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St John staff and police were called to the Steamer Wharf building, in downtown Queenstown, after the 42-year-old man fell from a stair balustrade in an internal courtyard of the building, Southern District Command Centre deployment co-ordinator Senior Sergeant Dave Scott, of Dunedin, said.
The man was taken to Lakes District Hospital with serious head and back injuries after the fall about 9pm.
The man, who was intoxicated, attempted to ''slide down a railing on a flight of stairs, lost his balance and fell about one storey'', Snr Sgt Scott said.
Sergeant Tracy Haggart, of Queenstown, said the man had been denied entry to the SkyCity Wharf Casino just before the fall because he was intoxicated.
Bryce Whall, head chef at Finz Seafood and Grill restaurant, said he heard an ''almighty crack'' as the man landed and then a woman, apparently the man's wife, screaming.
Mr Whall was told the man attempted to slide down the balustrade after his brother successfully did.
Minus5 Ice Bar barman Jaffe Santos was just metres away when he heard a ''massive thump''.
''To my surprise, I just saw a man lying here with blood all over his head.''
The man's brother put him in the recovery position, Mr Santos said, but he did not move for about a minute.
''I was pretty scared by then.''
However, he recovered and by the time he was stretchered into the ambulance he was smiling, Mr Santos said.
Early on July 24, a 19-year-old Australian died from injuries he received after falling from a balcony on to a concrete car park at the Glebe Apartments.
He had been staying with friends at the hotel and had been drinking alcohol before the incident.
In 2009, a 25-year-old English backpacker fell about 10m to his death from the roof of Base Backpackers in Shotover St.
A 24-year-old Invercargill man fell to his death at the Glebe Apartments after gaining access to the courtyard and climbing to the roof in 2008.
His friends described him as ''quite intoxicated'' at the time.
- David Williams and Timothy Brown