Sunderland have parted company with club doctor Ishtiaq Rehman.
Dr Rehman has resigned in the wake of Patrick van Aanholt’s late withdrawal from the Sunderland squad ahead of the recent game with Tottenham Hotspur after a heart scare.
The Echo understands the split was amicable with both parties deciding it was the best decision moving forward.
Sunderland appointed new chief executive Martin Bain and new manager David Moyes in the summer and changes are being made behind the scenes across all areas at the Stadium of Light.
Dr Rehman, who joined the club in 2013, and assistant academy manager Danny Philpott are among the backroom members of staff to leave the club.
Dr Rehman’s resignation comes in the wake of the van Aanholt saga at White Hart Lane.
The Dutch left-back was withdrawn from the Sunderland team 40 minutes before kick-off.
He had been named on the team sheet and had completed a warm-up before fellow defender Jason Denayer was filmed telling the left-back he was replacing him in the side.
There was confusion after it was originally stated van Aanholt had been withdrawn after advice from cardiologists, who sit on the FA Consensus Panel.
But the FA then released a statement distancing themselves from their involvement in the situation.
The cardiologist involved in van Aanholt’s case does sit on the panel but was working independently from the FA in this case.
Speaking about the incident last week, Moyes said: "The timing of the decision was very difficult for us.
"The information came back from the doctor. The information I was given was that there was a panel, but it seems that was not quite correct.
"Ultimately the decision was taken for the right reason."
Van Aanholt has since played 90 minutes against QPR in the EFL Cup and Crystal Palace in the Premier League.
Philpott, meanwhile, is set to leave the club after being placed on gardening leave.
Highly-rated Philpott joined from Everton in November 2014 on the understanding he would eventually replace academy chief Ged McNamee.
"Joining Sunderland is a hugely exciting opportunity for me," said Philpott when he was unveiled.
"I’m really looking forward to playing my part in successfully developing more homegrown players to integrate into the first team."
Philpott enjoyed a successful stint in charge of Everton’s academy recruitment before moving to Wearside.
Meanwhile, Sunderland continue to argue their case in the Ricky Alvarez saga.
Sunderland could still have to pay Inter Milan the £8million transfer fee which was originally agreed in Alvarez’s season-long loan switch to the Stadium of Light, which became compulsory if the Black Cats were able to retain their Premier League status in 2014-15.
Sunderland argued that Inter’s hesitation in approving knee surgery for the Argentine international was a breach of contract and justified them pulling out of the move.
The case is still with the Court of Arbitration for Sport (CAS) but Sunderland face paying out £8million for a player no longer at the club, if they lose.