A lawyer for Pakistan’s former president Pervez Musharraf who is on trial for high treason said his client needs to go to the U.S. for further medical treatment following a heart scare.

The attorney, Anwar Mansoor Khan, said a doctor in the United States who has treated Musharraf in the past has advised that the former president and retired general be transferred to the U.S. following recent heart problems.

The development is the latest legal twist in a series of legal cases Musharraf has faced since returning to the country nearly a year ago.

Musharraf’s legal drama has also become a tug-of-war of sorts between the military establishment and the courts. It is threatening to undermine the fragile balance of power between the civilian-led government and the powerful military in a country where the military has often called the shots.

Musharraf’s repeated failure to appear in court and his admission to the hospital — where he was taken Jan. 2 while on his way to a court hearing — has led to rampant speculation that he’ll leave the country under the guise of seeking medical treatment.

Khan, one of Musharraf’s defense lawyers, submitted a letter to the court from a doctor at the Paris Regional Medical Center in Paris, Texas. The letter, signed by the Director of Interventional Cardiology at the Texas center, Arjumand Hashmi, asked that Musharraf be transferred to the hospital.

Musharraf is currently a patient at the Armed Forces Institute of Cardiology in Rawalpindi, just outside of Islamabad. He was taken there after suffering a “heart problem” on the way to court after failing to appear at previous court proceedings.

The court subsequently reviewed a medical report from the Rawalpindi hospital outlining his condition and ruled last week that he was to appear in court last Thursday. The hospital report, the judges concluded, did not reflect that Musharraf was “unable to appear before the court.”

But Thursday, Musharraf failed yet again to appear in court, and his lawyers said he is still not well.

“He has not been discharged from the hospital, and continues to be under treatment,” Khan told the court.

Musharraf’s failure to appear during any of the previous high treason proceedings, which started on Dec. 24, has given rise to accusations that he is trying to avoid subjecting himself to the justice of a civilian court — an embarrassing prospect for a man who was once the most powerful in Pakistan. The prosecution has scoffed that the medical scare was a ploy to keep him from court.

The high treason case relates to his 2007 decision to impose a state of emergency and detain a number of judges.

Musharraf took power in a 1999 coup and ruled until he was forced to step down in 2008. He later left the country.

The 70-year-old former army commando returned to Pakistan in March 2013, hoping for a political comeback but instead got embroiled in court cases relating to his near-decade in power.

The high treason case, which can result in the death penalty or life in prison, is the most serious but other cases are ongoing as well.

(AP)