A 9-year-old girl, misdiagnosed with the stomach flu, died after a doctor failed to communicate to her Vietnamese-speaking parents that the drug he prescribed for her could have dangerous side effects.

A 78-year-old stroke victim had to have her leg amputated after doctors and nurses didn’t understand her when she complained, in Russian, of pain and numbness.

And a 7-year-old boy suffered organ damage because his pediatrician mistakenly diagnosed him with strep throat, having struggled to communicate with his Spanish-speaking father and grandparents during repeated visits over several weeks.

New federal rules requiring thousands of hospitals, doctors and dentists to provide free interpretation and translation services for people who don't speak English aim to prevent tragedies like these, which were among those included in a study of interpretation-related malpractice cases in four states.

The new rules, which apply to providers who receive Medicaid reimbursement or other federal funds, are expected to expand access to preventive care and reduce medical costs, at least in the long run. A language other than English is spoken at home in 21 percent of US households.

"The language services are going to keep people healthier and that will end up saving health care dollars down the road," said Cary Sanders of the California Pan-Ethnic Health Network. "It's a small investment for a big return."

But some struggling rural hospitals and smaller medical and dental practices are worried about the cost of following the new rules, which require them to offer interpretation and translation services for the most popular 15 languages in their state.

In a letter to the US Department of Health and Human Services, the American Medical Association argued that "the financial burden of medical interpretive services and translation should not fall on physician practices." The AMA suggested that insurance plans should be required to cover those services.

The American Dental Association described the new rules as "confusing, duplicative and burdensome, as well as unnecessary," and a coalition of dental groups that includes the ADA warned that dentists may turn away Medicaid patients who don't speak English to avoid having to comply.

And the American Osteopathic Association, which represents doctors who practice osteopathic medicine, is worried about how the rules will affect small practices. "If physicians don't receive additional funding or the rules are enforced in a strict manner then I can see some doctors choosing not to take Medicaid patients," said Laura Wooster, interim senior vice president of public policy for the group.

Some states have their own laws related to language services. A number of states, including Kansas, Louisiana and Michigan, require that non-English-speaking women considering abortions receive information about the procedure or have their questions answered in their own languages.