institution approved under the Afflicted Children's Act. A year later, in 1933-34, there were more than one hundred approved institutions with a resultant decrease in the University Hospital of nearly twelve hundred patients committed under the Afflicted Children's Act. Registrations under the Crippled Children's Act rose from 190 to 1,049, and the commission reported that the University Hospital increase accounted for more than three-fourths of the year's increase in cases for all hospitals under the Crippled Children's Act.
As a result of continuing dissatisfaction with the allocation of fees between state and counties, the old children's law of 1913 was once more amended. In 1935 Act No. 94 made transportation expenses of afflicted children rechargeable to the counties, but left treatment fees payable by the state. But then a new difficulty arose; the state appropriation for children's medical care was not adequate to cover physicians' fees. The commission estimated in 1936 that about one million dollars should have been added to the fund to cover these fees. The physicians, however, agreed to accept a nominal fee of one dollar a case during the 1934-36 biennium, and within a year a more liberal schedule was tentatively adopted.
The Afflicted Children's Act was further amended in 1935 by Act No. 208, which required that before a child could be hospitalized an agreement to reimburse the state for expenses was necessary between the auditor-general and the child's parents or guardian. Within two years such repayments rose from $841.92 to $11,723.88.
Three amendatory statutes in 1935 also changed the Crippled Children's Act of 1927. One (No. 169) shifted transportation costs to the counties, directed hospitals to report on the admittance and discharge of patients, and specified that no person should be considered a recipient of pauper aid because of inability to pay for a child's treatment. Another act (No. 182) prescribed that all collections from parents and school districts, as well as gifts to the commission, should be deposited to the commission's credit in the state's general fund. A third (No. 207) made repayment pledges by parents or guardians mandatory and fixed the amount per day payable by the state and local school districts for hospital schools. In 1937 these amendments were consolidated in Act No. 158, which replaced Act No. 236 of 1927.
This new law included the needed definition of "crippled child" and gave the commission additional responsibility, financial backing, and greater authority to enforce its decisions. It became responsible for handling each case committed
