Vuitch was arrested a total of 16 times for abortion, with the pivotal arrest in 1968 for performing abortions in violation of District of Columbia law. In 1969, Judge Gerhard A. Gesell ruled that the law was unconstitutionally vague because it permitted abortions only to preserve a mother's "life or health," without clearly defining those terms. Gesell wrote that the word "health" provided "no clear standard to guide either the doctor, the jury or the court." Gesell dismissed the Vuitch indictment.
The U.S. Supreme Court disagreed with the ruling, holding that the standard was clear. But Justice Hugo Black, in the majority opinion, included language that limited enforcement of the D.C. law, as well as similar laws: "Health includes psychological as well as physical well-being." Black's ruling also changed how the law was to be enforced by shifting the burden of proof. Rather than being incumbent upon the physician to prove that the abortion had been medically necessary, Black put the burden on the prosecution to prove that the abortion had not been necessary. If the prosecution did not sufficiently prove that the woman's "life or health" was not in danger, a trial judge would be required to set aside a guilty verdict.
Vuitch was pleased with the outcome of the case, saying, "This is a big step forward. Now the government lawyer will be in the position of challenging my medical decision. What are the jury members going to decide when a lawyer tries to tell them that the doctor is wrong about a medical matter?"
Vuitch performed roughly 1,000 abortions annually in his illegal practice, three blocks from the White House. However, Vuitch said that his abortions were purely done for medical reasons.  Vuitch was left free to operate his abortion practice, though he had been lacking hospital privileges since 1963.
After Roe vs. Wade, Vuitch ran into trouble in his abortion practice, leading to numerous malpractice suits and public disgrace.
On June 15, 1974, he performed an abortion on a 17-year-old girl who died five days later. The girl's family sued, alleging that Vuitch allowed the girl to remain unattended for 12 hours and to lapse into a coma before transferring her to a hospital. Though the family won a judgment on December 23, 1976, the settlement was sealed by court order.
Vuitch performed an abortion on a 32-year-old woman in 1980. Vuitch administered general anesthesia, but was unable to revive the patient, who died after transport to a local hospital. Inspectors also noted multiple violations of medical standards regarding sanitation and anesthesia.
A patient who said she had an abortion performed by Vuitch at his Laural Clinic in 1981 said that after he'd lacerated her uterine wall, he kept her overnight at his "Clinic Annex", which turned out to be his home, and not licensed as any kind of medical care facility. The woman developed peritonitis and required hospitalization and a hysterectomy.
In 1984, Vuitch was ordered to pay a $125,000 settlement to a 19-year-old patient who had gone to his Laurel Clinic for treatment, only to be subjected to an unwanted abortion.
In 1984, WDVM-TV, Washington, D.C. won the Peabody Award for its investigation of Vuitch. The investigation found that Vuitch's practice had been cited for a multitude of violations, such as in 1980 for dirty instruments and lab specimens being refrigerated with food; in 1981 for taking patients to Vuitch's home overnight and having expired drugs; in 1982 for unlicensed drug distribution and mixing dirty and clean surgical instruments and for a patient sent home though she was passing red urine and had a catheter still inside her body; in 1983 for having anesthetic drugs "not freshly prepared and yellowish in color". The investigator also noted that despite these violations, the city kept renewing the clinic's license until 1982, after which Vuitch just operated without one.
The story, by Mark Feldstein, noted a patient who said that Vuitch had operated on her without anesthesia. Feldstein also reported on a 17-year-old patient who had been sent home with instructions to return with $400 before Vuitch would complete her abortion. Though Vuitch had told her not to go to a hospital, she was taken to an emergency room after she collapsed. She gave birth to a live premature baby, of six months gestation, who subsequently died.
Feldstein also provided a female co-worker with a vial of his own urine. She took the specimen to Vuitch's clinic, where staff told her she was pregnant and offered an abortion.
Vuitch did little to help his public image when he said on-camera, "This is not the only lacerated uterus in 15 years. I lacerated uteruses and other surgeons lacerated. And perforated. And this and that."
- "Justice Blackmun and the Little People", Mary Meehan, Human Life Review, Summer 2004
- Open City for Abortion, Time, November 21, 1969
- "Ambivalence on Abortion", Time, May 3, 1971
- U.S. Supreme Court, UNITED STATES v. VUITCH, 402 U.S. 62 (1971)
- DC Court of Appeals 82-1077
- US District of Columbia District Court Case No. 75-1156
- Washington Times, April 19, 1984
- Washington Post, April 19, 1986
- "The worst city government in America - Washington, D.C," Jason DeParle, Washington Monthly, January 1989
- "Dr. Milan Vuitch, 78, Fighter for Abortion Rights," Linda Greenhouse, New York Times, April 11, 1993