In Bruckshaw v. Frankford Hospital, 58 A.3d 102 (Pa. 2012) (No. 47 EAP 2011), a medical malpractice action was tried in a Pennsylvania state court to a jury consisting of twelve principal jurors and eight alternates.  At the close of the trial, and just prior to deliberations, the court officer sent the principal jurors into the deliberation room.  However, in so doing, and for reasons not stated in the record, the court officer removed and released one of the principal jurors and replaced her with an alternate, without notifying the parties or the trial court.  The jury returned a verdict in favor of defendant.  When the juror-switch was later revealed, plaintiff moved for a new trial.  The trial court denied the request, holding that because the alternate juror had been acceptable to all parties as an alternate, plaintiff could not complain that she was in the final jury panel.  The trial court further found that any error was harmless, because plaintiff had not shown that the result would have been different if another replacement juror had been chosen.  On appeal, the Pennsylvania Supreme Court reversed and ordered a new trial, holding that the removal of a juror can only be done by a trial court, on the record, in open court, with notice to the parties, for cause.  The court further held that prejudice need not be shown, but may be presumed, because removal under these circumstances “is so inimical to the integrity of our jury system that the presumption of prejudice arising therefrom is conclusive.”