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I got it a couple patches ago so I suppose it could be a new bug, but its definitely been achieved by a big chunk of the playerbase.
Hmm, now I'm wondering if the event that occurs when you have teaching hospitals may count as a death. Its the event that pops up and you can have the students watch the surgery or dismiss some chief doctor, anyway I think its RNG but sometimes the surgery is messed up and its called a "macabre performance"
However the event doesn't really register itself as a death despite the messed up surgery which may be a bug.
Hadn't had any of those happen,
Some people have supposed hospital procedure success RNG can be influenced by building more than 2 hospitals from this same zeitgeist. I didn't test it, though.
edit: After looking around it seems the achievement is locked to utopia mode only, oops.
Good to know, I would like to achieve that outcome with the doctor discovering penicillin more often then lol. I feel like I had more than 2 hospitals built but my disease was still a minor issue so maybe I'll try on a lower difficulty
Also gotta love the no faith of the developers in us actually doing no-death campagin