Waterdog and Flydog,
A Squared is correct. The bottom line is that the hold isn't depicted with a heavy line; it's part of the missed approach proceedure and may not be used to commence the proceedure. The designers intended that a proceedure turn be used, and a proceedure turn is required. Simply because one thinks it looks about right, doesn't make it acceptable. Yes, you pass over the VOR roughly lined up, but that does NOT make you established.
Clearly the designers of this approach mean for you to be established on course before crossing the VOR. You commence the approach at the IAF, which is the VOR, but you must proceed outbound, turn around, and then proceed inbound. The depicted hold is not shown as a way for beginning the approach; if you happen to be holding there, it's by coincidence, and it's not part of the proceedure for the purpose of commencing the approach. It just happens to be colocated with the IAF...strictly coincidence.
Weather one flies right or left turns in the hold, has nothing to do with anything. I don't see the logic of that question.
Flydog, AIM 5-4-8(a)(4) doesn't state, "A procedure turn need not be established when an approach can be made from a properly aligned holding pattern." Instead, it states that a holding pattern in lieu of a proceedure turn may be specified for course reversal in some proceedures. As A Square noted, the key element in this statement is "specified." An arbitrary holding pattern doesn't cut it; it must be specifically designed into the approach as such, and is part of the proceedure. The reference you provided states nothing about not needing to perform a proceedure turn, and wouldn't apply in this case, anyway.
I suggest a close reading of the first Refresher article referenced by TDTurbo. Wally Roberts covers the topic well, with several good references and examples.
AIM 5-4-8(b)(3) specifically addresses the hold in lieu of a proceedure turn, and references a depicted hold for the express purpose of course reversal, as part of the approach proceedure. It does not refer to missed approach holding patterns, or other patterns that may be arbitrarily colocated with the IAF, FAF, or other such fixes.