Cabal Cutter achievement - Problem with unlocking

I'm having trouble getting this to unlock, in the beginning it shows 5 dead patients right off the bat which die during the cut scene. no one is dying during the incoming waves but no achievement unlocks at the end. any ideas or is this a bug? the hospital rating is also at half a star before I even open so im guessing the cut scene patient deaths for some reason are counting against the hospital. I checked older youtube videos and they dont show the body bags or negatively inpacted stats as well. its also showing 5 dead patients in the log as well. I tried on the xbox series X as well and bug seems to persist