Hey, saramandonga! You are indeed correct!
I have actually posted about a Hotfix update last night and that is definitely a bug! What you could do however is try your best to get it level 4 right off the bat and that's how others have gotten around it. Hotfix#2
On another note, it is definitely planned for patients portraits to update based on their stats such as horniness or cum bar ;D
Thank you for your patience and looking to roll out the HF very soon!